MANPOWER REQUISTION FORM

1 Name of the Position

Is the position approved in the
2
Manpower Budget
If it is a replacement vacancy,
3
Please mention in place of whom
Brief job profile (Please attach
a Sheet if required)

Qualification Desired
5
Preferred
Preferred Age
6
(From ____Yrs to ______Yrs)
Expereience Required & Nature
7
of Experience (Industry)
8 Salary offer (Gross / CTC ) P.M.
9 To be joined (Period)

Initiated By : Approved By :

Name : Name :

( Signature ) ( Signature )

Date : Date :

Issue Dt.
TION FORM

Approved By :

( Signature )

Page 1 of 1
 Conveyance Reimbursement Form
Name : __________________________Emp. Code No.___________Department_________________

Designation: ________________________ Account Head _________________________________

Reimbursement of conveyance expenses incurred while on official duty during the month of_____________
as per details given below:-

Date From To Kilometer Purpose & Customer Visited

Total Kilometers

Actual Expenes Rs. _______________Per K.M.

Rs.________________

Rupees (________________________________________________________________________)

Voucher No._______________________________Signature of the employee__________________

(Accounts Head) (Head of the Department)

Issue Dt.
imbursement Form
.___________Department_________________

Head _________________________________

e on official duty during the month of_____________

& Customer Visited

________________________________________)

_Signature of the employee__________________

(Head of the Department)

Page 1 of 1
 OUT DOOR DUTY SLIP

Emp. Code No.-:___________________ Date-: _____________________

OUT DOOR DUTY SLIP

I, _______________________________________Department _______________________________

will be / was on official duty on dtd.___________________ from (time) _________________________

to (time) ____________________________________.

PURPOSE FOR OFFICIAL DUTY

__________________________________________________________________________________

EMPLOYEE'S SIGNATURE AUTHORISED SIGNATORY

Issue Dt. Page 1 of 1
__________

__________

___________

____________

Page 1 of 1
 GATE PASS
No.
Date………………
Pass Out……………………………………………..Department…………..………….………..……….

From……………………………To…………………….With/Reason………………………….…...…

Pay affected Time Out……………………………………

…………………………………….. ………………………………………………

Pay not affected Time in………………………………………

Authorised By……………………………………… Time Keepar

 Date………………
……….………..……….

………………….…...…

…………………………

…………………………

…………………………

Time Keepar
 APPLICATION FOR LOAN
To be filled by the applicant
Date

Employee Code

Name of Applicant

Basic + DA

Date of Joining (Total Yrs of Service)

Deptt. / Section / Unit

Amount of Loan / Advance

Reason for Loan / Advance

Signature of Applicant

Recommendations

Deptt. Head Plant Head Managing Director

(Recommended By) (Reviewed By) (Approved By)

For office use

Previous Loan if any

Head - Accounts

For office use-HRM -in case of advance

Date of Joining

Salary (Basic) P.M.

Amount Approved
Elegible / Not Eligible

Deductions Per Month

Authorised Signatory (HRM)

Issue Dt.
Managing Director
(Approved By)
Page 1 of 1
 Medical Reimbursement Form
To
Accounts Head
<Insert the name of the company>

MEDICAL EXPENSES REIMBURSEMENT VOUCHER / DECLARATION

Dear Sir,
Name ________________________________________________Emp. Code No.________________

I enclose herewith following bills for reimbursement of Medical Expenses incurred on obtaining Medical
Treatment for myself and / or my family during Current Financial year.

I will submit all such Medical treatment bills for balance period of the Current financial year before the end of
the year. Else the unavailed amount, if any may be added to my salary for the month of March as Medical
allowance.
Sr. No. Date of Bill Bill Amount Related to
1
2
3
4
5
6
7
8
9
10
Total in Rs.

