Form 42

{See clause (a) & (d) of sub-rule (3) of rule 115 and sub-rule (6) of Rule 115}

[Particulars of rooms in the factory]

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Dimensions in feet

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Ventilation

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Height

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Signature of the Occupier......................

Signature of the Manager.......................

Questionnaire Annexed to Form-42

Careful attention to the questionnaire will assist in drawing up the plans in accordance with the law,

and thus prevent delay in dealing with the plans.

Note: The site-plans should be draw to a minimum scale of 100'-1" and the other plans drawn to a minimum

scale of 10'-1".

1. Plans—

(a) Has a site-plan showing the immediate surroundings including adjacent buildings and other structures,

roads, drains, etc., been submitted in triplicate.

(b) If there is a system of underground sewage within 100 ft. of the factory, has its position been shown in

the site plan ?

(c) Have the direction i.e., north, south, east and west been shown on the site-plans as well as on the

detailed plans ?

(d) Have the municipal nos. or the field nos. of the premises and the surrounding areas been shown on the

site-plan ?

(e) Have the factory premises been clearly demarcated in the site-plan in distinctive colour ?

(f) Have the detailed plans of the factory indicating all relevant details " relating to doors, windows,

ventilators, fire escapes, etc., been submitted in triplicate ?

(g) Are all new buildings, parts of buildings (if extensions) or alterations in existing buildings shown by

boundaries duly marked in a distinctive colour ?

(h) Are all rooms, sheds, enclosures, etc., serially numbered inside a circle on the plans, corresponding to

the serial entry in Form-42?

(i) Are the outlines of all rooms, sheds, enclosures, etc., shown in the site-plan and allotted the same

number as in Item 1(h) above?

(j) Is the Sectional elevation of such a room or shed, etc., shown separately?

(k) Is the minimum and 'maximum height of every room, shed, etc., shown clearly in the Sectional elevation

?

(l) Is the material of which the roof is constructed indicated the Sectional elevation?

(m) Are the heights of all the workrooms in accordance with the provisions of Rule 70 as under :

(i) Is the minimum height 20 ft. with C. I. sheet roofing ?

(ii) Is the minimum height 14 ft. with A. C. sheet roofing or R.B./R. C. C. roofing ?

(iii) Has an inner ceiling of a heat resisting material with an air gap of at least 4" been provided at a

minimum height of 14 ft. and the name of the heat resisting material given?

(iv) Has an exemption been sought for a height of up to 12 ft. R.B/R. G. C. roofing?

(v) Has an exemption been sought for on the assurance of not employing more than 150 employees in the

factory on any day ?

(n) Is the minimum distance of the nearest building from latrines and urinals shown on the plans?

(o) Is the minimum distance of the nearest well, hand-pump or other drinking water centres shown in the

drawing ?

(p) Are water centres shown on the plans ?

(q) Are the sizes of all the doors and ventilators shown on the plans along with their exact position?

(r) Are all the drains, pipes and sewers for carrying sullage sewage water effluent and waste products

running within the factory premises constructed and shown in the plans ?

(s) Are the positions of various machines fitted or proposed to be fitted shown in the drawings together with

their names ?

2. Form No-42

(a) Is Form No-42 submitted in triplicate, filled in for all workrooms, godowns, etc. which are proposed to

be constructed or extended ?

(b) Have the internal dimensions only been entered in all the columns of Form No-42?

(c) Is the breathing space of workroom, shed, etc., calculated as shown below:

Floor area of room x its mean height (height above 14 ft. has to be left out of calculation).

(d) Is the maximum capacity entered in Column No. 15 of Form No-42? the maximum number of persons

shown as the lower value of the two calculations shown below :

(i) Floor area of a room less area occupied by machinery in the room divided by 36 [Rule 70(2)].

(ii) Breathing space [as in (c) above] divided by 500.

(e) Have the maximum number of persons as worked out above (lower value) been also shown on the plans

for each workroom corresponding to Column No. 15 of Form No-42?

(f) Is the window, ventilator and skylight area provided at the minimum rate of 1 sq. ft. to every 15 sq. ft. of

floor area of the room ? (Section 23 (2) (II) & its rule) ?

(g) Can the windows and skylights under Columns Nos. 12 and 13 of Form No. 42 Ball be opened for

ventilation ?

