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EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 1
ENVIRONMENT MANAGEMENT PLAN (EMP)
Introduction
The environment management plan has been prepared for subject
opencast /fully mechanized mining operation for Granite with capacity
of 20000 m3 per year. The EMP includes formulation, implementation
and monitoring of environmental protection measures during operation
of the project. The EMP list out all these measures for the mining
activities. The EMP is prepared keeping in view of all possible strategies
oriented towards impact minimisation. The main objectives of EMP are
given below:
To establish the present environmental scenario considering the
other activities in the study area.
To anticipate the impacts of existing and proposed mining
operations on the environment.
To prepare a detailed action plan for implementation of mitigative
measures.
To suggest preventive and mitigative measures to minimise
adverse impacts and to maximize beneficial impacts.
To suggest a post operational monitoring programmes of mitigative
measures to ensure the quality of environment
To suggest the formation of a core group responsible for
implementation of protective measures and regular monitoring of
such implementation
To prepare a capital cost estimate and annual recurring cost for
Environmental Management Plan
Through environment plan is under execution for existing operation;
however it is required to provide further strength for effectiveness.
Mitigation measures at the source level and an overall management plan
are elicited so as to conserve the environment.
It is observed that quarry area is recorded as degreased forest land. Two
quarries are adjacent to the subject area and ten another quarries are
located in the 10 km radius. One village and one surface water bodies
have also been observed near to quarry area. Implementation of EMP is
should consider the above stated tenure.
The environmental attributes, which are likely to be affected, are land
use, topography, water resources, soil, air quality, socio-economic
status, ecology and public health.
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 2
Environmental Management System
The management as a part of its environment policy declared its
responsibility and commitment to protect the environment and to ensure
the public safety. To realise the implementation of its environmental
policy, project management should give proper structure to
environmental management system.
Air Environment
The potential sources of air pollution arising from the existing is
observed from excavation of mineral, waste dumps, haul roads and
transportation of mineral in the vicinity. Air pollution caused by mining
and associated activities can be classified into the following categories:
Gaseous pollutants (Nitrogen Oxides, Sulphur Dioxide and Carbon
Monoxides); and
Particulate Matter.
Forever mitigative measures suggested for air pollution control are based
on the baseline ambient air quality monitoring data. It is desirable that
air quality should be monitored on a regular basis to check it vis-à-vis
the standards prescribed by CPCB and in cases of non-compliance,
appropriate mitigative measures has also been adopted.
Dust control measures
Dust is the major pollutant generated from the mining operations. Dust
is also generated during handling and transportation of the material.
The environmental control measures, which has been taken up are
existing as well as proposed to control the fugitive dust released during
the granite production are given below:
a) Haulage road & Dumps:
During the mining of granite for enhanced capacity the predicted value
reveals that the maximum incremental short term 24 hourly ground
level concentrations of particulates is 3.18 g/m3. Following measures
has been taken to mitigate the effect of granite mining operation over
ambient air environment:
Frequent Water spraying has already been carried out on the
haulage roads, services road & dump area and same practice will
continue in future also.
Considering the location of village (north east direction), dumping
has been done in North West and south direction.
Over burden dumps will not be left active for longer period and will
be used for reclamation purposes.
Over burden dumps has been temporary stabilized with legumes
and grasses to prevent the erosion of soil and to arrest the dust
emission during windy days.
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 3
Water has already been sprayed over the muck pile and dumps to
reduced the dust generation;
Dust mask has already been provided to all workers.
Regular maintenance of vehicles and machines has been carried
out in order to control emissions;
Cutting tools for granite have been used with the spray of water to
reduce the dust emission.
During the drilling of granite block, water has been sprayed, so
reduced the dust emission
Haulage of overburden/mine waste to the siding has been done by
dumper. After excavation, mineral has been transported to the
port or Indian customers at Bombay or Jaipur by hired dumper
(24t capacity). The approach road from lease area to PWD road is
about 0.2km, which is kuchha road; however no habitations have
been observed along the said kachha road. Dust generation due to
transportation will be for limited period and extent to small area.
Water spraying has already been carried out frequently and same
will be continued.
Emission Sources and Control Options
Operation or source Control options
a) Mining Operations
Loading Water wetting
Hauling (emissions from roads)
Water wetting, Soil stabilization, Traffic
control.
All above measures is expected to be continue in future
Controlling of CO levels
The concentration of CO in ambient air was less than 1 ppm at all the
air quality monitoring locations. Expected increase in the CO
concentration is very low as CO emissions from mining operations are
negligible as compared to other pollutants. Heavy and light vehicles are
the major sources of CO in the mine. All vehicles and their exhausts
would be well maintained to reduce the CO concentrations.
Controlling of NO2 levels
The source of NO2 would be due to vehicular emissions. This can be
controlled by proper maintenance and servicing of vehicles.
Occupational health & safety measure wrt air environment
All the above precautions has been adopted to prevent dust generation
at site and to be dispersed in the outside environment. However, for the
safety of workers at site, dust masks have also been provided. Dust
masks is help to prevent preventing inhalation of PM thereby reducing
the risk of lung diseases and other respiratory disorders. Regular health
monitoring (ones in a year) of workers has also been carried out.
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 4
Noise Environment
The main source of noise in mining activity is drilling, blasting,
excavation & transportation of ore. As there are one village observed
within 500m ranges, noise level has been insignificant as the operations
are of intermittent nature. The prevailing day and Night noise levels at
Village reported are between 46.8-50.4 dBA and 35.6-36.3dBA
respectively. Although the ambient noise level monitoring carried out in
and around the existing quarry shows that ambient noise levels are well
within the stipulated limits of CPCB. Blasting and drilling has been
required for mining activity. In order to further control the noise levels in
the work zone following measures are adopted:
A) Drilling
1. Hydraulic drills has been used for drilling;
2. All moving parts are properly lubricated; and
3. Non-moving parts are properly fastened.
B) Blasting
1. Blast shall be well designed and arranged in such a way that only one
or two holes are blasted at a time with the use of short delay
detonators in combination with sequential blasting machine and also
maintaining the charge per delay;
2. Maximum noise shall be generated during secondary blasting.
Primary blasts shall be so designed that boulder generation will be
minimum. Hydraulic Rock Breaker shall be used for breaking
boulders instead of conventional pop shooting;
3. Explosives shall be blasted in confined stage or optimum stemming
column is maintained during charging of holes;
4. Blasting shall be done between 12 noon’s to 4 pm when temperature
inversions are not likely to be there and air density is less.
5. At least three rows of trees are planted to reduce propagation of noise
and dust due to blast outside the lease;
6. No blasting shall be done when the sky is clouded because cloud
cover can cause reflection of pressure wave back to the ground level
at some distance from the blast; and
7. Electric detonators shall be used instead of the detonating fuse as
trunk line.
Mitigation Measures to Reduce Ambient Noise Levels
The following control measures are being adopted to keep the
ambient noise levels well below the limits:
A thick tree belt shall be being provided in phased manner around
the periphery of the mine to screen the noise;
Trees shall be planted on both sides of roads used for transport of
men and material;
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 5
Proper maintenance has been done of noise generating machinery
including the transport vehicles; and
Silencers have been provided to modulate the noise generated by
machines.
Installation of noise generating machinery, strictly in compliance
with the recommendations of the manufacturers. This would
ensure an installation free from vibration and exhaust leaks which
are also major contributors to increased noise levels
Provision of insulating caps and aids at the exit of noise source on
the machinery.
Use of damping materials such as thin rubber sheet for wrapping
the worn places of compressors, generators etc.
Shock absorbing techniques to reduce impact
Apart from above, the formation of internal dump and green belt
development will also muffle the noise to a great extent.
Regular maintenance of machines and vehicles have been carried
out regularly. All moving parts of machine have been properly
lubricated; Non-moving parts of machine have been properly
fastened
Acoustic treatment for rotating equipments
Measures to Protect Workers from High Noise Levels
The following measures have been taken to protect the workers from
exposure to higher noise levels:
i. Noise is considered as an occupational hazard. Blasting is an
occasional and impulsive event, which needs to be carried out in
an isolated manner.
ii. The workforce working at the mining face, where high noise level is
expected, has been provided with protective device for
occupational safety.
