GENERAL INFORMATION

 Name of the Chief Executive Officer/ Chairperson -

 Contact Details (for information) -

 Name & Designation-
 Telephone No
Land -
Mobile -
 Fax -
 Email -

GREEN APPROACHES

 Do you have an environmental policy for your industry/activity for environmental

management (Yes/No) -
o If yes, state such policy -
o If yes, state the strategies adopted to implement such environmental policy -
 Financial allocation for environmental activities
o Annual total operational cost -
o Annual cost for environmental activities -

Surrounding Environment of the Industry/Activity

 Displays in factory.
Posters (Yes/No) -
Notices (Yes/No) -
Newsletters (Yes/No) -
employees’ ideas (Yes/No) -
environment articles (Yes/No) -
 What are the preventive measures to eradicate mosquito breeding places?
 o

Internal Environment of the Industry/Activity

 Details of housekeeping system –

 Availability of sufficient number of wash rooms and proper maintenance of them -

C (Carbon) and Water Footprints

 Ratio of green area to total land area -

 Did you calculate the carbon footprint and water footprint?
Carbon footprint (Yes/No) -
Water footprint (Yes/No) -
 What is your carbon footprint for the year 2023 -
 What is your water footprint for the year 2023 -
 Do you have a carbon management plan for carbon reduction (Yes/No) -
(If yes, submit the executive summary.)
 What action have you taken to reduce GHG emissions in the year 2023-
 Amount of GHG reduced/tons
Energy efficiency -
Renewable Energy -
Reforestation / Afforestation -
Carbon Credits -
 Percentage reduction of GHG emission from 2023 -
 Details of adaptation of C (Carbon) negative product concept -

Optimum Resources Management

 Strategies for overall energy savings -
 Strategies for minimization of wastewater generation -
 Strategies for optimum labor productivity -
 Strategies for minimizing raw material consumption. -
 Extent of using waste as raw material -
 Extent of Reduction and Substitution for hazardous materials -
  Extent of using ecofriendly raw materials -
 Extent of utilizing green building concept -
Environmental Documentation and Reporting
 Frequency of self-reporting -
 Describe method of record keeping (if available) -
 Maintaining a notice board for environmental awareness (Yes/No) -
 Provide details on environmental publications, including annual reports ( if any) -
 Are you a member of National Green Reporting System (NGRS) / Global Reporting
Initiatives (GRI) or any other acceptable reporting system -
(Submit a copy of the latest report.)
 Availability of committed officer to the environment sector -

Environmental Health and Safety

 Do you have an emergency preparedness plan including flood prevention plan -

 Details of the emergency preparedness plan –

(Provide factory layout plan with emergency exits)
 Details of display of sign boards for health and safety -
 Details of firefighting equipment in place -
 Details of better ventilation system with lighting -
 Usage of personal protection equipments by workers -
 Do you conduct regular emergency preparedness drills and awareness for workers
(Yes/No) –
( If yes, state the frequency.)

Solid Waste Management

 Method of separation at source -

 Method of Collection -
 Method of Storage/Transportation -
 Strategies for minimization of non-degradable materials -
  Strategies for minimization of waste generation -
 Waste treatment methods (composting/bio gas/incineration/other) -
 Final disposal methods for residues -
 Monitoring mechanism of waste management process including waste auditing -

Pollution control strategies

 Existing treatment facilities and controlling systems.

Air emission (Yes/No) -
Noise & vibration (Yes/No) -
 Status on functioning of emission controlling systems and mitigation measures for noise
& vibration -
 Self-monitoring methods to treatment facilities and pollution control systems -
 Mitigation measures for noise and vibration -
 Do you have HR policy to recruit personnel with environmental qualifications (Yes/No) -
(If yes attach the policy) -

 How many have you recruited in year 2023 with the qualification of environment
management -
 Percentage of the total recruitment -
 Do you have a policy to procure products, machinery or materials with environmentally
friendly features (Yes/No) -
(If yes, attach a copy of the policy)

Legal Status

 Certificate of Conformity for constructions –

(Submit copies)
 Indicate continuity of the EPL from commencement -
 Indicate continuity of the Scheduled Waste Management license from commencement (If
applicable) -
 Do you have Trade license/Company Registration/Business Registration or other relevant
approvals as required (location specified and category specified) for your activity
(Yes/No) -
(Submit copies)
 Is there any legal action taken against the industry/ activity? Provide details-

 Approvals for discharges or input raw materials (if any) -

 Availability of maintaining a file for legal requirement -
 Details of new systems, procedures and process invented and introduced during year
2023 to improve your productivity/process to enhance efficiency/quality of the
environment -
 What are the benefits gained by enhancing the quality of the environment by applying
above innovations –

Corporate Social Responsibility

 List social activities done by your industry/activity during year 2023 -

(Submit details with proof.)
 Environmental awareness programs -

 Tree planting programs

No. of programs conducted -
Monitoring & Maintenance -
 Environment related community/rehabilitation programs -
 Other environment related programs/Projects –

Previous Awards
 Environmental Awards and Certificates obtained in past 3 years -
(Attach copies of certificates )