Form 50

{see rule 129}

Format of report of Site Appraisal Committee to be submitted to State Government

From,

Labour Commissioner, UP,

G.T. Road, Kanpur.

To,

Additional Chief Secretary/ Principal Secretary,

Labour and Employment,

Govt. of Uttar Pradesh, Lucknow.

Subject: Submission of report of Site Appraisal Committee in the case of application of ……………….

(name of applicant) with respect to the proposed construction/ expansion/ location/ operation of

hazardous activities in ………………………. (name of factory).

Sir/ Madam,

Kindly refer to the Govt. order number ………………………… dated ……………… through

which the Site Appraisal Committee in the case of application of ………………. (name of applicant) w.r.t.

the proposed construction/ expansion/ location/ operation of hazardous activities in ……………………….

(name of factory) was constituted under sub-section (1) of Section 83 of the Occupational Safety, Health

and Working Conditions Code, 2020 and rules made thereunder.

The above mentioned committee has examined thoroughly the application made by

………………. and the report of the committee is as follows:

a. Name and address of the applicant:

b. Name of the factory:

c. Registration number (if any):

d. Licence number (if any):

e. Site ownership details:

f. Date(s) of field visit(s) of the committee:

g. Details of meetings of the committee (plz .enclose all minutes of meetings):

h. Details of recommended corrective measures to be adopted by the applicant (if any):

i. Details of adopted corrective measures (give details):

j. Recommendations of the Site Appraisal Committee:

k. Any other comments/ recommendations:

Date: Signature of

Labour Commissioner

Place:

Seal