It is recommended that windows and skylights may be provided one opposite to another so as to provide

cross ventilation.

(h) Has a flow chart of the manufacturing process supplemented by its brief description in various stages

been submitted in triplicate ?Rule 69(1) (b)

3. Doors and ventilators.—

(a) Is every work room provided with at-least two doors or exits ?

(b) Is the minimum size of every door or exit 6'-6"x3'

(c) Have any doors of ventilators in common with two adjacent rooms been counted in both ?

(d) Are all the doors opening outwards ?

(e) Do the windows and skylights entered under Cols. 12 and 13 of Form No-42 Actually serve

the purpose of ventilation ?

4. Fire Escapes.—(In case of buildings of more than one story

(a) Are two fire escapes provided on either side of the building ?

(b) Are the fire escapes accessible from every room in the upper floor in the buildings ?

(c) Is the material used in construction of the fire escapes non-combustible ?

(d) Are the windows, doors giving access to an external stair-case arranged to open immediately

from inside.

(e) Is any fire escape or stair-way constructed at an angle greater than "450 ft. with the horizontal?

(f) Is any fire escape or stair way less than 45'Un width ?

(g) Is any part of the factory building further (along the line of travel) than 150 ft. from the fire

escape stair ?

(h) Have the particulars given against Items 4(e), (f) and (g) above been also clearly shown in the

various drawings being submitted ?

(i) Is the setback area of the factory and its premises uncovered and free from obstruction?

5. Latrines and urinals.—

(a) Are the latrines and urinals provided separately for men and women?

(b) Are these sufficient to meet the requirements of Section 23(2)(viii) read with its Rules ?

(c) Is the surrounding ground up to a distance of 4 ft. all round of impermeable material?

(d) Is the surrounding ground raised to at least 6" above the ground level?

(e) Is any latrines, ventilator or opening in the proximity of any opening of the main building?

(f) Do any latrines or urinals communicate with any work room without any intervening space

open to the sky ?

(g) Are the latrines of the flush type ?

(h) Are all the drains, pipes and sewers for carrying sullage, sewage water effluent and waste

products running within the factory premises constructed of impermeable material?

(i) Are the drains of flush type latrines connected to the drainage system of the local Boards?

(j) Is an efficient system of septic tanks provided if no drainage system exists?

(k) Are the latrines provided with roofing?

6. Drinking water.—

(a) Is the drinking water provided from a source provided by the local Board.

(b) Is any well constructed in the premises of the factory for drinking water or humidification

purposes ?

(c) Is the cylinder of the well pucca and impervious to water throughout and up to a depth not less

than the lowest level of sub-soil water ?

(d) Are the positions of water centres including wells, hand pumps situated at least 20 ft. away

from the washing place, latrines and urinals ?

7. Rest shelter, canteen and creches.—If the plans relate to any of these, the following questions should

also be answered—

(i) Rest shelter:

(a) Does the building fully meet the requirements of Section 24(2)(lll) and it's rules.

(b) Is the roof ef heat-resisting material ?

(c) Is the height of every room in the rest shelter at least 12 ft. from the floor level to the lowest

part of the roof ?

(ii) Canteen:

(a) Does the building fully meet the requirements of— Section 24(1)(v) and it's rules.

(b) Are the canteen buildings situated not less than 50 yards from any latrines, urinals, boiler

house, coals, stack coals dumps etc.?

(c) What is the minimum height of the buildings of the canteen measured from the floor level to

the lowest part of the roof ?

(iii) Creche :

(a) Does the building of creche meet fully the requirements of— Section 24 (3) and it's rules.

(b) Is the height of buildings not less than 12 ft. from floor level to the lowest part of roof ?

We certify that the replies given to the questionnaire above are correct.

Signature of Manager. Signature of Occupier.

N. B.—(i) After showing the above details, the plans and site-plan this questionnaire and Form-42 should

all be submitted in triplicate to the Inspector-cum-facilitator having jurisdiction for the approval of the

Chief Inspector cum facilitator, Uttar Pradesh.

(ii) A certificate of stability signed by a Competent Person having the qualifications, shall be

submitted on Form-43 before the manufacturing process with the aid of power is begun in the building.