Industrial Safety Division

District Factory Inspecting Engineer (......................................)

1. Name of the factory/Construction site :-

2. Address of the factory/Construction site :-

3. Telephone No :-
E-mail :-

4. Name of the Human Resource Manager :-

Telephone No :-
E-mail :-

5. Name of the Safety Manager/ compliance officer/ Manager :-

Telephone No :-
E-mail :-

6. Appointed the following officers as the committee members on :-

List of the committee members

( Attach the details of all members)
I confirm that the above details are true and correct