SIGNATURE

FOR OFFICE USE

Basic Salary / Entitle : Rs. __________________
Balance : Rs. __________________
Passed for : Rs. __________________
Account Head : Medical Benefit Payable
Entry No._________________ Date____________________
ENTERED BY PASSED BY AUTHORISED BY

VOUCHER

Received with thanks Rs. ______________RUPEES______________________________

As Settlement of my above medical treatment bills

Cash / Cheque No._________________________Date______________________________________

Date:________________ _______________________
SIGNATURE

Name of Employee___________________

Issue Dt.
imbursement Form
Date:-

CHER / DECLARATION

_________Emp. Code No.________________

Medical Expenses incurred on obtaining Medical

t Financial year.

ce period of the Current financial year before the end of

dded to my salary for the month of March as Medical

Related to

SIGNATURE
 AUTHORISED BY

____________________________

______________________________________

_______________________
SIGNATURE

Employee___________________

Page 1 of 1
 Loss of ID Card / Manual Punch Intimation

To

HRM.

I Have lost / Forget, my I-Card cum Attendance Card on date _________________. You are requested to

register my complaint and issue me a new I-Card / Mark my attendance

The cost of the card may please be recovered from my salary or I shall make the payment to the Accounts

Department.

Name __________________ Emp. Code No.

Card Code No. __________________ Department

Date ________________________ In time ______________________Out time _________________

Signature of Employee Recommended By

(HOD) (HR Deptt.)
Issue Dt.
anual Punch Intimation

Date:-

_________________. You are requested to

r I shall make the payment to the Accounts

__________________

__________________

______Out time _________________

Approved By
(HR Deptt.)
Page 1 of 1
 INCIDENT REPORT
PART - A
(To be forwarded to HRM within 24 hours of the incident)

1. Name of the injured person :

2 Code Number :
3 Details of the injuries :

4 First Aid Status :

5 Date, Time and place of accident :

6 Machine / Process involved

7 Description of how did the incident occur :

…………………………………………………………………………………………………………………………..
Name and signatures of the witness
S.NO NAME SIGNATURE DATE

…………………………………………………………………………………………………………………………..

Shift Incharge Dept. Head

Date : Date :
…………………………………………………………………………………………………………………………..
Issue Dt.

INVESTIGATION REPORT
PART - B
 SIGNATURES OF THE INVESTIGATION TEAM
……………………………………………………………………………………………………………………………

PART - C
RECOMMENDED CORRECTIVE ACTIONS / FOLLOW UP

DATE:

INVESTIGATION TEAM:

…………………………………………………………………………………………………………………………..

PART - D
FOLLOW UP REPORT / NON COMPLIANCE IF ANY

DATE:

SIGNATURE OF INVESTIGATION TEAM

Issue Dt.
f the incident)

……………………..

……………………..

……………………..
Page -1 of 2
………………………

……………………..
Page 2 of 2
 SAFETY AUDIT REPORT FORM
AREA : TIME :

SUPERVISOR: AUDITORS :

CLASS OF OBSERVATIONS

1. Safety / Housekeeping Rule Violation SHRV

2. Unsafe or Poor Housekeeping Practice UPHP
3. Unsafe or Poor Housekeeping Condition UPHC

Sr. OBSERVATION CLASS PROPOSED

CORRECTIVE ACTION

FOLLOW UP AUDIT DATE : _______________________

SUPERVISOR SIGNATURE : _______________________

AUDITORS SIGNATURES : ___________ ____________ _____

DATE : FOLLOW UP AUDIT - VERIFICATION OF CORRECTIVE ACTIONS

FOLLOW UP AUDIT REPORT - NON COMPLIANCE IF ANY

SUPERVISOR SIGNATURES : _______________________

AUDITORS SIGNATURES : ___________ ____________ _____

Issue Dt.
ORM
AUDIT NO.
DATE :

DEPARTMENT
RESPONSIBLE

____________ _____________ ________

F CORRECTIVE ACTIONS

____________ _____________ ________

Page 1 of 1
 SAFETY AUDIT CONTROL LOG BOOK
SCHEDULED DATE OF TYPE OF
S.No. AREA
DATE AUDIT AUDIT

Prepared By

Issue Dt.
OG BOOK
SIGNATURE OF
AUDITOR

Approved By

Page 1 of 1
 SAFETY AUDIT SCHEDUL

YEAR:

DEPARTMENT / AREA / LOCATION JAN FEB MAR APR MAY

Signature: Safety Auditor Signature: Safety Auditor

Issue Dt.
IT SCHEDULE

JUNE JULY AUG SEP OCT NOV DEC

Signature: Safety Auditor Signature: Unit Head

Page 1 of 1
 SUGGESTION SHEET
Date-:

