Yes / No Section 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Management Documents Factory License Factory Standing Orders Minimum Wage Notification Factory Policies on Harassment,

H & S, Discrimination and OT State Pollution Control Board Consent for Air and Water Organization Chart Verbal Abuse and Harassment Water Pottability Test Report ESI & PF Challans for last 3 months / Form 5 & Form 10 Permission for 2nd Shift ( If 2nd Shift is there ) Major and Minor Accidents Report No of persons trained in First Aid and Certificates No of persons trained in Fire Fighting and Certificates Fire Safety Certificates Last date of Fire Drill Evacuation & Records Documented Material Safety Data Sheet (MSDS) Training Documents Over Time OT Register / Payments Total Sundays worked for the last month / Quarter 7th Day Rest /Comp -off How many employees crossed OT legal limits Authorization/Permission for OT Approval / Sunday Working Exceeding Manpower strength as per the Fixed Strength Boiler Fitness Certificate and Operators certificate ( Form 6 & 7) Machine Maintenance Register Personal Files - Application Form, Appointment Letter, Fitness Certificate, Nomination, Age proof, DA - Increment details, ESI Card copy ,Emergency Contact Person's name & No. Mustor Roll - Time Record - Salary Statements Medical Fitness Certificate for Canteen Workers and Security Guards ESIC and ID Cards/PF/Gratuity / Full & Final Settlements Does the facility has a Welfare Officer Does the facility has documentation of boiler and pressure vessels inspections on files and posted? Are Elevator Inspection Documents up to date & posted? Sub Total Yes / No B Emergency Exits

20 21 22

23

24 25 26 27 28 29

30 31 32

Is there sufficient directional and exit signs to ensure that all exit routes are clearly indicated in bilingual language Do all work areas have at least two exits Emergency Exits door to be opened out side. Sub Total Aisles Are aisles clearly marked with directional sign Red arrow ? Are aisles larger than 3 feet wide? Sub Total Emergency Lighting Do all emergency lighting units work properly? Are all Emergency lights tested monthly and records of test kept? Sub Total Fire Extinguishers/ Hose Reel / Hydrant Are there adequate number of fire extinguishers available? Are locations of fire extinguishers clearly marked? Are extinguishers visually checked monthly ( with control tags)? Are fire extinguishers inspected annually by outside professional agency; documentation is on file Sub Total

C 33 34

D 35 36

E 37 38 39 40

F 41

42 43

Emergency Preparedness Does a facility has a documented emergency preparedness program? Records of Evacuation Drill Records of tests of alarm & emergency lighting system Does the facility has the documented fire & emergency evacuation plan? The plan has floor maps prominently displayed in the factory ( including office)? Actual Location ( "You are here") Extinguisher location Identification of major fire risks Phone numbers of local fire dept(s) Phone numbers of ambulance/hospital Evacuation routes Assembly areas First Aid kit locations Sub Total First Aid Clinic Is the clinic suitably equipped in compliance with the guidelines ( beds, first aid materials, medicines)?

44

45 46 47

Are screens/curtains provided to allow privacy? Is there system in place to check expiration dates of medicine? Are sufficient number of employees trained in First Aid by a recognized organization Sub Total First Aid Kits Are First Aid kits available in all work areas ( 1 per every 100 workers) Are First Aid kits are easily accessible, identified and/or unlocked? Are First Aid kits adequately stocked and appropriate for work areas? Sub Total Chemical Storage Area Are appropriate warning signs displayed? Is there an effective ventilation system? Is there an effective secondary containment system for liquid chemicals? There should be no floor drain in the chemical ware house Are all drums, containers, dispensers clearly labeled? Is eye wash is available within 30 M of where chemicals are stored? Are Fire Extinguisher available? Is MSDS ( Material Safety Data Sheet ) is posted in areas where chemicals are stored? Sub Total Signs/Labeling Are signs /labeling displayed in bilingual language? Are signs are large enough to see from a distance and clear? Sub Total

H 48 49 50

I 51 52 53 54 55 56 57 58

J 59 60

61 62

General Equipment / House Keeping / Electricity Use of Electricity Are electrical switches labeled in bilingual language? Are generators installed suitable earthed?

63 64

Are copies of Electrician qualifications certificates etc. kept on file? Are all electrical maintenance carried out are properly recorded? Sub Total General Equipment / House Keeping / Electrical Hazards Are "Danger: high Voltage" warning signs clearly displayed around high voltage areas and access to authorized personnel only? Are high voltage areas are clean and tidy with no material storage? Is access to generator areas restricted to authorized personnel only? Are warning signs posted? Is generator room is clean and tidy with no material storage? Is adequate noise protection provided for workers working in generator rooms? Are hearing protection warning signs displayed? Is electrical wirings suitably insulated and labeled? Are workers provided with necessary protective equipment (PPE) and trained in the correct use of PPE? Sub Total Lighting Are work areas adequately ventilated ( fans, windows)? Is emergency lights provided in stairways, corridors and exits? Sub Total Machinery Is the risk of personal injury from dangerous machinery controlled by adequate (a) hand operation switches (b) guards (c) minimized gaps (d) emergency stops (e) protective gloves (f) warning signs Are fan blades adequately guarded (Mesh /screen holes)? Are all conveyer belt gears, drive shafts and belts adequately guarded? When necessary, is suitable eye protection provided and used to reduce the risk of eye injuries? Are air compressor areas clean and tidy and free of material storage? Are noise level in the work areas acceptable? Have noise survey been conducted? Sub Total Waste Water Treatment

65

66 67

68

69 70

M 71 72

73

74 75 76 77

78 79 80 81

Does the factory have a waste water treatment plant? Is there any mechanical, biological and chemical treatment plants in the facility? Are all discharges are within allowable limits? Are discharges test annually and records of test results kept? Sub Total House Keeping, sanitation and Hygiene Toilets, Dining and Kitchen Facilities Kitchen Are Kitchen & floors are kept clean, sanitary, odor free and free of grease? Are Kitchen Staff given regular medical Check ( particularly test for transmissible disease such as hepatitis and typhoid )? Are refrigeration facilities available in kitchen? Are food preparation surfaces clean, free of cracks, cuts etc? Are there sufficient tables/chairs inside canteen or eating facilities provided under a roof? Are all preparation knives & chopping boards kept clean, sharp, rust free and are correctly stored? Are all electrical appliances are in good condition in kitchen? Is system in place to ensure the food prepared in canteen is fresh /hygienic? Are all dry foods correctly stored, clear and above the floor? Is the factory maintained in a clean and tidy state? Is there arrangements to remove produced waste effectively and regularly? Are passage way kept clear of obstructions? Do all kitchen personnel wear hats or hair nets? Sub Total

82

83

84 85 86

87 88 89 90 91 92 93 94

Q 95 96 97 98 99 100

Bathrooms / Toilets Is number of toilets sufficient for both men and women ? The bathroom facilities are clean and generally free of odor? Are the bathroom facilities are well ventilated and have running water? Is soap / liquid soap, tissue paper, hand towels available in the toilets? Are proper masks, rubber shoes, aprons etc provided to house keepers? Toilets have water flushing system?