iii. Compulsory use of personnel protective equipment (PPE) such as
ear plugs for the workers
Water Environment
There is no water course in the lease area. The main drainage of the area
is through seasonal Nalla which is in south west at 100m distance. The
water table in the quarry area varies from 20m to 22m whereas mining
will be done up to avg. 15m depth thus ground water table will not touch
during conceptual period. Surface water source will not be affected in
the quarry area due to small scale, opencast mining. Rainwater may get
accumulated in the working pit. The pumped out water will be used to
fill the village pond, which is used by villagers. The quality of discharged
water must be ensured after settling tank before draining at pond. Water
requirement of the project is estimated is 21kl per day, which will be met
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 6
from existing bore well, pit water and through tanker. Following
measures has been taken to avoid accumulation of water:
1. Pump has already been installed to lift accumulated rain water from
working pit.
2. Garland drain has already been made along the waste dumps which
help to restrict/retain the loose particles. Depth & length of garland
drain is observed 0.50m and 1000m respectively.
3. Garland drain has also been made along the slop of hill along the
village side. Length & depth of garland drain is observed approx
1000m and 2.5m
4. It must be ensured that silt content in the mines discharged is
minimum.
5. It must be ensured that quality of drinking water for the worker is
hygienic.
Land Environment and solid waste management
The original topography of the part of area will further be affected due to
the expansion operation. It has been observed that 16.80ha area has
already been excavated during past mining. During the life of mine total
20.75 ha areas will be excavated and same will be reclaimed using mine
waste, OB and soil. During the conceptual period, about 2355115 m3
mine waste will be generated and same will be dumped at outside of the
quarry area. Weathered granite/mine waste will be used for backfilling
and reclamation purpose. During the mine life about 2075ha area will be
reclaimed and afforested. Lessee has already been developed the 125ha
land by afforestation, which will be continue in future also. Presently
1.80ha and 3.0ha area has been covered by waste dump within and
outside of quarry area respectively. Existing waste dump has been
stabilized by grasses and shrubs. Garland drain has already been made
along the waste dumps which has been restrict/retain the loose
particles. Depth & length of garland drain has been observed 0.50m and
1000m respectively, which will be increased with the paces of further
mining.
Biological Environment
Since there are no notified endangered species in the area, which will be
effected due to the mining activities, therefore the biological environment
will not have significant impact due to proposed activity. The impact on
the biological environment due to amount of dust generation is
minimised by well-developed green belt in and around mining lease area.
The green belt development not only functions as foreground and
background landscape features resulting in harmonizing and
amalgamating the physical structures of the mines with surrounding
environment, but also acts as pollution sink as indicated above. Thus,
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 7
implementation of afforestation program is of paramount importance. In
addition to augmenting present vegetation, it will also check soil erosion,
make the ecosystem more complex and functionally, stable and make
the climate more conducive. The plantation matrix should be adopted for
the green belt development includes pits of 0.3m x 0.3m x 0.3 m size
with the spacing of 2.0 m x 2.0m.
Selection Criteria of plant species for Green Development Plant
The selection of plant species for the development depends on various
factors such as climate, elevation and soil. Area falls under the tropical
region and thus the local species should be selected. Following criteria
may be taken for selection of species.
The species should be fast growing.
The species should form a dense canopy.
As far as possible, the species should be indigenous and locally
available
Soil improving plants (Nitrogen fixing, rapidly decomposable leaf
litter).
Plant Species for Mine Area and its Boundary
• Acacia nilotica
• Leuceana leucocephala
• Albizzia species
• Morus indica/alba
• Acacia auriculiformis
• Prosopis species
• Azadirachta indicata
• Syzygium cuminii
• Annona squamosa
• Tamarindus indica
• Bauhinia variegata
• Terminelia arjuna
• Butea monosperma
• Zizyphus species
• Cassia festula
• Carissa species
• Dalbergia sisoo
• Feronia species
• Erythrina indica
• Phylanthus species
• Ficus bengalensis
• Madhuca species
• Ficus religiosa
• Magnifera species
• Grewia species
• Leuceana leucocephala
Plantation Schedule
A stage-wise comprehensive afforestation program is prepared and shall be
implemented. The locations of the proposed greenbelt along with area of the
green cover are given in the conceptual plan.
Afforestation plan
ENVIRONMENT IMPACT & MANAGEMENT: Ecology: Stage Wise Cumulative Plantation
REQUIREMENTS OF PLANTS FOR AFFORESTATION/RECLAMATION
Year Unworked
area green
belt
Outside dumps
(reclaim)
bench of pit village side Total
Area
(Ha)
Tree
s
Area
(Ha)
Trees Area
(Ha)
Trees Area
(Ha)
Trees Area
(Ha)
Trees
Present 0.1 100 - - - - - - 0.1 100
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 8
1st to 5th - - - - - - 0.5 750 0.5 750
5th to conceptual
period
0.386 580 20.75 31125 - - - - 21.136 31705
Total 1.386 680 20.75 31125 - - - - 21.736 32555
Occupational, Health and Safety
To avoid any adverse affects on the health of workers due to dust &
noise, sufficient measures have been provided in the mining project.
These may include:
Provision of rest shelters for mine workers with amenities like
drinking water, fans, toilets etc.
Provision of personal protection devices to the workers;
Dust suppression of haul road; and
First-aid facilities in the mining area.
The management will carry out periodical audit of safety and health
with view to ascertaining the effective implementation of policy.
Regular medical examination will be conducted for the employees.
Protective measures for Occupational Safety & Health hazards has also
been implemented, so that such exposure can be kept within permissible
level. Evaluation of health of workers has been made through pre-
designed format, for chest X-ray, Audiometry, Spirometry Vision testing
(Far & Near vision, colour vision and any other ocular defect) ECG,
during pre placement and periodical examinations.
Medical Check-up Schedule
Total Blood Picture Once a Year
Blood Pressure and Heart Function Once in 6 Months
Skin Check Up Once a Year
ENT Once a Year
Chest X Ray If needed
Spirometry Once a Year
Audiometry Once a Year
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 9
CONFIDENTIAL ENTRY MEDICAL
EXAMINATION
I hereby authorize any of the doctors, hospitals or clinics mentioned in this form to provide the Medical Service with copies of all my medical records so that the Organization can take action upon my application for employment.
I certify that the statements made by me in answer to the questions below are, to the best of my knowledge, true, complete and correct, I realize that any incorrect statement of material omission in the medical information form or in
any other required by the Organization renders a staff member liable to termination or dismissal.
Date : (dd/mm/yy)
Signature
Pages 1 and 2 are to be completed by the candidate
Family Name (In Block
Capitals)
Given Names Maiden Name (For Women Only) Sex
M [ ] F [ ]
Address (Street, Town, District or Province, Country) And Telephone Date Of Birth (Day/Month/Year)
NATIONALITY
Position Applied For (Describe Nature Of Work)
Telephone Birthplace
DUTY STATION
Present Marital Status Single [ ]
Married [ ] Date : (Dd/My/Yy) ----------------- Divorced [ ] Date : (Dd/My/Yy) ----------------- Separated [ ] Date : (Dd/My/Yy) ----------------- Widowed [ ] Date :
(Dd/My/Yy) ---------------------
Have you ever undergone a medical examination for any other agency ? ____________________________________________
Have you ever been employed by this company or any other agency ? ______________________________________________ If so, please stae when, where and for which organization: ________________________________________________________
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 10
FAMILY HISTORY
Relative Age (if still alive)
State of Health (If still alive,
present state: if
deceased cause of death)
Age at death Have members of your family
had the following
illnesses or disorders?
Yes No Who?
Father High Blood Pressure
Mother Heart Disease
Brothers Diabetes
Sisters Tuberculosis
Spouse Asthma
Children Cancer
Epilepsy
Mental Disorders
Paralysis
TO BE COMPLETED BY THE OFFICIAL REQUESTING
THE MEDICAL EXAMINATION
TO BE COMPLETED BY THE DIRECTOR OF THE
MEDICAL SERVICE
Name of the Official : Comments :
Department or Unit :
Date : Date : (dd/mm/yy) Signature:
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 11
VERY IMPORTANT : Please indicate the recruiting Agency or Organization:
Each question requires a specific answer (yes, no, date etc.); to leave a blank or draw a line is not sufficient. If the questionnaire is not fully completed and enquires are therefore needed, time may be lost.
1. Have you suffered from any of the following diseases or disorders? Check yes or no, If yes, state the year-
YES Date
NO YES Date
NO YES Date
NO YES Date
NO
Frequent sore throats
Heart and blood vessel
disease
Urinary disorder
Fainting spells
Hay fever Pains in the heart region
Kidney trouble
Epilepsy
Asthma Varicose veins
Kidney stones
Diabetes
Tuberculosis Frequent Back Pain Gonorrhoea
Pneumonia Ulcer of stomach or duodenum
Joint problems
Any other sexually transmitted
disease
Pleurisy Jaundice Skin disease Tropical
diseases
Repeated
bronchitis
Gall Stones Sleeplessness Amoebic
dysentery
Rhueumatic
fever
Hernia Any nervous
or mental disorder
Malaria
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 12
High blood
pressure
Haemorrhoids Frequent
headaches
2) Are you being treated for any condition now ? ________________ Describe : _________________________
________________________________
3) Have you ever coughted up blood ? ___________________________________________________________
4) Have you ever noticed blood in your stools ? ________________In your urine ? ________________ Give details:
________________________________________________________________
5) Have you ever been hospitalized (hospital, clinic,etc.)? ____________________________________________ Why,
where and when ? _____________________________________________________________________
6) Have your ever been absent from work for longer than one month through illness ? ________________ If so,
when? ________________________________________________________________________________ And for what
illness ? _______________________________________________________________________
7) Have your had any accidents as a result of which your are partially disabled? ________________ If so, what
and when? ________________ ______________________________________________________________ Do you have
any other disability? _____________________________________________________________
8) Have your ever consulted a neurologist, a psychiatrist or a psychoanalyst? _____________________________
_________________________________________________________________________________________
9) Are you taking any medicine regularly? ________________If so, which? ______________________________
_________________________________________________________________________________________
10) Have you gained or lost weight during the last three years? ________________ if so, which? _________
_________________________________________________________________________________________
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 13
11) Have you ever been refused life insurance? ________________________________ If so, state reason:
_________________________________________________________________________________________
12) Have you ever been refused employment in health grounds? ________________ If so, state reason:
________________
13) Have your ever received or applied for a pension or compensation for any permanent disablity?
________________ Degree ? ________________________________ Please give details: ________________
________________________________________________________________________________
14) Have you ever stayed in any other country? ___________________________________________if so, for how
long? ________________________________________________________________
15) Have you in the past suffered from any condition which prevented travel by air? ________________
________________________________________________________________________________________
16) Do you consider yourself to be in good health ? ________________Do you have full work capacity ?
________________ ________________________________________________
17) Do you smoke regularly? [ ] Yes [ ] No. If so, what do you smoke? [ ]
Cigerettes [ ] Pipe [ ] Cigars For how many years have your smoked? ________________ How
much per day? ________________________________________________________________
18) Daily consumption of alcoholic beverages: ___________________________________________________
19) Has any doctor or dentist advised you to undergo medical or surgical treatment in the foreseeable
future? ________________________________________________ ____________________________________ Give
details: _____________________________________________________________________________
20) Give any other significant information concerning your health: ________________________________
_________________________________________________________________________________________
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 14
21) What is your occupation? ________________________________Indicate at least three posts you have
occupied: ________________________________________________________________________________
22) List any occupational or other hazards to which you have been exposes:
________________________________ ________________________________
23) Have you ever been rejected for military service for medical reasons? ______________________________
________________________________________________________________________________
24) FOR WOMEN
Are your periods regular? [ ] Yes [ ] No. Do you take contraceptive pills [ ] Yes [ ] No If so, for how
many years have
Are they painful ? [ ] Yes [ ] No. You been doing sio? ____________________Have you ever been treated for a
gynecological
Do you have to stay in bed when they come [ ] Yes [ ] No. complaint? [ ] Yes [ ] No.
If so for how long? ______________________Date of your last period: _______________ If so, which?
___________________________________________________________________________________________________________
TO BE COMPLETED BY THE EXAMINING PHYSICIAN
GENERAL APPEARANCE Height cm. Weight: kg.
Skin: Scalp:
SIGHT, MEASURED VISUAL ACUITY
Gross vision Right Left Pupils: Equal? Regular?
