To, The Occupier / Manager SUB: Invitation of applications for GTS Safety Awards-2019 Sir, GREEN TRIANGLE SOCIETY in association with Inspectorate of Factories & Boilers, Govt. of Goa is organizing 8th GTS Safety Awards. The objective of the Safety Awards Scheme is to recognize industrial undertakings for their consistent and meritorious Occupational Safety and Health (OSH) performance and implementing effective OSH management systems, practices and procedures and to encourage their further commitment to OSH. All the factories registered in Goa under The Factories Act, 1948 are eligible to apply for the awards. The assessment period is the data for three calendar years i.e (2016, 2017 and 2018). The entries are categorized into four groups and three prizes will be awarded in each group. — Category - A: Licensed to employ up to 150 workers. — Category - B : Licensed to employ up to 500 workers. — Category - C: Licensed to employ up to 1000 workers. — Category - D : Licensed to employ above 1000 workers. Application forms along with rules & regulations for participation in the GTS Safety Awards -2019 can be obtained from the Office of Green Triangle Society, Flat No. 1, Upper Ground Floor, Wing 'C' , Manoshanti Complex, Behind Hotel Manoshanti, Dr. Dada Vaida Road, Panaji Goa. 403001 by sending e-mail to gtstrg@gmail.com. Inquiries regarding the scheme can be made during working hours on 0832-2232446 or 9403880500. The last date for submission is 4th February 2020 Thanking you Yours faithfully Vivek P. Marathe Hon. Secretary Prizes Name of the Award No. of Award (s) in each category Prize 1 st Gomant Sarvochcha Suraksha Puraskar (For most outstanding Performance) 1 Trophy 2 nd Gomant Uchcha Suraksha Puraskar (For outstanding Performance) 1 Trophy 3 rd Gomant Suraksha Puraskar (For Good Performance) 1 Trophy GREEN TRIANGLE SOCIETY Registration No. 138/Goa/2000 - under Societies Registration Act., 1860 PAN No AAAAG6368C TAN No. BLRG13674D Flat No.1 Upper Ground Floor, Wing "C" Manoshanti Complex, Behind Hotel Manoshanti, Dr. Dada Vaidya Road, Panaji - Goa 403001. Tel : 0832 2232446 Mob: 9284544207, 8623095800, 9403880500 E-mail: gtsgoa@gmail.com GREEN TRIANGLE SOCIETY DEDICATED TO OCCUPATIONAL SAFETY, HEALTH AND ENVIRONMENT Last date of submission 4rd February 2020 Application No.: (To be filled by GTS) APPLICATION FORM GREEN TRIANGLE SOCIETY (GTS) SAFETY AWARDS–2019 Assessment period - 2016 to 2018 Notes: i) Fill in the Checklist enclosed as Annexure - I and attach it with the Application Form. ii) Refer Annexure-II for the Rules and Regulations to participate in GTS Safety Awards – 2016. iii) Refer Annexure-III for including scheduled charges for disabilities where ever applicable as per IS-3786 to calculate total man days lost. iv) Attach separate sheets wherever required. v) Please submit application form with proper binding. 1. Information about the Factory 1.1 Name and address of the factory : ----------------------------------------------------------- : ----------------------------------------------------------- : ----------------------------------------------------------- : ----------------------------------------------------------- 1.2 Name and address of the registered office : ----------------------------------------------------------- : ----------------------------------------------------------- : ----------------------------------------------------------- : ----------------------------------------------------------- 1.3 Licence no. under The Factories Act, 1948 : ----------------------------------------------------------- 1.4 Telephone No. : ----------------------------------------------------------- : ----------------------------------------------------------- 1.5 Name, Mobile No., and Email Address a. The Occupier under The Factories Act : Name --------------------------------------------------- : Mobile No. -------------------------------------------- : E-mail -------------------------------------------------- b. The Manager under The Factories Act : Name --------------------------------------------------- : Mobile No. -------------------------------------------- : E-mail -------------------------------------------------- c. Nodal Officer for communication : Name --------------------------------------------------- : Mobile No. -------------------------------------------- : E-mail -------------------------------------------------- 1.6 Year of commissioning of factory/plant : ----------------------------------------------------------- 1.7 Products manufactured : ----------------------------------------------------------- : ----------------------------------------------------------- : ----------------------------------------------------------- : ----------------------------------------------------------- 2. The