Safety Division

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Safety Division

OSH Self Evaluation Form

[To be sent to the Commissioner of labour (Industrial Safety)]

Name and Address of the Factory :

B.R.C.No. :

No. of Employees :

Male :

Female :

Young :

Total :

Number of Shifts :

Maximum No of Employees per Shift :
Male :

Female :

Total :

1. Factory Registration at DFIE Office

Available

Not Available

If Available, Factory Registration No.

2. Building Plan Approval

Available

Not Available

3. Means of Escape Approval

Available

Not Available

4. General Register

Available

Not Available

5. Six-Month Reports Forwarded to the DFIE

Yes

6. No. of Accidents Occurred in Last 6 Months

7. No. of Dangerous Occurrences in Last 6 Months

8. No. of Industrial Disease Cases in Last 6 Months

9. DFIE/CFIE Address Displayed

Yes

10. House Keeping

Satisfactory

Not Satisfactory

11. MSDS for all Chemicals

Available

Not Available

12. Proper PPEs

Provided

Not Provided

13. No. of Steam Boilers available

14. Have you obtained the examination reports for all boilers, from an authorized officer?

Yes

15. Are all boilers registered in the DFIE office?

Yes

16. No. of Boiler Attendants

17. Do all Boiler Attendants have boiler operator license?

Yes

#	No of items	Examination Reports Availability
18. Steam Receivers
19. Air Receivers
20. Gas Receivers
21. Hoists/Lifts
22. Cranes & Other Lifting Machines (Mobile Cranes/ Tower Cranes / Gantry Cranes / Fork Lifts……)
23. Chains, Ropes& Other Lifting Tackles

24. Are all dangerous parts (revolving or moving parts) of machinery securely guarded?

Yes

25. Electrical Wiring System Provided with Required Safety Devices (RCCB, MCB…)

Yes

26.Type of Fire Extinguishers	A	B	C	D	Other
No of Units
Date of Expiry

27. Fire Hydrant System

Available

Not Available

28. Evacuation Plan

Displayed

Not Displayed

29. Date of Last Evacuation Drill

#	Availability
30.First Aid
31.Meal Rooms
32.Adequate Drinking Water Facilities
33.Adequate Washing Facilities
34.Suitable Sanitary Conveniences
35.Lockers
36.Changing Rooms
37.Rest Rooms

38. Designated Person Appointed for OSH

Yes

39. OSH Committee

Available

Not Available

District Factory Inspecting Engineer's Offices