Schedule II [See rules 8 and 9(1)] Proforma for Safety Audit Report Part-A (to be furnished by the Safety Auditor)
(1) Name and address of the factory:
(2) Name of the Occupier:
(3) (a) Date and time of opening meeting of safety audit:
(b) Date and time of closing meeting of safety audit:
(c) Total man days taken to conduct the safety audit:
(4) List of raw material with maximum storage quantity and its mode of storage:
(5) List of finished products with maximum storage quantity and its mode of storage:
(6) Manufacturing process flow chart (attach separate sheet):
(7) List of dangerous operations carried out in the factory as defined in rule 114 of the Maharashtra Factories Rules, 1963 :
(8) (a) Name/s of the Safety Auditor/s:
(b) Certificate no. and it’s validity duration:
भााग एक-ल-६६–३अ 16 महाारााष्ट्र शाासन रााजपत्र असााधाारण भााग एक-ल, जूून १९, २०२४/ज्येेष्ठ २९, शकेे १९४६
(9) Whether enclosed Safety Audit Report is as per the Indian Standard, IS 14489 : Code of Practice on Occupational Safety and Health Audit, or any such standards prevailing at the relevant time, whichever is latest : (mention standards, check list, guidelines used in addition to the Indian Standard, IS 14489 : Code of Practice on Occupational Safety and Health Audit) (Detailed Safety Audit Report along with recommendations to be attached.)
Date of submission of Safety Audit Report to the factory:
Digital Signature of Safety Auditor/s or employee/s of an Institution authorized to carry out safety audit.
In case of Internal Safety Audit Signatures of Team of Plant Personnel.
Part-B (to be furnished by the occupier) Date of receipt of safety audit from the Safety Auditor:
I ………………………………… undersigned occupier of the factory …………………………………….
situated at .................................... hereby declare that, I have thoroughly reviewed and taken appropriate actions based on the findings and recommendations mentioned in Safety Audit Report by safety auditor/s namely ………………………..
In response to the Safety Audit Report I have taken appropriate measures and report of the same is attached herewith.
Digital Signature of the Occupier.
महाारााष्ट्र शाासन रााजपत्र असााधाारण भााग एक-ल, जूून १९, २०२४/ज्येेष्ठ २९, शकेे १९४६ 17 Schedule III [See rule 9(2)] Proforma for verification of action taken report
(1) Name and address of the factory :
(2) Name of the Occupier :
(3) Name of Safety Auditor :
(4) Date of Safety Audit :
(5) Date of submission of Safety Audit report to Occupier :
(6) Date of action taken report submitted by Occupier :
(7) Date of visit for verifying action taken report :
(8) Details of non-compliance observed, if any:
I ……………., hereby declare that I have verified all the observation / recommendation mentioned in Safety Audit report and action taken report submitted by the occupier of the factory.
Digital signature of the Safety Auditor.”.
13. In Form A appended to the principal Rules,—
(1) in entry at serial number (5), the word “Fax” shall be deleted;
(2) in entry at serial number (6) the word “Diploma” shall be deleted;
(3) in entry at serial number (7) the word “Diploma” shall be deleted;
(4) after entry at serial number (9), the following entries shall be inserted, namely :— “(10) Details of the training attended (attach copies).
Sr. No. Name of the Institution Subject / Topics of the training Duration From To
(11) Details of Payment of fees for application :
Challan No./ Reference No. Amount Date”.
(6) in the DECLARATION, for clause (c) the following clause shall be substituted, namely :— “(c) The list showing the name, address of the factory and date of audits are attached herewith.”.
14. In Form B appended to the principal Rules,—
(1) in entry at serial number (3), sub-entry (d) shall be deleted;
(2) in entry at serial number (5), for the words “bio-data” the word “details ” shall be substituted;
18 महाारााष्ट्र शाासन रााजपत्र असााधाारण भााग एक-ल, जूून १९, २०२४/ज्येेष्ठ २९, शकेे १९४६
(3) after entry at serial number (7) the following entry shall be inserted, namely :— “(8) Challan No./ Reference No. Amount Date”;
(4) in the DECLARATION,—
(i) for clause (c), the following clause shall be substituted, namely :— “(c) The list showing the name, address of the factory and date of audits are attached herewith.”;
(ii) in clause (d), for the words “bio-data it” the word “details” shall be substituted ;
(5) in Annexure,—
(i) in entry at serial number (5), the word “Fax” shall be deleted ;
(ii) in entry at serial (6), the word “Diploma” shall be deleted ;
(iii) in entry at serial (7), the word “Diploma” shall be deleted ;
(iv) after entry at serial number (8), the following entry shall be added, namely :— “9. Details of the training attended (attached copies).
Sr. No. Name of the Institution Subject / Topics of the training Duration From To”.