SCHEDULE 5 See Rule 61-UC (1) Information to be furnished Regarding Notification of a Major accident Report No………………………….. of the particular accident 1. General data (a) Name of the site (b) Name and address of the occupier (Also state the telephone/telex number) (c) (i) Registration number (ii) Licence number (As may have been allotted under any statute applicable to the site, e.g. the Factories Act) (d) (i) Nature of Industrial activity (Mention what is actually manufactured, stored etc.) (ii) National Industrial Classification, 1987 at the four digit level 2. Type of major accident | Explosion | | Fire | | Emission of Hazardous chemical | |
3. Description of the major accident (a) Date, shift and hour of the accident (b) Department/Section and exact place where the accident took place (c) The process/ operation undertaken in the Department/Section where the accident took place (Attach a flow chart, if necessary) (d) The circumstances of the accident and the hazardous chemical involved 4. Emergency measures taken and measures envisaged to be taken to alleviate short term effects of the accident. 5. Causes of the major accident Known (to be specified) Not known | | Information will be supplied as soon as possible | |
6. Nature and extent of damage (a) Within the establishment -casualties -Killed -Injured -Poisoned -Persons exposed to the major accident -Material damage -Damage is still present -Danger no longer exists (b) Outside the establishment -casualties -Killed -Injured -Poisoned -Persons exposed to the major accident -Material damage -Damage to environment -Damage is still present -Danger no longer exists 7. Data available for assessing the effects of the accident on persons and environment,. 8. Steps already taken or envisaged: (a) to alleviate medium or long-term effects of the accident. (b) to prevent recurrence of similar major accident. (c) Any other relevant information. | 