Factory 2.1 Type of industry as per National Industrial Classification (NIC) : ----------------------------------------------------------- 2.2 Brief description of manufacturing process (Please attach separate sheet) : ----------------------------------------------------------- 2.3 Category under which applied : Category-A: Licensed to employ up to 150 workers : Category - B: Licensed to employ up to 500 workers : Category - C: Licensed to employ up to 1000 workers : Category –D: Licensed to employ above 1000 workers 2.4 Are you certified under OHSAS 18001 standard /ISO 45001:2018? If yes, attach a copy of certification. Employment of workers 3.1 Average number of workers engaged in factory: Types of workers Assessment Period (Three Preceding calendar years) 2016 2017 2018 Regular Contract Others Total 3.2 Man-hours worked by all workers including overtime: Types of workers Assessment Period (Three Preceding calendar years) 2016 2017 2018 Regular Contract Others Total 4(a) Membership: - 4.1 Is your factory a Patron /Donor / Corporate Member of Green Triangle Society (GTS)?: ------------------------- (Please put “(√)” mark, in the appropriate box) If yes, indicate: 4.2 Membership Number : ----------------------------------------------------------- 4.3 Are any of your employees, member(s) of GTS.If yes, furnish details Name Membership no. Assessment Period Prosecution, if any, under The Factories Act, 1948 Conviction, if any, for contravention with regard to Safety and Health provisions 2016 2017 2018 4 (b) Fee Structure Entry fee: ` 5,000/- ( For Category -A ) Entry fee: ` 7,500/- ( For Category-B ) Entry fee: ` 10,000/- ( For Category-C ) Entry fee: ` 12,500/- ( For Category- D ) Demand Draft / Cheque No. ................................. date ....................... drawn on ......................................................... ( Bank) for ` ................................... ( Rupees ............................................................................................) Bank Details for electronic transfer (ECS) with copy of intimation Name of Bank : HDFC Bank Ltd., Branch :Panaji Goa. th Address : 18 June Road, Near Mathais Plaza, Panaji Goa. 403001 Account No . 00591000041663 ; RTGS/NEFT :HDFC0000059 MICR : 403240002 PART A: Safety Performance 5. Reportable Accidents , Dangerous Occurrence and Notifiable Diseases Particulars 2016 2017 2018 a. Man-hours worked b. No. of fatal accidents (deaths) c. No. of reportable accidents (submit details in the format as per Annexure IV) d. Total accidents (b+c) e. Man-days lost due to accidents f. Man-days charged (as per IS-3786, Annexure:III) g. Total man-days lost (e+f) h. Frequency rate ( refer clause 8 of annexure II ) i. Severity rate ( refer clause 8 of annexure II ) j. Frequency Severity Index ( refer clause 8 of annexure II ) k. No. of dangerous occurrences which do not result into bodily injury/death as defined under Rule 132 of Goa Factories Rules, 1985 l. No of Notifiable Diseases reported as listed under THE THIRD SCHEDULE of the Factories Act, 1948 6 . I s your factory prosecuted under The Factories Act, 1948 during the assessment period. If yes, give number of prosecutions and convictions. PART B : Safety Management ( All questions are to be answered. Details may be given item-wise separately, indicating the item no .) 7. Health & Safety Policy 7.1 Does the factory have a Safety and Health policy? a.When was the last revision made? b. Specify the language in which it is prepared and displayed. (attached copies) c. What is the method of communication of the policy to the employees / contractors / visitors? 8. Health & Safety Organization 8.1 What is the organisational set-up, assignment of responsibilities and arrangements for implementation of the Health & Safety policy? Attach details along with a copy of the Health & Safety Organisation setup. 8.2 What activities are undertaken to promote Health & Safety objectives? Attach details. 8.3 How is the safety and health performance of individuals taken into account while considering career advancement? Give brief details of the system and attach a copy of Performance Appraisal Form with consideration / weight-age for Health & Safety. 8.4 Appointment of Safety and /or Factory Medical Officer a. How many persons are working in the Safety and Health Department? Give details. b. Whether the appointed Safety Officer works fulltime in the factory and also works for other factory under the same group of company. If yes, provide the details as under SN. Name of safety officer Name of factory No. of days 1 2 3 4 9. Participation of workers in “Health & Safety” Management 9.1 Describe the structure and composition of Safety Committee(s) in your factory. Attach a copy of the Constitution of the Safety Committee (s). 