Vision with spectacles Right Left Fundi (if necessary):
Near vision Right Left Colour vision:
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 15
With correction Right Left
Right Left
HEARING
(test by whispering
Right Normal: Sufficient: Insufficient:
Left Normal: Sufficient: Insufficient:
Ear drum Right: Left:
NOSE- MOUTH-NECK Nose: Pharynx: Teeth:
Tongue: Tonsils: Thyroid:
CARDIOVASCULAR SYSTEM Pefipheral arteries
Pulse rate: Auscultation: - carotid:
Rhythm: Blood
pressure:
-posterior tibial:
Apex beat: Varicose
veins:
- dorsalis pedis:
Electrocardiogram-Please attach tracing
RESPIRATORY SYSTEM
Thorax:
Breasts RIGHT LEFT
DIGESTIVE SYSTEM Spleen:
Abdomen: Hernia:
Liver: Rectal examination:
NERVOUS SYSTEM Plantar reflexes
Papillary reflerxes:
- To light: Motor functions:
-On accommodation: Sensory functions:
Patellar reflexes: Muscular tonus:
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 16
Achilles reflexes: Romberg's sign:
MENTAL STATE
Appearance: Behaviour:
LABORATORY The results of all the following investigations must be included except where marked "if indicated"
Urine: Albumin Sugar Microscopic
Blood:
Haemoglobin:
%
grams/I Leucocytes:
Haemoglobin: %
Differential count (if indicated):
Erythrocytes: Blood sedimentation rate:
Blood chemistry:
Sugar: Urea or creatinine:
Cholesterol: Uric acid:
Serological test for syphilis: Please attach laborartory report
Stool examination:
COMMENTS (Please comment on all the positive answers given by the staff member and summarize the abnormal findings):
CONCLUSIONS(Please state your opinion on the physical and mental health of the candidate and fitness for the proposed post):
The examining doctor is requested before sending this report to verify that the questionnaire, pages 1 and 2 of this form, has
been fully completed by the candidate and that all the results of the investigations required are given on the report. Incomplete report are a major source of delay in recruitment.
Name of the examining physician (in block capitals): Signature:
Address: Date: (dd/my/yy)
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 17
CONFIDENTIAL PERIODIC MEDICAL EXAMINATION
For recruitment do not use this
form
Periodic Examination [ ] Extension[ ] Reassignment [ ]
End of Service [ ]
Pages 1 and 2 are to be completed by the staff member
FAMILY NAME(IN BLOCK CAPITALS)
GIVEN NAMES
MAIDEN NAME (FOR WOMEN ONLY)
SEX
M [ ] F [ ]
ADDRESS (STREET, TOWN, DISTRICT OR PROVINCE, COUNTRY) AND TELEPHONE
DATE OF BIRTH (day/month/year)
NATIONALITY
EMPLOYMENT HELD
SINCE FAMILY SINCE THE LAST EXAMINATION:(MARRIAGE, BIRTH, DEATHS, DIVORCE: GIVE THE DATES)
YEARS OF SERVICE
DEPARTMENT OR UNIT
OFFICE OR DIVISION/SECTION LAST COMPLETE MEDICAL EXAMINATION Date: (d/m/y) Place :
DUTY STATION (CITY AND COUNTRY)
A. INTERIM HISTORY - Since your last examination-
1. Indicate the illnesses or accidents which you have had, stating their length- Give the place of hospitaliztion if
applicable-
2. Do you consider that your health is altogether satisfactory? if not, for what reason?
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 18
3. Have you been examined by: Your own doctor? [ ] Yes [ ] No A specialist? [ ] Yes [ ] No
if so, when and for what reason?
4. Have your consulted: A neurologist? ? [ ] Yes [ ] No A psychiatris? [ ] Yes [ ] No A psychoanalyst? [ ]
Yes [ ] No If so, when and for what reason?
5. Are you under medical treatment at present? If so, state treatment followed:
6. Have members of your family had any serious health problems? ? [ ] Yes [ ] No If yes, give detailsL:
7. Please give any additional information that might help the examining doctor:
8. Name and address of your own doctor:
TO BE COMPLETED BY STAFF MEMBER TO BE COMPLETED BY THE DIRECTOR OF THE MEDICAL SERVICE
Place: Medical Classification: 1a 1b 2a 2b
Comments: Date(d/m/y):
Signature:
Date: (d/m/y) Signature:
VERY IMPORTANT : Please indicate the Agency or Organization concerned L:
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 19
B. PRESENT HEALTH - Each question requires a specific answer (yes, no, date, etc.); to leave a blank or draw a
line is not sufficient. If the questionnaire is not fully completed and enquiries are therefore needed, time may be
lost.