Name of Employee-: Deptt. / Section

Suggestion-:

Before Implementation-: After Implementation-:

Benefit Expected-:

Cost of Implementation

Management Review and Comments

Accepted / Rejected-:

Reason, if rejected
 REVIEWED BY

Prepared By Approved By Revision No. Revision Date

Issue Dt. Page 1 of 1

 ANNUAL APPRAISEL-MANAGER
Format - "A"
NAME: DESIGNATION : DEPTT:

GRADE DATE OF JOINING:

PART-1

BEHAVIOUR EXHIBITED

ABILITY TO PLAN & ORGANISE TO MEET TARGETS & DEVELOP SU

1. Plans objectives, activities well ahead & provides logical &
effective course of action for self / group for acheiving the
targets
2. Along with 1 provides alternate plan of action in case the
original plan fails or is inappropriate due to altered situations &
reviews action plan accordingly.
3. Along with 1 & 2 helps subordinates to improve & develop.
4. Along with 1, 2 & 3 shows concern about his/her
subordinates career, guides & assist him/her.(e.g. Own &
departments Targets, Activity Calender, Daily Work
Management etc)
COMMUNICATION ABILITY & ASSERTIVENESS
1. Gets across his message very comfortably.
2. Along with 1 creates congenial rapport with the receiver.
3. Along with 1 & 2 has the ability to get across his opinion.
4. Along with 1, 2 & 3 is able to achieve results without being
offensive. (e.g. how often you are able to convince your team
members about new & innovative ideas and actively
participated in meetings etc.)
INNOVATION / CREATIVITY & INITIATIVE
1. Open for new areas /suggestions / ways of doing things.
2.Along with 1, Creates systems best suited for the company
3. Along with 1 & 2, views mistakes as a necessary part of
implementing
new new.
ideas. (Like how many improvement ideas implemented,
was able to give out of box ideas / helped others with your
INTERPERSONAL EFFECTIVENESS
1. Is perceived as a positive person by all those who interact
with
2. him.with 1 is polite as cheerful while dealing with both
Along
Internal
3. Along and
withExternal
1 & 2 is customers.
able to develop rapport with all the
individuals
4. who
Along with 1, interact
2 & 3 is with
able him / her
to win and
over vice
the a versa. with
individuals
whom he/she interacts.
NETWORKING
1. Spent time in building working relationship with people
beyond
2. Alonghis/her
with 1 sphere
utilised of control.association or agencies to
business
accomplish
3. Along withown
1&2,business results.
utilised business association to help others
in accomplish
4. their
Along with 1, 2 &business
3 has anresults.
integrated outside inside
perspective to operate in external secanario.
FHR - 10 / 00 Issue Dt.

CHANGE DRIVER & ROLE MODEL

1. Has capabilities to put forward new ideas / suggestions.
2. Along with 1 is capable to put in action and implement ideas
/ suggestions.
3. Along with 1 & 2 is capable to deliver the results as per new
ideas
model//suggestions
change driver in his / her area of expertise. (Like
leading his / her own initiative or by extending active support
RISK TAKING ABILITY & ENDURANCE
1. Along
2. Has courage
with 1, to
hastake tasktoinvolving
ability risk.effect of his
foresee the
judgement & forecast on the basis of present & past
3. Along with 1&2, has ability to respond quickly to changing
behaviour.
sittuations & environment.
4. Along with 1,2&3, has the capacity to recover after strain.
PROCESS CENTERED
1. Ensure for documenting idea / implementation and outcome
whatever
2. it be.1, Able to visualize and map things
Along with
/process/problems
3. Along with 1&2,systematically
mostly examines inputs and processes
rather
4. Alongthan
withresult/output.
1,2 &3, coaches the team to define process and
refer them everytime it's required.
TOTAL

Note -
Please note that above definitions are indicative only and not exhaustive one
Final Rating to be given by Appraiser after discussion with Appraisee.
Please use Point Rating Scale (1-8where 1 is the lowest rating and 8 is the heighest.
e.g. An employee can be rated for Communication ability & assertiveness at a scale
TOTAL (Part I)
PART-2
TARGETS & ACHIEVEMENTS
WEIGHT
AGE
S.No. TARGET (Marks) PERF

