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CLI-MAHC-88(CKL) Nov'92(Revised)

GENERAL (1) (2) Name and address of the factory: Industrial Activity (a) Main products manufactured (b) Hazardous materials stored/handled on the premises and the quantities in metric tonnes (c) Hazardous processses conducted on the premises (d) Nature of Identified hazards (Please tick () the revelant ones) Fire Explosion

Release Of Toxic Vapour Release Of Toxic/Corrosive/Flammable/Dangerous Liquid

(e) Techniques adopted to assess the hazards HAZOP Safety Audit

Risk Assessment

Any Other


Total number of workers (a) employed in a day (b) present during the visit

(4) (5) (6)

Number of shifts Number of entry and exit points of the factory Condition of approach roads (1) to the factory (2) to the plant inside the factory


(a) Number of safety officers (b) Name and address of Chief Safety Officer


Whether adequate safety equipment available ? (attach list)



Fire fighting facility certified by (Please tick ()the relevant ones) State/Local Autority Tariff Advisory Committee



Whether adequate emergency equipment available ? (Attach list) Whether adequate first-aid antidotes and medical facilities available ?





Type of training given to First Aider Essential Person General Public Fire Fighter Key Person

(13) (14) (15)

Provision for emergency power supply for essential services Whether mutual aid scheme exists ? Number of factories included in mutual aid scheme and types of facilities available(attach details)

Yes/No Yes/No



Do the emergency plan incorporate a directory of external technical support ? Does evacuation procedure exists? Arrangement of keeping details of visitors at site


(17) (18)

Yes/No Yes/No


(a) (b) (c)

Total number of alarms installed Type-Electrical/Mechanical/Manual Whether this system of alarming is available in all work area ? Whether distinct alarm signals adopted for different types of emergencies Are all the alarms in good working condition ? Alarm signals for (1) (2) Employees Public Yes/No Yes/No



Yes/No Yes/No

(e) (f)

MAHC-88(CKL) CONTROL ROOM AND COMMUNICATION SYSTEM (a) (b) ( c) (d) Whether control room exists ? Number of control rooms Is the control room(s) in minimum risk area ? Facilities available in the control room {Please tick () appropriate ones} Emergency Plan (a) On-Site (b) Off-site P Plan of the area Telephone Hotline to District Magistrate Hotline to Fire Brigade Wireless sets Yes/No Yes/No

Planof the factory Public address system List of important phone no's Hotline to Police Control Room Hotline to emergency/casuality ward of the hospitals

Clear access Meterological Information 4

Vehicles Non-stop power supply

ASSEMBLY POINTS AT THE TIME OF EMERGENCY (a) (b) Assembly points details Whether there is any board/display to indicate the point of assembly ? Is it a safe place ? Whether routes to assembly points have been identified and marked ? Wehether the place is under the charge of a person ? Whether roll-call arrangement exists ? Yes/No

(c) (d)

Yes/No Yes/No

(e) (f)

Yes/No Yes/No

EMERGENCY SHUTDOWN AND START UP (a) Does the emergency plan provide for the emergency shutdown and start up procedure of equipment/unit/plant ? Have specific individuals been designated to be responsible for shutdown implementation ?

Yes/No Yes/No


ALL CLEAR SIGNAL (a) Whether there is any"all clear signal"system in existence ? Yes/No

MAHC-88(CKL) (b) (c) 7 Is the code for giving "all clear signal"established ? The person responsible for giving "all clear signal" Yes/No

INFORMATION REGARDING MOCK DRILL/REHEARSAL (a) (b) (c) (d) (e) Date Time Place of mockdrill/rehearsal Type of mockdrill/rehearsal Total time for (1) Execution of emergency plan (2) Control of emergency Fire/Explosion/Toxic gas release

A -

INFORMATION GIVEN TO : Officers of the factory department Pollution Control Board Police District Medical Authority/Local Hospital Fire Brigade Civil Defence Distrct Emergency Authority (Note:Indicate the no. in the box according to the contact made. For example if the contact made to the police is first,,the number in the box against police should be 1)


Does the alarm audible in all work area ? C WIND DIRECTION INDICATOR Whether the indicator for wind direction visible from all places in the plant CONTROL ROOM AND COMMUNICATION SYSTEM (a) Were the communication systems and their maintenance adequate ? (b) Communication system available in the case of power failure including the name of the messenger E ASSEMBLY POINTS (a) Whether any confusion noted ?





Yes/No MAHC-88(CKL)

(b) Whether people assembles in the designated area ? (c ) Whether roll-call taken ? (d) Whether evacuation procedure followed ?

Yes/No Yes/No Yes/No

REPORTING OF KEY PERSONS (a) Incident controller at site (b) Site Controller at control Room (c ) Communication officer at control room (d) Other key persons at control room

REPORTED Punctual/Late Punctual/Late Punctual/Late

Punctual/Late (1) Transport (2)Medical (3) Security (4) Safety (5) Fire fighting Punctual/Late Punctual/Late Punctual/Late Punctual/Late

(e) Assisting teams at the control room


e.g. Electrical/Mechanical crew,salvage team Drivers,Riggers,Runners,Volunteers,Home,Guards,etc. Were the site controller and incident controller in distinct clothes,helmet,or coloured apron ? Yes/No

Number of mutual aid factories participated in rehersal (a) Fire fighting (b) First aid and Medical management (c ) Any external technical support utilised during rehearsal (Attach Details) Yes/No Yes/No Yes/No

MAHC-88(CKL) I FIRE BRIGADE Whether equipment/ system adequate 7 Yes/No

S.No. 1 a

Name of the fire brigade 2 Internal

Name of the fire station 3

Distance Reported from the Puntual/L factory ate 4 5

Whether equipment worked ? 6 Yes/No

Under mutual aid scheme External team






Time of first information 1

Attended 2



S.No. 1

Time of Name of Distance first Whether theOrganis in Kms informatio reported ation n 2 3 4 5

If reported 6 Puntual/Late


ASSESSMENT (a) (1) Whether timely information given to concerned authorities ? (2) Whether the execution of the emergency was within the time limit ? Yes/No (b) Did alarm systems work properly ? If not,state the reasons. Yes/No Yes/No


( c)

Whether the facilities available in the control room were adequate ? If not,indicate shortfalls.


(d) ( e)

Was there any confusion in the assembly point ? Did the key persons report within minimum response time at the

Yes/No Yes/No

appropriate places ? (f) (g) Was mutual aid assistance available in time and adequate ? Indicate response time and adequacy of emergency system. Yes/No

(h) (i) (j)

Did police arrive at site in time ? Indicate response time and adequacy of Ambulance/Transport facilities. (a) Whether the mock drill/rehersal was carried out in the past ? (b) Whether any improvement noticed from the previous reherrsal ? (c) Whether the emergency plan is updated in view of the previous rehersal and copy given to concerned ?


Yes/No Yes/No Yes/No Yes/No

(k) (l) (m)

Adequacy of training of the key persons General Remarks Does the procedure for proper assessment for safe operation of the plant before recommissioning after the incident exist.



Place: Date:

Signature: Name: Designation: