Separate Applications are required if you wish to nominate
more than One Unit / Site / Factory / Projects
  PART-1. GENERAL INFORMATION
 

1.         Name of Organisation__________________________________.
            Address (Corporate Office)_______________________________.
  2.         Total number of Factories / Units / Projects:
             Name & Designation of Heads of Factories / Units / Projects, Address,  Phone no., Fax no.,  &  Email              address of all units.
  3.         Board of  Directors (please attach list with official address & contact nos.)
4.         Scale of Organization  :
            Large Scale                   Medium  Scale                Small Scale.        
               Type of Organization :  
            Private Sector              Public Sector               Other (Specify).
  5.         This  Application is for:  Unit / Works: (Address of Unit).
 

6.         Name & Designation of one Contact Persons regarding the award: (as per following format).            
 

            Name______________________________________________.           
 

            Designation_________________________________________.
 

            Telephone  (O)___________________  (R)_________________.
              Fax________________Mobile___________________________.
              Email______________________________________________.
 

7.         Annual turnover Rs./ US$_______________________________.
               Number of employees_________________________________.
  8.         Main business activities ,  Products/ Services:
            Annual production capacity:
  9.         Attach Company logo in Black & White and Multi Colour in various sizes ½, 1, 1½  inch.
  10.       If Selected for award, name of the Company/ Unit to be printed on Award Certificate &
               Trophy:_____________________________________________.
  11.       Significant five points in support of your claim for the award.
  12.       Special Achievement/Success Story in the field of Environment Management (during the Award Year).
   
  PART - 2.  ENVIRONMENT MANAGEMENT
  1.         Briefly describe the Manufacturing Process of the Unit.
  2.         Furnish the following:-
               (a) Environmental Clearance from State Government as well as MOEF. (Attach copy).
               (b) Compliance status of various conditions stipulated in above documents.
               (c) Validity of Consents under Water Act and Air Act from State Pollution Control Board (attach copies                    of Consent Order).
  3.         Product manufactured during the last 3 yrs. (Tonnes per year).
 
Sl. No.
Base Year (2005)
2nd Year (2006)
3rd Year (2007)
1. Name Qty. Name Qty. Name Qty.
2. .       .  
3. .       .  
  4.         Raw material Consumption during last 3 years. (Tonnes per years).
 
Sl. No.
Base Year (2005)
2nd Year (2006)
3rd Year (2007)
1. Name Qty. Name Qty. Name Qty.
2. .       .  
3. .       .  
  5.         Describe briefly :
              (a) Measures taken to abate / mitigate various pollutants.
              (b) Other initiatives taken for Environmental Protection.
 
Effluent/Pollutant Emission & Control
 
Pollutants
Pollution Control Technology/ Systems adopted
BASE YEAR (2005)
BASE YEAR (2006)
BASE YEAR (2007)
Emission
% of Violation
Emission
% of Violation
Emission
% of Violation
Prescribed Standard
Observed Value
Prescribed Standard
Observed Value
Prescribed Standard
Observed Value
                     
                     
  6.         Does the facility / unit generates any Hazardous Waste?  If yes, please attach copy of the Authorization             Letter obtained from Regulatory Authority.
  7.         (a) Does the facility / unit have undergone Study of any Environment Risk Management /Risk                   Studies and Emergency Preparedness? If yes, please provide recommendations of the                   studyalong with their implementation status. Also provide details of Mock drills.
              (b)Has your Company declared the level of  Acceptable Risk ?
  8.         Consumption / Conservation of Natural Resources per unit product :
 
Sl. No. ITEM
Base Year
Jan - Dec (2005)
Base Year
Jan - Dec (2006)
Base Year
Jan - Dec (2007)
Qty. Consumption % + or - Qty. Consumption % + or - Qty. Consumption % + or -
1 Fuel(s)            
2 Electricity .       .  
3 Water            
4 Others .       .  
  9.         Quantity of Waste utilization for various purposes during last three years.
  10.       Percentage of Annual turnover vis-a-vis funds allocated and utilized for Environmental              Management for the last three years.
 
ITEM
Base Year (2005)
Rs. / US $ in Lakhs
Base Year (2006)
Rs. / US $ in Lakhs
Base Year (2007)
Rs. / US $ in Lakhs
Budget Allocated      
Budget Utilised     .
Utilisation %      
  11.       Attach latest copy of Annual Environment Statement submitted to Regulatory Authority.
  12.      No. of persons trained for Environmental Management (Corporate Level, Manager Level and Plant Level)             during award year. Also provide the detail of various Environmental Awareness Programs (World Env.             Day,Earth Day, Ozone Day etc.) organized vis-a-vis no. of persons involved.
  13.      Total Area of Industry / Organization  vis-a-vis total area covered with  Plantation.
  14.      Plantation Yearwise. (Last 3 years).
 
Sl. No.
Base Year (2005)
2nd Year (2006)
3rd Year (2007)
1. Name Qty. Name Qty. Name Qty.
2. .       .  
3. .       .  
  15.      Give details of the water requirements met from Rain Water Harvesting. Furnish details of the             facilities created.
  16.      Initiatives taken for the abatement of Green House Gases.  Has your Organization taken any             Carbon Credit?  If so, furnish the details.
  17.       Is your Organization / Unit ISO 14001 accredited? If yes, please attach copy of the certificate.
 

18.       Has your company won any Environment Awards during last three years? If  yes, please furnish list and              attach copies of Certificates.