TOTAL 40 MARKS TOTA

Issue Dt.
PART-3
S.No. Targetted Area of Improvements for the Year (to
Functional
1
2
Behavioural
1
2

DEVELOPMENTAL FEEDBACK SECTIO

TO BE FILLED BY THE APPRAISEE
Motivating/Interesting Factors of my Job/Workplace De-Motivatin
 TO BE FILLED BY THE APPRAISER
APPRAISEE'S STRENGTH APPRAISE

OVERALL PERFORMANCE REMARKS

SCORE:
60 TARGET &
BEHAVIOUR ACHIEVEMENT

Final Rating

O/standing Excellent Good

Grades-
Outstanding- above 90%
Excellent- above 75%
Good- above 60%
Satisfactory- above 40%
Below Expect. Below 40%

*Final rating to be given by appraiser after discussion with appraisee

Any Remarks (by Appraiser) ------------------------------------------------

________________________________________________________________________________

SIGNATURE OF APPRAISEE

Any Remarks (by HOD)------------------------------------------------------

________________________________________________________________________________

SIGNATURE OF HOD
Issue Dt.
-MANAGER & ABOVE
"A"
UNIT:

PERIOD of Appraisal

RATING
(Please mention BY awarded in
the marks
nos. in scale mentioned for each
WEIGHTAGE statement)
SELF BY FINAL RATING
APPRAISEE BY APPRAISER

& DEVELOP SUBORDINATES

(Scale 1-8) (Scale 1-8)
2

2 (Scale 1-8) (Scale 1-8)

4
6

2 (Scale 1-8) (Scale 1-8)

4
6
8
 2 (Scale 1-8) (Scale 1-8)

4
6
8

1 (Scale 1-4) (Scale 1-4)

2
3
4
Page 1 of 3

2 (Scale 1-8) (Scale 1-8)

4
6
8

2 (Scale 1-8) (Scale 1-8)

4
6
8

2 (Scale 1-8) (Scale 1-8)

4
6
8
60 MARKS

haustive one

d 8 is the heighest. Marks in point is allowed (e.g. 3.75)

tiveness at a scale of 1-8, as 6.5.
 EVEMENTS

PERFORMANCE SELF FINAL

TOTAL (Part II)

Page 2 of 3

r the Year (to be filled by appraiser)

DBACK SECTION
HE APPRAISEE
De-Motivating/Un-interesting Factors of my
HE APPRAISER
APPRAISEE’S AREAS OF IMPROVEMENT

40 100
TOTAL :

Satisfactory Expectation
ith appraisee

--------------------------------------------------

_____________________________________________________________

SIGNATURE OF APPRAISER

------------------------------------------

______________________________________________________________

Page 3 of 3
 ANNUAL APPRAISAL- SUPERVISORS

FORMAT “B”

Name of Employee:______________________ D. O. J.:__________

Designation____________________________ GRADE :_____________
Department: __________________________ Section:__________

Part I
Indicative Evaluation
S.No. Traits
Maximum Self Evaluation Reviewing
First Segment: Weightage Authority
1 Job knowledge 5
2 Leadership qualities
2(i) Initiative 3
2(ii) Decision making ability 3
2(iii) Owning of Responsibility 3
2(iv) Control over work 3
2(v) Quality Consciousness 3
2(vi) Transparent and unbiased 3
3 Skills
3(i) Interpersonal skills 3
3(ii) Communication Skills— 3
4 Level of Commitment 6
Sub-total 35
Second Segment:
1 Teamwork 2
2 Seeks only needed 2
3 Eagerness to learn job- 2
4 Willingness to shoulder 1
5 Sincere &,Hard working 2
6 Safety consciousness 2
7 Regularity, Punctuality 2
8 Do it now approach 2
Sub-Total 15
Total (Part I) 50
Issue Dt. Page 1 of 2
PART-2
TARGETS & ACHIEVEMENTS
WEIGHTAGE
S.No. TARGET (Marks) PERFORMANCE SELF
 TOTAL 50 MARKS TOTAL (Part II)
PART-3