9.2 Give a brief resume covering -Number of meetings held during the assessment period (Attach separate sheet) -Attach a copy of minutes of meeting. (one copy of each year) 9.3 Give details in separate sheets of the major activities/assignments carried out by the Safety Committee during the assessment period. c. Is your factory required to appoint Safety Officer and / or Factory Medical Officer recognized by Chief Inspector of Factories & Boilers? If yes, provide details as under. SN. Name Designation If recognized by Chief Inspector, give details 1 2 3 4 5 6 7 8 11. Work Permit, Lock out & Tag Out System Do you have a system of Permit to Work, Lockout& Tag out System? If yes, give details along with formats. 12. Accident/incident reporting system Do you have a procedure/system of nearmiss /Incident /Accident reporting, investigation, and analysis? If yes, give details along with formats. 13. Safety of Contract workers Give a brief description of specific safety measures taken for safety of contract workers in the Assessment Period covering the following points:- 13.1 Safety Clause in contractor's work orders'. Attach a copy of the document. 13.2 Safety meetings with contract workers. 13.3 Provision of personal protective equipment 14. Emergency Management 14.1 Does your factory have an “On-Site Emergency Plan/Evacuation plan”? 14.2 How often are the drills carried out for emergency situations (fire, toxic release)? Attach copy of mock drill reports for 2016, 2017 and 2018. 15. Health & Safety Auditing 15.1 a)Whether you are required to conduct Internal OSH Audit as per Goa Factories (OSH) Audit Rules 2014. If yes, when was the same conducted? _____________________________________________________________________________ b)How many recommendations were suggested and how many are complied with? _______________________________________________________________________________ 15.2 a)Whether you are required to conduct External OSHAudit per Goa Factories (OSH) Audit Rules 2014. If yes, when was the same conducted? _______________________________________________________________________________ b)How many recommendations were suggested and how many are complied? _______________________________________________________________________________ Assessment Period In house Training Programs External programs No. of programs No. of participants No. of programs No. of participants 2013 2014 2015 10. Training in Health & Safety 10.1 Give details of two days Training on Safety and Health conducted by through Inspectorate of Factories & Boilers 16. Occupational Health & Hygiene 16.1 Give brief details of facilities and arrangements available at the disposal of the factory for attending medical emergencies. _______________________________________________________________________________ 16.2 What are the decontamination facilities available for the workers in case of any exposure to chemicals? _______________________________________________________________________________ 16.3 How may are trained in First Aid. _______________________________________________________________________________ 17. Have you done any innovations in Safety & Health field during the assessment period? If yes give details 18. Any other additional safety motivational /promotional activities carried out? Please attach details. 19. Declaration: I, Dr./Mr./Ms______________________________________ Manager / Occupier declare that, the information given herein is true to the best of my knowledge and belief. I am fully aware that furnishing wrong information will lead to rejection of my application. Form Reg. No. ____________ date ____________. Entry Fee Receipt no. __________________ Date _____________ GTS SAFETY AWARDS - 2019 Application No: (To be filled by GTS) Sr. No. Description Item Checked By No Applicant GTS 1. Information about the Factory Brief description of the process attached Enclose OHSAS 18001 certificate GTS membership details given Payment Details Details of reportable accidents given in Annexure IV Details of dangerous occurrences given Copy of Safety and Health Policy attached Copy of Safety and Health Organization chart attached Details about the activities undertaken to achieve Safety and Health objectives Details of performance system and copy of the Performance Appraisal Form attached Copy of constitution of Safety Committees attached Brief resume covering no. of meetings and copy of minutes of meeting of 2015, 2016 & 2017 attached ( 1 copy of each year) Details of the major activities/ assignment of safety committee Copy of permit to work, lock out and tag out system attached Details along with formats of procedure /system of accident/incident reporting , analysis attached. Brief description of measures taken for Safety of Contract workers attached. Details of Internal and External safety audit attached. Details regarding Occupational Health & Hygiene Any innovation in the field of Safety & Health Additional activities promoting Safety & Health Declaration Certificate 1.1 - 2.4 2. 