Government of Karnataka
Department of Factories, Boilers, Industrial Safety & Health
53
rd
National Safety Day Celebration - 2024
Safety Oath Registration Form
Full Name of Factory
*
Licence Number
*
Full Address of Factory
*
Manufacturing Process Carried
*
State
*
Select State
Karnataka
District
*
-- select one --
Taluk
*
Landmark (Optional)
Oath Administrator's Name and Title
*
Responsible Person's Name and Title
*
Responsible Person's Email
*
Responsible Person's Mobile Number
*
Name of Factory Manager
*
Email of Factory Manager
*
Mobile of Factory Manager
*
Name of EHS Head
Contact No. of EHS Head
Email of EHS Head
Total Workers (Who will take Oath)
*
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