YES
Date
NO YES
Date
NO yes
Date
NO Yes
Date
No
Frequent sore throats
Heart and blood vessel
disease
Urinary disorder
Fainting spells
Hay Fever Pains in the
heart region
Kidney trouble Epilepsy
Asthma Varicose veins
Kidney Stones Diabetes
Tuberculosis Frequent
indigestion
Back pain Gonorrhoea
Pneumonia Ulcer of
stomach or duodenum
Joint
problems
Any other
sexually transmitted disease
Pleurisy Jaundice Skin disease Tropical diseases
Repeated bronchitis
Gall stones Sleeplessness Amoebic dysentery
Rheumatic feber
Hernia Any nervous or mental
disorder
Malaria
C. DAILY HABITS
1. Do you smoke regularly? ( ) Yes ( ) No
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 20
If so, what do you smoke? ( ) Cigarette ( ) Pipe ( ) Cigars
For how many years have you smoked
How much per day?
2. Daily consumption of alcoholic beverages:
3. Recreation:
What kind now?
How often?
D. FOR WOMEN STAFF ONLY.
1. Do you take contraceptive pills? ( ) Yes ( ) No
2. When did you last visit a gynecologist?
For what reason?
3. Any pregnancies since last examination?
4 Date of menopause (if applicable): (d/m/y)
LABORATORY Except by prior agreement, only the investigations mentioned are done at the Organization's expense
Urine: Albumin Sugar Microscopic
Blood:
Haemoglobin: %
grams/I Leucocytes:
Haemoglobin: %
Differential count (if indicated):
Erythrocytes: Blood sedimentation rate:
Blood chemistry:
Sugar: Urea or creatinine:
Cholesterol: Uric acid:
Serological test for syphilis: Please attach laborartory report
Stool examination:
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 21
COMMENTS (Please comment on all the positive answers given by the staff member and summarize the abnormal findings):
CONCLUSIONS(Please state your opinion on the physical and mental health of the candidate and fitness for the proposed
post):
The examining doctor is requested before sending this report to verify that the questionnaire, pages 1 and 2 of this form, has been fully completed by the candidate and that all the results of the investigations required are given on the report. Incomplete
report are a major source of delay in recruitment.
Name of the examining physician (in block capitals): Signature:
Address: Date: (dd/my/yy)
All first aid facilities has already been provided in the quarry office
All the medicines prescribed by doctors has been provided to the employees at free of cost by the
management.
The working personnel has already been given the following appropriate personnel protective equipments.
Industrial safety helmets.
Ear plugs.
Industrial safety shoes with steel toe.
EMP
M/s Fortune Stone Ltd., Chhatarpur (MP) 22
Socio economic Measures
Socio-economic survey was been conducted in 10 villages of the study
area out of total 36 villages. The selected villages are Kathara, Marwa,
Ranmau, Devikhera, Andhiyara Bari, Parsaniyan, Ratanpara, Raja
purwa, Devpura and Mureri of the study area. M/s Fortune Stone Ltd.
under its CSR plan identifies the needs of the surrounding villages and
has developed a social management plan to benefit the surrounding
areas. Thus the surrounding villages have been benefited from the
existing mining activity. M/s Fortune Stone Ltd. has already been given
the employment to local peoples in the existing quarries i.e. approx 145
numbers as per the qualification and skill. M/s Fortune Stone Ltd. has
already carried out number of welfare activities in the area like:
Samuhik Kanya Vivah: year 2009
Deeping of local pond (Kathara)
Free Medical Camp (Eye & Dental check-up) at Lovekush nagar –
26.12.2011
Construction of Hospital Building at Kathara
Provision of Doctor and Compounder in Hospital (Kathara)
Contribute to Local Area Development Fund
Free drinking water supply facility to nearby village by Tanker
Proposed activity
Free Medical Camp
Free drinking water supply facility to nearby village by Tanker
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