2.2 3. 2.4 4. 4 (a) 5. 4 (b) 6. 5 c 7. 5 k 8. 7.1 9. 8.1 10. 8.2 11. 8.3 12. 9.1 13. 9.2 14. 9.3 15. 11 16. 12 17. 13 18. 15 19. 16 20. 17 21. 18 22. 19 GTS SAFETY AWARDS-2019 Annexure II RULES AND REGULATIONS FOR PARTICIPATION IN THE GTS SAFETY AWARDS-2019 1. OBJECTIVE Green Triangle Society (GTS) a Non-government organization dedicated to Occupational Safety, Health and Environment has instituted Green Triangle Society (GTS) Safety Award – 2018 . The main objective of the Safety Awards isto recognize industrial undertaking's performance, good safety practices, leadership and to encourage commitment of the management and workers in the fields of Occupational Health and Safety. The awards also recognize the attainment of Consistent Level of Achievements in Occupational Health and Safety Performance. 2. DEFINITIONS The Rules may be called as the GTS Safety Awards Rules (a) “Assessment Period” means the three Consecutive Calendar Years previous to the Award Year. (b) “Awards Evaluation Committee” means the Committee constituted by the GTS Board for scrutinizing a n d evaluating the Applications for the Awards. (c) “Award Year” means the Calendar Year for which the Applications are invited (d) “Chairman” means the Chairman of the Award's Evaluation Committee. (e) “Contract Worker” includes Temporary, Casual, Badli 3. ELIGIBILITY FOR PARTICIPATION (a) The Scheme is open to all the factories registered under The Factories Act, 1948. (b) An individual undertaking will be disqualified, if it has been convicted for any contravention with regard to any Health and safety provision under The Factories Act, 1948 or the rules framed there under uring t h e assessment year.(If convicted, the factory need not apply for the award itself). 4. AWARDS & PRIZES The Awards are categorised into 3 categories Category-A :Licensed to employ up to 150 workers. Category -B :Licensed to employ from 501-500 workers. Category -C :Licensed to employ from 501-1000 workers Category–D :Licensed to employ above 1000 workers 5. BASIS OF AWARDS Applications would be evaluated under two parts viz, Part A - “Safety Performance” and Part B - “Safety Management”. Various elements of Safety Performance and Safety Management on which the assessment would be made are given in the Application Form. The information furnished in the application will be assessed and points awarded. Prizes Name of the Award No. of Award (s) in each category Prize 1 st Gomant Sarvochcha Suraksha Puraskar (For most outstanding Performance) 1 Trophy and a Certificate 2 nd Gomant Uchcha Suraksha Puraskar (For outstanding Performance) 1 Trophy and a Certificate 3 rd Gomant Suraksha Puraskar (For Good Performance) 1 Trophy and a Certificate 6. ASSESSMENT PERIOD The Awards will be given in a calendar year (Awards Year) based on the assessment of Safety Performance and Safety Management over the Assessment Period of the three preceding Calendar Years. 7. AWARDS EVALUATION COMMITTEE (a) Constitution The Awards Evaluation Committee will be constituted by Managing Committee of Green Triangle Society for the scrutiny and assessment of the applications received. (b) Functions The Awards Evaluation Committee will assess the applications received and announce the Awards. For the purpose of assessment of the applications, it may call for additional information and shall also conduct site visit of the factory. Site visit shall consist of presentation to be made by the applicant and site round by committee members (c) Decision of the Awards Evaluation Committee The decision of the Awards Evaluation Committee for selection of winners shall be final and binding. No correspondence in this regard will be entertained by the Green Triangle Society. 8. FORMULAES FOR CALCULATING ACCIDENT RATES 6 Frequency rate :No. of accidents X 10 Man-hours worked 6 Severity rate :Days lost X 10 Man-hours worked Frequency Severity Index : Square root of (Frequency rate X Severity rate/1000) For calculating man-days charged refer ANNEXURE: III enclosed with this application. 9. ENTRY FEE Application duly filled in (bounded) alongwith should be submitted along with a Crossed Demand Draft or Cheque or RTGS transfer in favor of the "GREEN TRIANGLE SOCIETY" ,payable at Panaji -Goa. The entry fee is NON- REFUNDABLE. 