Annexure- 6

SAIL-IISCO STEEL PLANT

Memorandum of Understanding between the (Company/ Plant) and

the (Contractor) for safe execution of contract work.

This Memorandum of Understanding is made and executed by and between

STEEL AUTHORITY OF INDIA LIMITED , a Company and/ or Plant registered under the Companies Act
1956 and/ or Factories Act and having its registered office at Ispat Bhavan, Lodi Road, New Delhi 110
003, India, or their authorised representative(s), hereinafter referred to as “Employer” (which expression
shall wherever the context so requires or admits be deemed to mean and include its successor in
business and assignees) of the one party

AND

Contractor Name having its Registered Office ______________________________________

(hereinafter referred to as "Contractor"), (which expression shall wherever the context so requires or
admits be deemed to mean and include its successors in business and assigns) of the other party.

WITNESSESTH THAT

Whereas the Employer gives highest importance to the safety in execution of work, seeks co-operation
from the Contractor in this endeavor.

Thus, the Memorandum of Understanding is for promoting the safety aspects required to be followed at
work place/ site and will be applicable to any site job to be done by the Contractor.

AND

Whereas the Contractor has read all the terms and conditions of the Employer and whereas the
Contractor has studied the following documents.

a) Tender documents, enquiry/ order specification including General Conditions

b) “General Safety Rules”, “Safety Rule for Construction work” and “Electrical Safety Guide”.
c) West Bengal Factory Rules 1958, Factories Act 1948, Indian Electricity Rules 1956.

The amendments to any of the above rules and any other rules and regulations or procedures,
circulars, notices and advices laid down by the Employer from time to time whereas these
documents are included as Annexure to this Memorandum of Understanding.

Now, it is hereby AGREED AND DECLARED by and between the Employer and the Contractor
as follows:

Clause-I The Contractor shall abide by the terms and conditions stipulated in “Annexure to
the Memorandum of Understanding between Employer and the Contractor for safe
execution of the Contract work

Clause-II The Contractor shall undertake full responsibility for safe execution of the job at
work place/ site and safety of his personnel from the time he enters the gates of
IISCO Steel Plant, Burnpur till the time he leaves the works gates after his duty.

Clause-III Without giving any prior notice, the Employer shall from time to time be entitled to
add/ or amend any or all terms and conditions with a view to improving safety of

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 personnel and safety of work, with immediate effect and the shall be binding on
the Contractor. The Contractor agrees to implement all such amendments which
shall be laid down by the Employer.

Clause-IV Besides following the guidelines, safety rules and regulations, safety codes given
in various safety procedures/ documents mentioned above, the Contractor shall
also prepare a job safety analysis wherever there are complicated and hazardous
working involved. The Contractor shall consult executing agency, supervisors
Safety and Accident Prevention Services Department and officers from specialised
agency of Employer in preparing such documents.

In witness thereof, the parties hereto by representatives duly authrorised have executed this
Memorandum of Understanding on _________, 2009.

Signed on Signed on
for and on behalf of ISP for and on behalf of (Contractor )

Signature Signature

Name Name

Title Title

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 SAFETY CODE FOR CONTRACTORS

INTER PLANT STANDARD FOR SAFETY IN STEEL INDUSTRY

SAFETY IN CONTRACT WORKS IPSS:1-11-011-01

0. FORWORD

0.1 This Inter Plant Standard formulated by the Standard Committee on Personnel Safety Appliances
& Procedures, IPSS 1:11 with the active participation of the representatives of steel plants and
associated organizations in the field, was adopted in May, 2001.

0.2 This is one of the series of Inter Plant Standards in the area of the safety in the steel plants with a
view to providing guidance to all concerned in accident prevention.

1.0 SCOPE OF WORK

1.1 Safety is the responsibility of the Contractor and his staff / employees/ workmen engaged/
deployed for execution of work under the Contract, individually and collectively. For this purpose,
the Contractor staff means and includes all its associates and sub-contractors / vendors/ sub-
vendors and their staff/ employees/ workmen deployed for execution of the work covered under
the Contract. The Contractor shall ensure that his workmen participate in the safety awareness,
health care and safety training programmes whenever such programmes are organised by the
Employer or the Contractor.

1.2 The Contractor’s scope of work shall include, but not limited to execution of work/ Contract,
adequate safety arrangements for men machinery etc. engaged during the execution of the
Contract.

1.3 While executing the Contract, the Contractor / his supervisor has to ensure safety of the
surroundings with regard to Employer’s work place/ site and other contractor’s men/ machine/
materials/ system etc.

2.0 DETAILED PROCEDURE/ PROTOCOL

2.1 Before starting the work, a safe work procedure/ protocol shall be prepared and signed jointly by
the executing department, representative of Safety Deptt. and the Contractor or his
representative. This procedure/ protocol shall be prepared by breaking the whole job into small
elements and listing them separately in the sequence. Against these elements, the agency
responsible for doing it, would be mentioned. Any other details about these elements, may also
be mentioned in the remarks column.

3.0 MEMORANDUM OF UNDERSTANDING (MOU)

3.1 A Memorandum of Understanding, placed at Enclosure-A, shall be signed between the

Contractor and the representative of the Contracts Department (on behalf of the Plant) before
award of the Contract.

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 ENCLOSURE – A

(Name of the Company/ Plant)

Memorandum of Understanding between the (Company/ Plant) and

the (Contractor) for safe execution of contract work.

This Memorandum of Understanding is made and executed by and between

_____________________________, a Company and/ or Plant registered under the Companies Act 1956
and/ or Factories Act and having its registered office at ________________________________ or their
authorised representative(s), hereinafter referred to as “Employer” (which expression shall wherever the
context so requires or admits be deemed to mean and include its successor in business and assignees)
of the one party

AND

M/s __________________________________________ having its registered office at

_____________________ hereinafter referred to as the “Contractor” (which expression shall wherever
the context so requires or admits be deemed to mean and include its successors in business and
assigns) of the other party.

WITNESSESTH THAT

Whereas the Employer gives highest importance to the safety in execution of work, seeks co-operation
from the Contractor in this endeavor.

Thus, the Memorandum of Understanding is for promoting the safety aspects required to be followed at
work place/ site and will be applicable to any site job to be done by the Contractor.

AND

Whereas the Contractor has read all the terms and conditions of the Employer and whereas the
Contractor has studied the following documents.

d) Tender documents, enquiry/ order specification including General Conditions

e) “General Safety Rules”, “Safety Rule for Construction work” and “Electrical Safety Guide”.
f) West Bengal Factory Rules 1958, Factories Act 1948, Indian Electricity Rules 1956.

The amendments to any of the above rules and any other rules and regulations or procedures,
circulars, notices and advices laid down by the Employer from time to time whereas these
documents are included as Annexure to this Memorandum of Understanding.

Now, it is hereby AGREED AND DECLARED by and between the Employer and the Contractor
as follows :

Clause-I The Contractor shall abide by the terms and conditions stipulated in “Annexure to
the Memorandum of Understanding between Employer and the Contractor for safe
execution of the Contract work (______________2001)” .

Clause-II The Contractor shall undertake full responsibility for safe execution of the job at
work place/ site and safety of his personnel from the time he enters the gates of
__________________ till the time he leaves the works gates after his duty.

Clause-III Without giving any prior notice, the Employer shall from time to time be entitled to
add/ or amend any or all terms and conditions with a view to improving safety of
personnel and safety of work, with immediate effect and the shall be binding on

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 the Contractor. The Contractor agrees to implement all such amendments which
shall be laid down by the Employer.

Clause-IV Besides following the guidelines, safety rules and regulations, safety codes given
in various safety procedures/ documents mentioned above, the Contractor shall
also prepare a job safety analysis wherever there are complicated and hazardous
working involved. The Contractor shall consult executing agency, supervisors
Safety and Accident Prevention Services Department and officers from specialised
agency of Employer in preparing such documents.

In witness thereof, the parties hereto by representatives duly authrorised have executed this
Memorandum of Understanding on ____________ day of __________ 2001.

Signed on Signed on
for and on behalf of (Company/Plant) for and on behalf of (Contractor )

__________________________ ___________________________

Signature Signature

Name Name

Title Title

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 GENERAL TERMS & CONDITIONS

1.0 SUPERVISOR
1.1 The Contractor shall engage qualified and competent supervisors for executing the
Contract. The supervisor must be able to i) read drawing ; ii) understand the safety
aspect of the job ; iii) take necessary precautionary measures ; iv) ensure leadership for
the safe execution of the job.
2.0 SAFETY SUPERVISION
2.1 The Contractor shall provide at least one competent full time safety supervisor who shall
be nominated for each contract depending on the number of persons employed and
safety requirements of the job including round the clock supervision on safety aspects,
wherever required.
3.0 GATE PASS
3.1 The Contractor shall, in accordance with prescribed procedure, obtain gate passes
(photo passes) from Employer’s Security Department who shall make it available to the
Contractor, to enable the Contractor and his staff / employees/ workmen to enter the
work area inside the plant as well as un-enclosed (open) work area like township. The
Contractor shall make arrangement for instant photography for those contract workers
who may be required to go to work in emergency and do not have photo passes.
4.0 SAFETY INDUCTION
4.1 In order to provide basic industrial safety training to the workers of Contractor, Employer
will provide on request, the general safety induction to the workmen/ supervisor at
Safety Engineering Department. The Contract or shall submit the list of persons with full
details for the job of safety induction to the Engineer for arranging the same. The
Contractor shall not engage untrained personnel for executing any Contract inside the
works. Job safety induction is a compulsory thing for every job to start with.
4.2 If at any point of time, Contractor feels or needs any special safety training for carrying
out a particular job the same shall be arranged by the concerned Engineer of the
Employer. For this, the Contractor shall inform the concerned Engineer of the Employer
well in advance of commencement of such job.
4.3 The Contractor shall motivate and encourage his employees/ workmen to make
personnel contribution towards enhancing safety on the basis of their knowledge and
experience.
4.4 The Contractor shall have adequate number of Pocket Sized Safety Cards containing
safety instructions prepared on the basis of Employer’s model safety book for
Contractors workers in Hindi or regional languages as may be required and shall issue
them to all his employees/ workmen and ensure that they read it before commencing
the work. The safety instructions from these Safety Cards shall be read and explained
by the Contractor or his representative to those employees/ workmen who are illiterate
and cannot read and ensure that they have been understood. If the employees are
signing in the attendance register, the Contractor shall arrange to write “Safety
Sentence” on the top of each page below which each employee will either sign or put
his thumb impression as a token of his/ her attendance also for having read/ understood
the safety instructions.
The “Safety Sentence” shall be “I have read/ understood the Safety Instructions and I
shall work according to these instructions”.
4.5 The work areas where a different system of keeping attendance exists, the Contractor
or his representative shall furnish the list of employees/ workmen deployed on the job
on any particular day and on top of which the following sentence will be recorded by the

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 representative of the Contractor.
“I have explained the safety instructions to my workers mentioned below and assure
that they have understood the instructions and shall work according to these
instructions”.
4.6 The Contractor shall provide safety induction every day before start of the job i.e.
briefing the nature of work to be carried and the necessary precautions to be taken
while executing the job/ Contract during the particular day.
4.7 Contractors shall follow all special safety precautions issued by the executing authority
or his site engineer from time to time.
5.0 LEGAL AND PENAL
5.1 The Contractor shall abide by the provisions of all statutory acts and rules as applicable
and maintain register/ documents, submit periodic reports and returns furnish
information/ report relating to accidents occurring in the area of work to competent
authority in time.
5.2 The Contractor shall be liable for prosecution and penalty in accordance with as
prescribed under the law of land, terms & conditions of Contract as well as rules of the
Company relating to safety, for not observing those provisions by the Contractor or his
employees/ workmen.
5.3 The Contractor shall keep the Company indemnified against all losses/ claims due to
accidents/ injuries/ damages caused at the Contractor’s works site. He shall be fully
responsible for accidents caused due to the Contractor or his agents or workmen’s
negligence or carelessness in regard to observance of the safety requirements and
shall be liable to pay compensation for injuries.
5.4 The Engineer or Head of the Safety Department or their authorised nominees, upon
their satisfaction that the Contractor is not conforming to the safety requirements, may
direct stoppage of work and direct the Contractor to remedy the defects or supply the
facility/ equipment as the case may be. The Contractor shall not proceed with the work
until he has complied with such directions to the satisfaction of the Engineer/ Safety
Department.
5.5 If a Driver or any staff of the Contractor is caught in theft case or in any unauthorised
movement of materials or in the activity which is punishable under the law or not
authorised by the plant, the Contractor shall bear the full responsibility for the loss and
other consequences which may result to the plant due to such illegal / unauthorised acts
besides the action to terminate the Contract by the plant.
5.6 The Contractor shall be responsible to ensure that vehicles belonging to him are not
driven in reckless or rash manner so as to become a potential threat to the safety of the
traffic in the plant or township area. The drivers of the vehicles shall be made to
adhered to the speed limits wherever applicable. Failure to comply with the above, may
result in termination of the Contract.
In case of accident or injury or damage caused by the Contractor’s vehicle or staff to
any person or property, the financial responsibility to compensate be borne solely by the
Contractor and this amount may, at the discretion of the Competent Authority of the
Plant, be recovered from the bills or security or other deposits of the Contractor.
5.7 The Contractor shall ensure that all his employees/ workmen are covered under
“Workmen Compensation Act” and shall pay compensation to his workmen as and
when the eventuality for the same arises.
5.8 To ensure effective enforcement of the rules and regulations relating to safety
precautions, the arrangements made by the Contractor shall be open to inspection by
the Engineer or his representatives, Safety Engineer and Labour Officer.

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 5.9 The Contractor shall enclose along with his first bill a true copy of the Safety Induction
Form (Annexure-1A) duly certified by the Executing Authority regarding use of safety
appliances, following of safety instructions and observance of all safety laws, failing
which the bill will not be processed for payment.
5.10 Notwithstanding the above clauses, there is nothing in those to exempt the Contractor
from the operation of any other Act or rule in Republic of India for the safety of men and
materials.
5.11 Without prejudice to the right conferred to the Employer for stoppage of work for
violations of safety requirements, the Contractor shall be liable, after written warning, for
a penalty of Rs.1,000/- for the first violation and up to Rs.3,000/- for the second
violation. For the third violation, the Contractor shall be liable to be debarred from
further Contracts up to a period of one year from the date of issue of debarring notice.
For low value contracts up to Rs.5 crores, fines up to Rs.25,000/- for medium value
contracts from Rs.5 crores to Rs.10 crores fine up to Rs.50,000/- and for high value
contract above Rs.10 crore, fine up to Rs.1,00,000/- at a time can be imposed by
Employer / Executing Authority on defaulting Contractors.
6.0 PPE & SAFETY APPLIANCES
6.1 The Contractor shall provide all the PPE (Personal Protective Equipment) and safety
appliances required to carry out the job to all the workmen deployed by the Contractor
and also ensure that his workmen use those PPE and safety appliances while on the
job. The Contractor shall not pay any cash amount in lieu of PPE to the workers.
6.2 The PPE and safety appliances provided by the Contractor shall be of the standard as
prescribed by the Inter Plant Standardisation in Steel Industry (IPSS) or by Bureau of
Indian Standards (BIS). If materials conforming to IPSS or BIS standards are not
available, PPE and safety appliances shall be procured by the Contractor as approved
by the Employer.
6.3 If the Contractor fails to ensure provision of safety appliances required to carry out the
job safely to the workmen and that his workmen do not use the PPE and safety
appliances as needed for safe working, Engineer and the Safety Engineering
Department upon the satisfaction that the Contractor is not conforming to the safety
requirement may direct the Contractor for stoppage of work and require the
Contractor to remedy the defects.
The Contractor shall not proceed with the work until he has complied with each direction
to the satisfaction of Engineer and Safety Engineering Department.
7.0 SITE CLEARANCE
7.1 Prior to commencement of work, the Contractor shall obtain a clearance from the
Safety Engineering Department of the Employer and concerned department/ section of
the Employer where the job is to be carried out. The Employer/ Engineer shall not
permit the Contractor to commence the work unless Contractor or his representative
produces such clearance certificate. The Department concerned shall grant such
clearance after ensuring that:
a) The Contractor himself has undergone Safety Induction Training organised by
the Employer’s Safety Engineering Department in the preceding twelve months.
b) The Contractor’s workers, identified for particular work / Department, have
undergone Safety Induction Training in the preceding twelve months.
c) The Contractor has arranged PPE and Safety appliances for himself and for all
his workmen, as required.
d) The Contractor possesses work permit issued by the Employer or Employer’s
representative for which the “Work Clearance Form” (Annexure-1B) shall be

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 filled in triplicate by the Contractor for record of :
i) Safety.
ii) Department/ Section of the Employer granting clearance and
iii) Contractor.
e) The Contractor and his supervisors along with the Contract documents and job
instructions received from the Employer, will come to Employer’s Safety
Engineering Department where the Contractor will obtain Safety Rule Book for
Contractor and seek clarifications, if any. The Contractor is not permitted to stop
the job without clearance from Employer’s Safety Engineering Department.
f) The Contractor shall possess handling equipment, tools & tackles of adequate
capacity and tested quality.
7.2 Contractor shall obtain specific permission in accordance with IPSS: 1-11-007-01
“Procedure to Permit to Work” and IPSS: 1-11-005-98 “Procedure for working at height
by Contractor’s Workers” from the Engineer of the company or the companies Safety
Department before commencing the following:
a) Working in an operating plant / equipment ;
b) Working at height ;
c) Working in areas expected to have toxic/ poisonous gases ;
d) Major site activities irrespective of the clearance already obtained ;
e) Wherever there are hazardous of electricity moving.
The Contractor shall obtain the copies of the above IPSS procedures from the Engineer
or the Safety Engineering Department.
7.3 The executing department shall take necessary shut down of operating plant before
commencement of job in that area. The Contractor shall ensure that shut down/
clearance is taken before sending workers to such locations particularly in the area
where there are hazardous of gases, electricity, moving machinery etc.
8.0 SKILL AND COMPETENCE OF WORKMEN
8.1 The Contractor shall be responsible to engage competent and skilled workers.
8.2 Before starting of the day’s job, the Contractor shall ensure that safety briefing has
been done to his workers by himself or his supervisors who have been imparted safety
induction earlier and also maintain records to this effect.
9.0 PHYSICAL FITNESS OF WORKMEN
9.1 The Contractor shall ensure that his employees/ workmen subject themselves to such
medical examination as required under the law or under the company’s rule and keep
a record of the same.
9.2 The Contractor shall not permit any employee/ workmen to enter the work area under
the influence of alcohol.
10.0 DEALING WITH ACCIDENT
10.1 The Contractor shall maintain a safety register, keep records of all minor and major
accidents, serious or averted (near miss) accidents, with or without injuries to human
beings and shall submit a report about the accident to the Engineer promptly, on the
form prescribed by the Employer.
10.2 The Contractor’s supervisor/ officer in charge shall arrange to take the injured person
first to Plant Medical Unit with IOW (Injury on Work) form given on Annexure-1C and
under no circumstances, take the injured person directly to his own doctors. The

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 information of fatal accident shall be given on Annexure-1D.
10.3 The Contractor shall not interfere with the site of accident, unless inspected and / or
permitted by the competent authorities.
10.4 The Contractor shall arrange to avoid any sort of commotions at site in the event of an
accident.
11.0 MISCELLANEOUS
11.1 Safety Records (Statutory Records)
The Contractor shall keep record of :
i) Test certificates of all lifting tools & tackles, pressure vessels etc.
ii) Periodical inspection report of safety appliances,
iii) Maintaining accident analysis report in proper format in consultation with Employer’s
Engineer.
iv) Safety record as per Factory Rules/ Safety Codes or any other statutory provision
shall also be maintained. However, necessary help in this regard can be taken from
concerned Safety Organisation.
11.2 Gas Lines
To work in dangerous gas lines e.g. Coke Ovens gas line, Blast Furnace gas line, LD gas
line etc. Employer will provide job safety induction to the Contractor’s personnel. For
this the Contractor shall give in writing the list of personnel likely to work in gas line
(new/ old) to the Engineer who in turn will arrange the safety induction to the
Contractor’s personnel inside Employer’s Works. The Contractor shall ensure the
presence of his personnel at place of safety induction (normally Central Gas Safety
Station, E&E Department) and follow the steps, General rules & regulations as
imparted during the training.
11.3 Electrician/ Other Electrical Personnel
The Contractor shall engage qualified and competent electricians and other electrical
personnel while working on electrical lines (which may be High Tension, Medium
Tension and Low Tension electrical lines) for safe execution of Contract. The
electricians and other electrical personnel must possess requisite certificate issued
from competent authority.
Electrical Equipment
The Contractor shall ensure proper earthing of all electrical equipment/ machinery
prior to start of the machine. The Contractor shall also ensure daily examination of the
earthing of equipment/ machinery prior to start of the job in order to avoid electrical
hazards.
The Contractor shall ensure use of proper cable (may be welding cable or power cable
or control cable). The joints of the cables shall be perfectly insulated. The Contractor
shall also ensure the use of proper plugs, sockets and other electrical fittings while
executing any Contract.
11.4 Scaffolding/ lifting/ lowering/ dismantling of equipment or fabricated structurals or any
other materials.
i) For safe execution of the Contract, Contractor shall make a programme of a piece/
whole job, in sequence of steps involved in execution the required safety measures
to be taken during the execution of the job.
ii) The Contractor shall ensure the use of sufficiently strong scaffolding with

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 sufficiently strong hand railings during the execution of the job. The Employer will
provide prints of “Standard Scaffolding Drawing” on request by the Contractor.
Scaffold/ platform to be used by more than 2 persons has to be approved by the
Site Engineer and the concerned Safety Organisation, jointly.
The Contractor shall ensure the use of scaffoldings at construction site by his
personnel working at height, fabricated as per standard drawing for scaffolding.
If the scaffolding as per the standard drawing is not found suitable at site, the
Contractor shall make necessary modification to strengthen the same.
For any civil engineering job, the Contractor will provide adequate support before
casting or any superstructure and provide approach, scaffolding etc., in such a
manner that is safe, easy for movement of men, women and materials.
iii) The Contractor shall make his own arrangement for the area lighting/ spot
lighting at fabrication yard. The Employer will provide power source at one point
only near to the fabrication yard.
iv) The Employer will provide area lighting at erection site only. The Contractor shall
make his own arrangement for spot lighting. The source of power supply at the
nearest possible point will be shown by the engineer at site.
11.5 House keeping
i) The Contractor shall ensure good house keeping in his working area, fabricating
yard as well as at erection site. The safe approach to the working place must be
ensured. Place for keeping raw materials, semi-finished materials should be
clearly marked with proper identification. Machine component shall be kept
properly under shed.
ii) The Contractor shall keep the scrap material at one place duly barricaded and
shall remove the same regularly from the work place.
iii) The Contractor shall stack properly the fabricated or any other items likely to be
erected very shortly at erection site, in such a way that the materials do not cause
congestion at site or create unsafe condition for free and safe approach.
iv) The Contractor should put up a board (minimum 4’ x 3’) indicating the name of
the Contractor, details of the job, order No., starting date and likely completion
date of the job. On completion of the job, the Contractor shall clear the site (good
materials and scrap). The board so displayed shall be taken out of the site. Any
material left after the job is over will be picked up by the Employer and the
Contractor will be charged back for the same.
v) Barricading
The Contractor shall ensure barricading of the unsafe area, which can lead to
accidents to any unknown person working in that area. In order to remove unsafe
condition and prevent accidents, this unsafe area such as trench/ pit/ foundation,
any type of opening made or left in any floor of the building including staircase etc.
must be barricaded.
The hand railings shall be immediately provided in all the floors, stairs etc. before
proceeding for erection/ dismantling.
vi) Removal of muck shall be done within 24 hours from road sides.
vii) The Contractor shall be responsible for removing all unwanted materials /
scaffolds from the work site.
viii) The Contractor shall issue written as well as oral instructions from time to time, in
addition to the precautions, measures spelt out above so as to ensure that the

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 workers adhere to safety norms specifically needed for the particular job during
the execution of the work. .
11.6 The Contractor shall ensure that compressed air is not used for removing the dust
from one’s clothes. Compressed shall not be blown against any one as it may injure or
even kill him / her.
11.7 The Contractor shall provide, maintain and arrange for periodical checking of
adequate numbers of fire extinguishers of appropriate type and other facilities (e.g.
sand buckets, asbestos covering etc.) in fire prone areas.
11.8 The Contractor shall provide clearly demarcated access and exits at work site to take
care in case of outbreak of fire or any other eventualities.
11.9 The Contractor shall ensure that smoking or keeping of naked light near gas lines,
valves and any other equipment connected with gas distribution system and handling
of all inflammable material is strictly prohibited.
11.10 The Contractor shall ensure that no one takes rest/ shelter below any dumped slag,
boulder or any other cut pit/ excavation near any stock of materials, electrical
installations and gas lines etc.
11.11 The Contractor shall ensure the availability of first aid box at the working sites.

***

ANNEXURE-1A
(Name of the Organisation)
(Name of the Unit)

SAFETY INDUCTION FORM

Safety induction to the Contractor for starting a job.

1. Name and address of the Contractor :

2. Contract/ Award Letter/ Work Order No. :

3. Name of the Department awarding Contract. :

4. a) Probable date of staring the job :

b) Duration :

5. Place & nature of work :

6. Name & designation of supervisors :

i) Department (1) (2)

ii) Contractual (1) (2)
7. Necessary safety precautions explained. :
8. Safety appliances advised for usage to the :
Workers

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 Safety Engineering Department
or Engineer’s representative

I have gone through the Safety Rules Book for Contractors and received a copy of the same. I shall follow
all safety precautions/ instructions given to me and shall be responsible for safety of my staff/ employees/
workmen.

Signature of Contractor

Certified that requisite Safety Appliances are available with workers and Contractor is permitted to start
the work.

Signature of Engineer

Certified that requisite Safety Appliances are being used and safety precautions/ measures are being
adopted.

Safety Officers of Employer

Copy to :

1. Safety Department.
2. Operation/ Works Department.
3. Contractor with one spare copy.

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 ANNEXURE-1B
(Name of the Organisation)
(Name of the Unit)

WORK CLEARANCE FORM FOR CONTRACTORS

1. Name of Contractor’s firm with address :

2. Engaged by which Department :

3. Name of the representative / supervisor

of the Contractor supervising the job. :

4. Precise nature of work to be carried :

out / work order reference.

5. Precise location of work :

1. Proposed date and time of commencement :

of work.

2. Expected No. of days required for the work. :

3. Whether Contractor’s workers are to be :

engaged in G/A/B/C shifts and No. of
people engaged.

I accept responsibility for ensuring that all men under my control shall observe the statutory
safety requirement and follow the safety instructions of the plant.

Date : Signature of the Contractor

Certified that the Contractor has been engaged by us for the work described above.

Date : Signature of the Engineer

(Certificate to be given by the Department/Section

where work is to be carried out)

You are authorised to carry out the work described below :

Date : Signature of the Safety Officer

of the Employer.

Note :
1. The form shall be filled-in in triplicate by the Contractor for the record of (I) Safety Engineering
Department, (ii) Department/ Section granting clearance, (iii) Contractor.
2. These certificates are not a substitute for the electrical permits and do not give permission to use
masked lights or work in gas hazardous areas or enter closed vessels or for explosives, which
shall be taken separately whenever required.

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 ANNEXURE-1C
(Name of the Organisation)
(Name of the Unit)

INJURY ON WORK

(Contractor’s Employees)
1. Name of the firm :

2. Name of the Contractor :

3. Name of Department (Awarding Contract) :

4. Name of the injured person :

5. Designation, gate pass No./ Token No. :

6. Date and time of accident :

7. Department where accident happened :

8. Exact place of occurrence :

9. Eye witness (name & designation) : 1)

2)

10. Persons appraised of : 1)

2)

11. Brief account of the accident :

Date: Signature of the Contractor /

Contractor’s supervisor

(Particulars to be filled in by the Medical Officer)

1. Nature of injury :
2. Injured person is fit/ unfit to return : to duty.
3. If unfit, period of rest recommended :
4. This employee has bee notified that :
he is fit/ unfit as per Sl. No.2.
(strike out which is not applicable).

Date: Signature of the Medical Officer.

Name :
Seal :

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 Annexure-1C (contd.)

Note :

1. When an injury occurs to a Contractor’s employee while inside the factory, the injured
person should be sent to Plant Medical Unit immediately, with this form in triplicate.

2. The Medical Officer on duty at Plant Medical Unit will retain one copy and send one
copy to Safety Engineering Department. The third copy shall be returned to the
Contractor concerned after duly filling up the forms.

In case, the Contractor takes the injured person to his private doctor, he shall do so by
giving a written undertaking to the doctor in Plant Medical Unit and to the Manager,
Safety Engineering Department.

If the private doctor declares the injured person unfit for duty more than 2 days, this
becomes a reportable accident under the Factories Act and the Contractor shall
immediately report this to the Manager, Safety Engineering Department for sending
reports to concerned Government agencies.

The Contractor shall also keep the manager (Safety) inform about :

a) The condition of the injured person ;

b) The period of disability and
c) Any loss of earning capacity certified by the doctor.

The Contractor shall produce the fitness certificate from the attending doctor after the
injured person is declared fit for duty.

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 (Name of the Organisation)
(Name of the Unit)

NOTICE OF FATAL ACCIDENT

(Contractor’s Employees)
Date:………..

From

(Name and address of the Contractor )

To

The Engineer
(Superintendent/ Manager)

Dear Sir,

We regret to inform you that _______________________________________, an employee of

M/s __________________________________met with a fatal accident at _______ AM/ PM, dated
____________ at _______________________. At the time of accident, he was engaged
in_____________________________________________________
__________________________________________________________________________.
(description of work)

Yours faithfully,

Signature of the Contractor /

Contractor’s supervisor

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