S.No. Targetted Area of Improvements for the Year

Functional
1
2
Behavioural
1
2

OVERALL PERFORMANCE REMARKS

SCORE:
50 TARGET & 50
TOTAL :
BEHAVIOUR ACHIEVEMENT

Final Rating

Below
Out Expectati
standing Excellent Good Satisfactory on

Grades-
Outstanding- above 90%
Excellent- above 75%
Good- above 60%
Satisfactory- above 40%
Below Expect. Below 40%

Any Remarks (by Appraiser) ------------------------------------------------------------

________________________________________________________________________

SIGNATURE OF APPRAISEE SIGNATURE OF APPRAISER

Any Remarks (by Appraiser) ------------------------------------------------------------

SIGNATURE OF Reviewer
Issue Dt. Page 2 of 2
RS

:__________
:_____________
:__________

Evaluation
Reviewing
Authority

Page 1 of 2

FINAL
ear

100

-------------
___________

APPRAISER

-------------
Page 2 of 2
 ANNUAL APPRAISEL - BELOW SUPERVISOR
FORMAT “C”
Name of Employee: _____________________ D. O. J.:__________
Designation _____________________ GRADE :_____________
Department: ________________________ Section:__________

Total Maximum Evaluation by Evaluation by

S.No. Traits
Weightage First Appraiser Reviewing
Knows the importance &
1 10
relevance of his work
2 Level of output per day 10
3 Safety consciousness 10
4 Do it now approach 10
5 Mistakes/deficiencies 10
6 Cooperative 10
7 Sincerity and Hard 10
8 Discipline / Obedience 5
9 Takes the feedback 5
10 Attendance 10
11 Punctuality 5
12 Good personal habits 5
Total 100

Any Recommendations: __________________________________________

_____________________________________________________________

Final Rating
Below
Outstanding Excellent Good Satisfactory Expectation
First Appraiser Second Appraiser
Name:__________________ Name: ___________________
Designation:______________ Designation:_______________

Grades-
Outstanding- above 90%
Excellent- above 75%
Good- above 60%
Satisfactory- above 40%
Below Expect. Below 40%

Any Remarks (by Appraiser) -------------------------------------------------------

SIGNATURE OF Reviewer
Issue Dt. Page 1 of 1
RVISOR

:__________
:_____________
:__________

Evaluation by
Reviewing

____________
____________

Page 1 of 1
 EMPLOYEE DECLARATION FORM

I, ____________________________________________________________________S/o, D/o, W/o,

Shri ________________________________________hereby declare that I have never worked in any of the

" Name of Company" in any capacity.

I further declare that the information supplied by me in any application form is tru to the best of my knowledge and
belief and I have not knowingly withheld / distorted any information.

I, hereby undertake that if any of the information provided by me is found to be incorrect or misrepresented, my
sdrvices may be terminated by the company.

Signature of employee

TO BE FILLED BY HUMAN RESOURCE DEPARTMENT

(On joining of the Candidate)

Date of Joining :
Employee Code :

Issue Dt.
ECLARATION FORM

________________S/o, D/o, W/o,

re that I have never worked in any of the

ion form is tru to the best of my knowledge and

found to be incorrect or misrepresented, my

CE DEPARTMENT
Page 1 of 1
 INTERVIEW ASSESSMENT FORM

Name ……………………………… Interviewed for ……………………………………

Dated ……………………………… Name of the Interviewer………………………….

Sr. Subject Max. Mar Marks Obtained Remarks

1 Acad / Technical Qualification 20
2 Technical / Prof. Knowledge 20
3 Previous Experience 10
4 Expression 10
5 Communication 10
6 Personality 10
7 Administration Capability 10
8 Loyality 10
Total 100

INTERVIEW ASSESSMENT
Sr. Strength of the Person Sr. Weakness of the Person

Overall Rating
Excellent 80 - 100 %
Good 60 - 80 %
Average 50 - 60 %
Below Average Below 50 %

Recommended / Not Recommended

If not Recommended, Give Details-:

If Recommended then expected date of joining - :

Present Salary-:
Expected Salary-:
Signature of Interviewer Signature of Reviewer Final Reviewer

Issue Dt.
M

………………………………

ewer………………………….

Remarks

Weakness of the Person

Final Reviewer

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