Yes / No

Section Management Documents

1 Factory License
2 Factory Standing Orders
3 Minimum Wage Notification
Factory Policies on Harassment, H
4
& S, Discrimination and OT
State Pollution Control Board Consent for
5
Air and Water
6 Organization Chart
7 Verbal Abuse and Harassment
8 Water Pottability Test Report
ESI & PF Challans for last 3 months /
9
Form 5 & Form 10
Permission for 2nd Shift ( If 2nd Shift is
10
there )
11 Major and Minor Accidents Report
No of persons trained in First Aid and
12
Certificates
No of persons trained in Fire Fighting and
13
Certificates
14 Fire Safety Certificates
Last date of Fire Drill Evacuation &
15
Records Documented
16 Material Safety Data Sheet (MSDS)
17 Training Documents
18 Over Time
19 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
20
Fixed Strength
Boiler Fitness Certificate and Operators
21
certificate ( Form 6 & 7)
22 Machine Maintenance Register
Personal Files - Application Form,
Appointment Letter, Fitness Certificate,
23 Nomination, Age proof, DA - Increment
details, ESI Card copy ,Emergency
Contact Person's name & No.
Mustor Roll - Time Record - Salary
24
Statements
Medical Fitness Certificate for Canteen
25
Workers and Security Guards
ESIC and ID Cards/PF/Gratuity / Full &
26
Final Settlements
27 Does the facility has a Welfare Officer
Does the facility has documentation of
28 boiler and pressure vessels inspections
on files and posted?
Are Elevator Inspection Documents up to
29
date & posted?
Sub Total

Yes / No
B Emergency Exits
 Is there sufficient directional and exit
30 signs to ensure that all exit routes are
clearly indicated in bilingual language
31 Do all work areas have at least two exits
Emergency Exits door to be opened out
32
side.
Sub Total

C Aisles
Are aisles clearly marked with directional
33
sign Red arrow ?
34 Are aisles larger than 3 feet wide?
Sub Total

D Emergency Lighting
Do all emergency lighting units work
35
properly?
Are all Emergency lights tested monthly
36
and records of test kept?
Sub Total

Fire Extinguishers/ Hose Reel /

E
Hydrant
Are there adequate number of fire
37
extinguishers available?
Are locations of fire extinguishers clearly
38
marked?
Are extinguishers visually checked
39
monthly ( with control tags)?
Are fire extinguishers inspected annually
40 by outside professional agency;
documentation is on file
Sub Total

F Emergency Preparedness
Does a facility has a documented
41
emergency preparedness program?
Records of Evacuation Drill
Records of tests of alarm & emergency
lighting system
Does the facility has the documented fire
42
& emergency evacuation plan?
The plan has floor maps prominently
43 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

G First Aid
Clinic
Is the clinic suitably equipped in
44 compliance with the guidelines ( beds,
first aid materials, medicines)?
 Are screens/curtains provided to allow
45
privacy?
Is there system in place to check
46
expiration dates of medicine?
Are sufficient number of employees
47 trained in First Aid by a recognized
organization
Sub Total

H First Aid Kits

Are First Aid kits available in all work
48
areas ( 1 per every 100 workers)
Are First Aid kits are easily accessible,
49
identified and/or unlocked?
Are First Aid kits adequately stocked and
50
appropriate for work areas?
Sub Total

I Chemical Storage Area

51 Are appropriate warning signs displayed?

52 Is there an effective ventilation system?

Is there an effective secondary

53
containment system for liquid chemicals?
There should be no floor drain in the
54
chemical ware house
Are all drums, containers, dispensers
55
clearly labeled?
Is eye wash is available within 30 M of
56
where chemicals are stored?
57 Are Fire Extinguisher available?
Is MSDS ( Material Safety Data Sheet ) is
58 posted in areas where chemicals are
stored?
Sub Total

J Signs/Labeling
Are signs /labeling displayed in bilingual
59
language?
Are signs are large enough to see from a
60
distance and clear?
Sub Total

General Equipment / House Keeping /

K
Electricity
Use of Electricity
Are electrical switches labeled in bilingual
61
language?
Are generators installed suitable
62
earthed?
 Are copies of Electrician qualifications
63
certificates etc. kept on file?
Are all electrical maintenance carried out
64
are properly recorded?
Sub Total

General Equipment / House Keeping /

L
Electrical Hazards
Are "Danger: high Voltage" warning signs
clearly displayed around high voltage
65
areas and access to authorized
personnel only?
Are high voltage areas are clean and tidy
66
with no material storage?
Is access to generator areas restricted to
67 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
68
hearing protection warning signs
displayed?
Is electrical wirings suitably insulated and
69
labeled?
Are workers provided with necessary
70 protective equipment (PPE) and trained
in the correct use of PPE?
Sub Total

M Lighting
Are work areas adequately ventilated
71
( fans, windows)?
Is emergency lights provided in stairways,
72
corridors and exits?
Sub Total

N Machinery
Is the risk of personal injury from
dangerous machinery controlled by
adequate (a)
hand operation switches (b)
73 guards (c)
minimized gaps (d)
emergency stops (e)
protective gloves (f)
warning signs
Are fan blades adequately guarded
74
(Mesh /screen holes)?
Are all conveyer belt gears, drive shafts
75
and belts adequately guarded?
When necessary, is suitable eye
76 protection provided and used to reduce
the risk of eye injuries?
Are air compressor areas clean and tidy
77
and free of material storage?
Are noise level in the work areas
acceptable? Have noise survey been
conducted?
Sub Total

O Waste Water Treatment

 Does the factory have a waste water
78
treatment plant?
Is there any mechanical, biological and
79
chemical treatment plants in the facility?
Are all discharges are within allowable
80
limits?
Are discharges test annually and records
81
of test results kept?
Sub Total

House Keeping, sanitation and

P Hygiene Toilets, Dining and Kitchen
Facilities
Kitchen
Are Kitchen & floors are kept clean,
82
sanitary, odor free and free of grease?
Are Kitchen Staff given regular medical
83 Check ( particularly test for transmissible
disease such as hepatitis and typhoid )?
Are refrigeration facilities available in
84
kitchen?
Are food preparation surfaces clean, free
85
of cracks, cuts etc?
Are there sufficient tables/chairs inside
86 canteen or eating facilities provided
under a roof?
Are all preparation knives & chopping
87 boards kept clean, sharp, rust free and
are correctly stored?
Are all electrical appliances are in good
88
condition in kitchen?
Is system in place to ensure the food
89
prepared in canteen is fresh /hygienic?
Are all dry foods correctly stored, clear
90
and above the floor?
Is the factory maintained in a clean and
91
tidy state?
Is there arrangements to remove
92
produced waste effectively and regularly?
Are passage way kept clear of
93
obstructions?
Do all kitchen personnel wear hats or hair
94
nets?
Sub Total

Q Bathrooms / Toilets
Is number of toilets sufficient for both
95
men and women ?
The bathroom facilities are clean and
96
generally free of odor?
Are the bathroom facilities are well
97
ventilated and have running water?
Is soap / liquid soap, tissue paper, hand
98
towels available in the toilets?
Are proper masks, rubber shoes, aprons
99
etc provided to house keepers?
100 Toilets have water flushing system?