APPLICATION FOR NATIONAL SAFETY AWARDS (NSA)

Performance Year-2018

A. INFORMATION ABOUT THE ORGANISATION:

1.
Name & address of the organization with telephone No. (With Faridabad address, if any
STD), Fax No. & E-mail ID with telephone No., Fax
No. & E-mail ID
KRISHAK BHARATI CO-OPERATIVE LIMITED, SURAT No
P.O- Kribhco Nagar, Surat, Gujarat, Pin-394 515.

Telephone Number with STD Code:

(0261)-2802389
Email ID: odps@kribhco.net; mrsharma@kribhco.net
Fax No. : (0261)-2860283
Details of the contact person with Mobile phone/ FAX No. Details of Contact person
phone with STD code: in Faridabad with Mobile
M.R. Sharma, Operations Director (KRIBHCO) (0261)- Phone No./ phone No.:
(M) 9925240255 2860283
Phone No. (0261)-2802303, 2860552 & 2802389 No

2.
Registration No. under Factories Act, 1948 / (a) Size of the (b) Turn over
The Building and Other Construction Company / during the
Workers (Regulation of Employment and Construction Site/ performance
Conditions of Service) Act, 1996 / Installation under year 2018
Installations under Atomic Energy AERB (Rs. in crore).
Regulatory Board (AERB)
Reg. No.: # 1350/24123/1985 Small/ Medium/ Large 9325.17 Crore
Licence No: # 5448 Large
License Copy is enclosed as Annexure-I.
# Enclosed copy of Registration No. and License No. of the organization.

3.
*Classification of Industry: *Major manufacturing activities of Average No. of
(As per Schedule attached) the factory / Construction site/ workers during the
Installation under AERB years
For Scheme- I & II Details are given in Annexure-II 2016 2130
3. Manufacture of Chemicals attached herewith. 2017 2314
& Chemical products 2018 2347
(including Fertilizers).
* Failure to provide information may lead to rejection of application.

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B. SCHEME I / III /V/VII/IX (LOWEST AVERAGE FREQUENCY RATE):
(Please tick mark the number of the Awards Scheme for which the application
is submitted).

4. Total man-hours worked during the years

2016 5,337,600
(This should be actual number of man-hours including
overtime worked inside the factory/construction site/ 2017 4,924,102
installations under AERB as defined in the Factories Act, 2018 4,903,128
1948. This also includes Contract Labour)

5.

Number of accidents reportable under Year No. of Reportable accidents

Factories Act, 1948 / The Building & a) Fatal b) Permanent c) Non-fatal
Other construction workers (Regulation total disability
of Employment and conditions of 2016 Nil Nil Nil
Employment & Conditions of Service)
2017 Nil Nil Nil
Act, 1996/ Installation under Atomic
Energy Regulatory Board (AERB) 2018 Nil Nil Nil
causing loss of time for 48 hours or
more during the years.

Permanent total disability means such accident cases, which lead to total loss of earning
capacity of the worker.

6.
Year Weighted Weighted Weighted Weighted Average
frequency Frequency Frequency Frequency rate Frequency Rate
rate of fatal rate of Rate for non- of all accidents over a period of
accidents** permanent fatal (Sum of Col. 2, 3 years
total Accidents** 3, & 4)
disability**
1 2 3 4 5 6
2016 Nil Nil Nil Nil
2017 Nil Nil Nil Nil
Nil
2018 Nil Nil Nil Nil

**The formula for calculating the Weighted Frequency Rate is given in enclosed
instruction sheet.

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C. SCHEME: II/ IV/VI/VII/X (Accident Free Year)

(Please tick mark the number of the Awards Scheme for which the application is
submitted)

7.

1. Man-hours for Accident Free Year 2018 (Jan. 2018 – Dec.2018) : 4,903,128

2. No. of Fatal / Non-fatal accidents & cases of PTD in the year 2018, if any: Nil

Note: Figures at column No. 4, page No.2 are mandatory, even though the company
applies only under Scheme II/ IV/ VI/ VIII/ X (Accident Free Year).

8. VARIFICATION BY CHIEF INSPECTOR / INSPECTOR OF FACTORIES/

BUILDING AND CONSTRUCTION HAVING JURISDICTION OVER THE
FACTORY / CONDTRUCTION SITE / INSPECTOR OF A.E.R.B. HAVING
JURISDICTION OVER THE INSTALLATIONS.

The information and data given under item 3, 4, 5, 6 & 7 are certified by me and found
to be correct. Further, the factory / construction site / installations has not been
convicted for any breach of provision under the Factories Act, 1948 / The Building &
other construction workers (Regulation of Employment and Conditions of Service) Act,
1996 / AERB Act, during the year 2018. The figures have also been cross checked
with ESIC

Date: _________________
__________________________
Place: _________________ Name & Signature of Inspector:

Official Seal

Note: Without Inspector seal / Stamp the application shall be rejected.

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9. ENTRY FEE DETAILS:

SCHEME NO. Transaction ID Date Amount Remark if

any
√ Online
(1) Scheme I / III / V / VII / IX 2309190004702 23.09.2019 Rs.200/- payment
√ on
(2) Scheme II / IV / VI / VIII / X 2309190004702 23.09.2019 Rs.200/- bharatkosh
.gov.in

(Fill up the details of the Demand Draft against that Scheme under which the application
is submitted.

Also tick mark (√) the Scheme Number)

CERTIFICATE
10.

I certify that: -

I. The information furnished above is correct to the best of my knowledge and

belief.
II. The industry / establishment is classified as per the National Industrial
Classification (NIC).
III. The details furnished have been scrutinized and approved by a Committee
assigned for the purpose by the management, which has a worker representative.

DECLARATION

We hereby declare that in case the company is adjudged as a winner / runner up, the
award will be received by the company during the Award Function.

Date: _________________ __________________________________

Name & Signature of Authorized Manager
(M. R. Sharma) – Operations Director, Occupier

Place: Kribhco Nagar (Surat)

COMPANY’S SEAL

Note: Without company’s seal /stamp the application shall be rejected.

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