Procedure for Reporting of Accidents / Dangerous Occurrences ANNEXUREAV FORMAL WEST BENGAL POWER DEVELOPMENT CORPORATION LTD. Santaldin Thermal Power ProjectStation ALLEGED WORK ACCIDENT (Inter Departmental Memo) To The St. Manager ( ) ‘Thermal Power Station Dete : Shri IMIS. No, . Designation .. of your Department: has reported to First Ald Centre / Hospital for treatment of work Injury without Form - |. Has been made fitfunfit to work for less than/more than 48 hours. Please expedite Form-t if it Is a work accident. Medicel Officer / First Ald Centre Incharge - .» Thermal Power Station Date : ‘Memo No. Copy to : 1. Sr. Manager (PEA) 2. Manager (Fite & Safety)Procedure for Ri of Accidents /| mous Occurrences ANNEXURE4IIt FORMA WEST BENGAL POWER DEVELOPMENT CORPORATION LTD. Santaldih Thermal Power Project / Station ALLEGED WORK ACCIDENT ((ntor Departmental Memo) To The Sr. Manager ( ) reported to First Aid Centre / Hospital for treatment of work injury without Form-la. He has been made fit / unfit to work for less than / more than 48 hours. Please expedite Form - la if it is a work accident. Date : Memo No. Copy to: 1. Sr, Manager (P & A) 2. Manager (Fire & Safety) Al Formeds are callectec!ANNEXURE-1 WEST BENGAL POWER DEVELOPMENT CORPORATION LTD. ‘Santaidih Thermal Power Station (inter Departmental Report) To The Medical Superintendent / Incharge . Hospital / First-aid Centre Thermal Power Station Subject : Accident of Shil / Smt. ... Shui / Smt. First-aid Centre for treatment. ‘The details of the Injured and Incidents are as below : Designation of Injured . MIS No. :. Department : .. Date & Time of accident Details of accident : ... ‘Cause of the accidentfor Reporting of Accidents / Dangerous ANNEXURE-II FORM-15, WEST BENGAL POWER DEVELOPMENT CORPORATION LTD. Santaldih Thermal Power Station (Inter Departmental Report) To The Medical Superintendent / Incharge ‘The details of the injured and incidents are as below : Designation of Injured : Name of the Contractor : Department under which the ‘contractor is working: «. Date & ume of accident : Details of accident : .. Cause of the accident +Procedure for Reporting of Accidents | Dangerous ANNEXUREV WEST BENGAL POWER DEVELOPMENT CORPORATION LTD, Santaidih Thermal Power Station Notice of Accident (coples to be submited to St. Mgr. (HR8A) & Manager (F&S) of the concerned Power Station by Sr. Manager of concemed O & M Department) Name of occupier (of Factory) / Employer : ‘Address of factory / premises where accident took place + Nature of Idustry : Branch or department and exact place where the accident took place : Name and address of the injured : (2) Sex: (b) Age (last birthday) (©) Occupation of the Injured person : Date, Shift end hour of accident : (a) () Hour at which the Injured person started work ‘on the day of the accident : Whether wages in full or part are payable to him for the day of accident ; Cause of accident - b) ° i (ii) d) If caused by machinery - () Give name of the machine and the part causing the accident : (i) State whether it was moved by mechanical power at that time : State exactly what the injured person was doing at that time : In your opinion, was the injured person at the time of accident - (acting in contravention of provisions of any law applicable to him ? OR acting in contravention of any orders given by or on behalf of his employer ? OR acting without instructions from his employer ? In case or reply to 9¢) (0). GI), oF (ii) Is in the affirmative, state whether the act was done for the purpose of and in connection with the employers trade or business.10. In case the accident heppened while traveling in the employer's transport, state whether - i) the injured pony ee tect tenremman to of from his place of il) the injured person was traveling with the express. or implied permission of his employer : ii) the transport Is being operated by or on behalf iv) the vehicle was being/not being operated in the ‘ordinary course of public transport vehicle. . In case the accident happened while meeting emergency, state )) its nature = i) whether the Injured person at the time of accident was employed for the purpose of his ‘employer's trade or business in or about premises at which the accident took place : 12, State how the accident occurred : 13. Names and address of witnesses : @) (b) 14, (2) Nature and extent of injury (e.g. fatal, loss of finger, fracture of leg, scale of scratch and followed by sepsis : (b) Location of injury (right leg, left hand or let eye etc.) 15. (2) If the accident is not fatal, state whether the Injured person was disabled for 48 hours or more : (b) Date and hour of return to work : 16. (2) Physician, dispensary or hospital from whom or in which the Injured person recelved or Is receiving treatment : (b) name of dispensary / panel doctor selected by the injured person : 17. (i) Has the injured person died : (ii) M so, date of death : | cefy that to the best of my knowledge and belief the above particulars are correct in every respect. Date :