FORM NO.

36
(See rule 110-A)
(a) Name of Fctory: CEAT Limited (e) Photograph:
Address: Get Muvala, Halol, Gujarat
(b) Name:
Address:
(c) Date of Birth:
(d) Date of Joining:
Name of Contractor

Signature of worker. Signature of Manager.

Date of Issue:
 EHS Requirements
Authorised for Material Sr. No. in Register
OJT Sign
Handling in: Medical Check Up
RMS / FGS
Mixing / 4-Roll Calander
PCR Stock Safety Induction Training
TBR Stock
PCR Building
TBR Building Remarks
PCR Curing & FF
TBR Curing & FF
Emergency Contact No: 02676-619102
 FORM NO. 36
(See rule 110-A)
(a) Name of Fctory: CEAT Limited (e) Photograph:
Address: Get Muvala, Halol, Gujarat
(b) Name:
Address:
(c) Date of Birth:
(d) Date of Joining:
Name of Contractor

Signature of worker. Signature of Manager.

Date of Issue:
 EHS Requirements
Authorised to do following work: Sr. No. in Register
Hot Work Medical Check Up
Work on Height
Excavation / Work on Roof
Electrical Safety Induction Training
Housekeeping / Gardening
Material Loading & Unloading
Fork Lift / BOPT On the Job Training

Emergency Contact No: 02676-619102

 Record of Safety Induction for Contarctor Employees

Material Loading & Unloading

New / Sign of Sign of
Sr. No. Date Name of Person Name of Contract Agency Remarks
Renew Person Trainer

Fork Lif / BOPT

Work At Height

Housekeeping
Work on Roof

G ardening
Excavaton
Hot Work

Electrical

Others