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Government of Karnataka

Department of Factories and Boilers

INSPECTION FORMAT – III

FACTORY INSPECTION REPORT FOR SECOND AND SUBSEQUENT

Postal address

(in full)

1.Name and address of the factory

(a) Date of last Inspection

(b) Number and date of previous order

(c) Date and time of present inspection

2.Licence number and covered section

3.(i) Non- hazardous industry –

(ii)Hazardous -

(a)MAH,

(b)Potential hazard

(iii) Dangerous operation, if any (Section 87)

4.Name of occupier

5.Name of manager

6.Factory working/not working

N.B.- If the factory is working, the industry that

is being carried on at the time of inspection should

be noted. If not working, the reason and the date

on which it last worked should be stated.

7.What are the exemptions applicable or

granted to the factory, and whether availed.

(Quote, the number and date of the order)

and conditions complied with.

  1. Number of employees on the day of inspection

Note: Actual number of employees present at the

time of inspection should also be noted.

Adults. / Adolescent adults. / Children / Adolescent adults.
Men ..
Women .. / Boys ..
Girls ..
  1. What is the maximum number of persons employed

on any day during the current calendar year and

the date of employment?

  1. Details of additional machinery, if any, installed

in the factory since the last inspection and the

maximum horse-power installed.

  1. Preliminary (Chapter-I)-Plans, licences and

notice of occupation.

  1. Health ( Chapter-III) Cleanliness, ventilation and

temperature, dust and fume, overcrowding,

lighting, drinking water; latrines and spittoons.

  1. Safety (Chapter-IV)-Fencing of prime mover,

transmission machinery, machine tools,

maintenanceoffences in proper order, provisions

for special, classesof factories. Safety of buildings

and machinery,protectionof person attending to

machinery,electrical fittings, precautions against

fire, special provisions for women and children.

  1. Whether dangerous machineries like lifts,

lifting machines and tackles, pressures vessels,

centrifuge, power press etc., are got tested by the

competent person. If so, No. of machines,

Date of testing, Name of competent person

  1. Whether the inspections carried out with the aid

of environment monitoring kit? If so, attach the

detail readings.

  1. Whether safety committee is constituted?

Regular meetings are conducted?

Safety Officers are appointed?

  1. Welfare ( Chapter-V)- Washing facilities

first-aid appliances, canteens, rest-rooms, crèche

and welfare officers.

  1. Working hours and employment of young persons

(Chapters-VI and VII)- Restriction working hours,

overtime wages, not period of work, register of

workers, exemption and restriction of employment

of children young persons.

  1. Leave with wages ( Chapter VIII)-Leave with

wages and exemptions.

  1. Special provisions ( Chapter IX and XI)- Dangerous

operations, accidents, notice of certain diseases,

display of notices, returns and maintenance of

inspection book and other registers. Number of

accidents of the previous years and those upto the

date of inspection to be noted with the number of

serious accidents. (Special remarks noted in the

case of injuries containing in loss of limbs of

power industrial diseases.)

  1. Display of notices, returns and maintenance of

inspection book and other registers.

Payment of Wages Act,1936

  1. Is wage given within the stipulated period.

2.Is abstract of the Act displayed in Form No.5.

3.Is wage slip given along with the salary.

4.Is rate of wages payable to different classes of workers displayed.

Maternity Benefit Act,1961

1.How many have been given maternity benefit.

2.Is medical bonus paid

3.Are the workers covered under ESI? If so, how many?

Miscellaneous

1.Is labour welfare fund paid

Amount Date:

2.(a) Is Sexual harassment prevention committee constituted?

(b) Whether meetings are conducted regularly

(c) Whether proceedings are recorded properly

(d) Whether any complaint received

3.Whether any exemptions are given this industry? If so, whether the conditions stipulated are followed.

4.Whether Annual Returns submitted? Rule 134(1)

5.Whether Half Yearly Returns submitted? Rule 134(3)

Occupier/ Managers signature Deputy / Senior Assistant/

Assistant Director of Factories,

Division No. - , (Place)

PART- IV

( For office use only)

1.Resume of inspections-Previous orders-

(1)Number of items complied with.

(2) Number of items not complied with.

(3)Number of items partly done.

(4)Action proposed.

2.Special features like accidents, complaints, strikes etc.,

3.General remarks, if any.

4.Note to the Director of Factories-

(1) Time of inspection.

(2)Whether working ornot.(if working, the nature of work).

(3)Proof, i.e., number of workers at the time of

inspection.If more than nine personsare not

employed on that day, the date ofsuch employment.

(4)Previous order number and date. (Items

complied with).

(5)Action proposed.

Deputy / Senior Assistant/

Assistant Director of Factories,

Division No. - , (Place)