10. AWARD APPLICATIONS Each application must be accompanied by the duly signed check list sent along with the application form as Annexure-1. The application form should be signed either by the Manager or the Occupier of Factory registered as per The Factories Act, 1948. The application form duly completed in all respects should be submitted in a sealed cover super-scribing “GTS Safety Awards -2018” to the Director Administration, of Green Triangle Society, Flat No. 1, Upper Ground, Floor, Wing 'C', Manoshanti Complex, Behind Hotel Manoshanti, Dr. Dada Vaida Road, Panaji Goa. 403001 on or before 15th April 2019. Furnishing of false information and/or incomplete applications, in any respect are liable to be rejected without giving any reason. Entry fee: 5.000 /- ( For Category -A ) Category-A : Licensed to employ up to 1 50 workers Entry fee: 7,500/- ( For Category-B ) Category: B: Licensed to employ from 501-500 workers. Entry fee: 10,000 /- ( For Category-C ) Category- C : Licensed to employ from 501-1000 workers Entry fee: 12,500 /- ( For Category-D ) Category –D : Licensed to employ above 1000 workers Details of Reportable Accidents for the year 2015, 2016 & 2017 Name of the Injured Sr No. Nature of Injury (1) (2) (3) (4) Brief Description of the Accident Body part Injured (5) Year : 2015 ANNEXURE: IV Year : 2016 Year : 2017 (Attach separate sheets if required) Name of the Injured Sr No. Nature of Injury (1) (2) (3) (4) Brief Description of the Accident Body part Injured (5) Name of the Injured Sr No. Nature of Injury (1) (2) (3) (4) Brief Description of the Accident Body part Injured (5) -13- Sub: Safety Week Celebrations 2020 – Publicity Material Sir/ Madam Compliments of the Season and Happy New Year 4th March is celebrated as the National Safety Day throughout the country. To commemorate this occasion, Green Triangle Society is bringing out safety promotional / publicity articles with safety slogans annually. The items are useful for distribution among your employees /displays etc. Kindly place your firm orders by email / Fax before 10 February 2020 and subsequently send order form along with payment ( No Credit Please). For the collection of material, you may please contact Ms. Namrata at the above- mentioned address. Any inquiry about material can be asked on phone, however, order placed on email will only be considered. Thanking you Yours faithfully Vivek P. Marathe Hon. Secretary Encl a/a Ref: GTS/NSD-20/20 Dated: 1st January 2020 To, The Occupier / Manager __________________________________ __________________________________ __________________________________ GREEN TRIANGLE SOCIETY Registration No. 138/Goa/2000 - under Societies Registration Act., 1860 PAN No AAAAG6368C TAN No. BLRG13674D Flat No.1 Upper Ground Floor, Wing "C" Manoshanti Complex, Behind Hotel Manoshanti, Dr. Dada Vaidya Road, Panaji - Goa 403001. Tel : 0832 2232446 Mob: 9284544207, 8623095800, 9403880500 E-mail: gtsgoa@gmail.com GREEN TRIANGLE SOCIETY DEDICATED TO OCCUPATIONAL SAFETY, HEALTH AND ENVIRONMENT National Safety Day / Week – 2020 Material Order Form / Quotation / Delivery Challan Full postal address: Name & Designation : ______________________________________________________________________ Name of the Organization :_______________________________________________________________________ Address :_______________________________________________________________________ Tel. No: _____________Fax No. :____________Cell :_______________ E-mail __________________________ Sr. No. Items Particulars Cost ` Qty Amount 1. Safety Day Badge 3 Colour, 300 gsm Card and laminated with safety pin (Pack of 100 badges) 225/- (per pack of 100 badges) 2. Flex Banner (with Safety Slogan Approx size (3*8 ft) E nglish / H indi / K onkani / M arathi 500/- E H K M 3. Safety Posters on 3mm sun board+eco vinyl matty laminated 18" X 27" (set of 10 posters) 6000/- 4. Classmate BFast Ball Pen ( set of ten ) 50/- 5. Classmate Octane Ball Pen 10/- 6. Classmate Pollax Roller ( Refillable Fluid Ink Pen ) 45/- 7. Highlighter ( Set of 5 ) 100/- 8. Classmate Pocket Book Spiral ( set of 5 pocket book ) 50/- 9. Classmate Pulse 6 Subject Book ( 300 pages ) 120/- 10. Classmate Smoothie Fountain Ink Pen with 2 ink cartridges 50/- 11. Classmates Mechanical Pencil 0.5mm (Da Vinci -II) 10 leads 15/- 12. Cap 65/- 13. Leather wallet 250/- 14. Shopping Handbag 275/- 15. Waist Pouch 100/- 16. Key Chain (Wooden) one side printing 30/- 17. Key Chain (Metallic) one side printing 20/- 18. Coffee Mug 150/- 19. Set of Coaster with slogans 400/- 20. Pen Drives 16 GB 300/- 21. Pen Drives 32 GB 425/- 22. Pen Drives 64 GB 750/- 23. Pen Drives 128 GB 1250/- 24. Cutlery Set ( 12 pcs) 350/- 25. Cutlery Set ( 18 pcs) 550/- 26. Cutlery Set ( 18 pcs) with box 850/- 27. Cutlery Set ( 24 pcs) with box 1300/- RUPEES TOTAL Cheque may be drawn in the name of “ Green Triangle Society”. th Last date for order –10 February 2020 Samples are displayed in the office of GTS Material should be collected from the office during office hours on payment. Plz call before coming Name & Signature: