FORM15A

FORM – 15 A
Prescribed under rule 90 – A

Format of Application to the Site Appraisal Committee
1. Name and address of the applicant.

2. Site ownership data.
2.1 Revenue details of site such as survey No. Plot No., Allotment / registration No. etc.,
2.2 Whether the site is classified as forest and if so whether approval of the Central
Government under section 5 of the Indian Forest Act, 1927 has been taken.
2.3 Whether the proposed site attracts the provisions of section 3(2) (v) of the Environment
(Protection) Act, 1986. If so, the nature or the restriction.
2.4 Local authority under whose jurisdiction the site is located.
2.5 Documentary evidence of ownership
3. Site plan:
3.1 Site plan with clear identification of boundaries and total area proposed to be occupied
and showing the following details nearby the proposed site:
a) Historical monument, if any, in the vicinity.
b) Names of neighbouring manufacturing units and human habitats, educational and
training institutions, petrol installations, storage of LPG and other hazardous
substances in the vicinity and their distances from the proposed unit.
c) Water sources (rivers, streams, canals, dams, water filtration plants, etc.) in the
vicinity.
d) Nearest hospitals, fire-stations, civil defence stations and police stations and their
distances.
e) High tension electrical transmissions lines, pipe lines for water, oil, gas or sewerage,
railway lines, roads, stations, jetties and other similar installations.
f) Height of tallest structure in the proposed site/ near the proposed site.
g) Presence or otherwise of given belts/ no industry zones in the vicinity.
3.2 Details of soil conditions and depth at which hard strata obtained.
3.3 Contour map of the area showing nearby hillocks and difference in levels.
3.4 Plot plan of the factory showing the entry and exit points, roads within water drains etc.
4. Project Report
4.1 A summary of the salient features of the project.
4.2 Status of the organisation (Government, semi Government, Public or Private, etc.)
4.3 Maximum number of persons likely to be working in the factory.
4.4 Maximum amount of power and water requirements and source of their supply.
4.5 Block diagram of the buildings and installations on the proposed supply.
4.6 Details of housing colony, hospital, school and other infrastructural facilities proposed.
5. Orgainisation structure of the proposed manufacturing unit/ factory.
5.1 Organisation diagrams of –
- Proposed enterprise in general
- Health, Safety and Environment Protection Departments and their linkage to
operation and technical departments.
5.2 Proposed Health and Safety Policy.
5.3 Area allocated for treatment of wastes and effluent.
5.4 Percentage outlay on safety, health and environment protection measures.
5.5 Details of staff development (category wise) in various departments.
6. Meteorological data relating to the site.
6.1 Average, minimum and maximum of -
- Temperature
- Humidity
- Wind velocities
during the previous ten years.
6.2 Seasonal variations of wind directions.
6.3 Highest water level reached during the floods in the area recorded so far.
6.4 Lighting and seismic data of the area.
6.5 Capacity of the local environment for quick disposal of toxic effluents (gasesous)
7. Communication Links.
7.1 Availability of telephone / telex/ wireless and other communication facilities for outside
communication.
7.2 Reliability of their functioning bad/average / good/ very good.
7.3 Internal communication facilities proposed
8. Manufacturing process information
8.1 Process flow diagram
8.2 Brief write-up on process and technology
8.3 Utilities / off-site facilities and their requirements.
8.4 Critical process parameters such as pressure build-up, temperature rise and run-away
reactions.
8.5 Other external effects critical to the process having safety implication such as ingress
of moisture or water, contact with incompatible substances, sudden power failure.
8.6 Highlights of the built-in safety/ pollution control devices or measures incorporated in
the manufacturing technology.
9. Information of Hazardous Materials
9.1 Raw materials, intermediates, products and by-products and their quantities (enclose
Material Safety Data Sheet in respect of each hazardous substance)
9.2 Main and intermediate storages proposed for raw materials/ intermediates/ products/
by-products (maximum quantities to be stored at any time.)
9.3 Hazard characteristics of raw materials / intermediates/ products/ by-products-
flammability – explosions – toxicity – radiation.
9.4 Transportation methods to be used for materials inflow and outflow, their quantities and
likely routes to be followed.
9.5 Safety measures proposed for:
- handling of materials
- internal and external transportation; and
- disposal (packing and forwarding of finished products)
10. Information on Dispersal / Disposal of wastes and Pollutants.
10.1 Major pollutants (gas, liquid, solid) their characteristics and quantities (average and at
peak loads)
10.2 Quality and quantity of heated effluent streams.
10.3 Quality and quantity of solid wastes generated methods of their treatment and disposal.
10.4 Air, water and soil pollution problems anticipated, and the proposed measures to control
the same, including treatment and disposal of effluents.
11. Process Hazards Information
11.1 Enclose a copy of the report on environmental impact assessment
11.2 Enclose a copy of the report on Risk Assessment Study.
11.3 Published (open or classified) reports, if any on accident situations/ occupational health
hazards or similar plants elsewhere (within or outside the country)
11.4 Compatibility of the proposed factory with neighbouring factories in terms of hazard
containment.
12. Information of proposed Safety and Occupational Health Measures
12.1 Details of fire fighting facilities and minimum quantity of water, CO2 and //or other fire
fighting measures needed to meet the emergencies.
12.2 Details of safety plans covering safety checks/ audits, training programmes, safety
information etc.
12.3 Details of in-house medical facilities proposed.
13. Information on Emergency Preparedness.
13.1 Onsite emergency plan.
13.2 Proposed arrangements, of any, for mutual aid scheme with the group of neighboring
factories.
13.3 Contracts made, if any , with local authorities for the off-site emergency plans.
13.4 Awareness of the local/ neighboring communities to the imminent dangers of the
proposed plant.
14. Any other relevant information
I certify that the information furnished above is correct to the best of my knowledge and
nothing of importance has been concealed while furnishing it.
Name and Signature of the Applicant
15. This application shall be accompanied by an endorsement from the competent local
authority.
(1) Density of population in the vicinity of the proposed factory.
(2) Presence or otherwise of given belts./ no industry zone in the vicinity
(3) Suitability of the roads in the vicinity of the proposed factory for the transportation of
hazardous chemicals.
(4) Any nearby historical monuments / drinking water sources / sensitive installations
likely to be affected by the presence of the proposed factory:
(5) Past history of conflicts with the local population over health and safety issues, if
any
(6) Type of communication links available with local authorities to meet the challenge
of the proposed emergencies and reliabilities of the communication network.

FORM15A

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FORM – 15 A

Prescribed under rule 90 – A

1. Name and address of the applicant.

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