Industry Name*

District* Select District Agar Malwa Alirajpur Anuppur Ashoknagar Balaghat Barwani Betul Bhind Bhopal Burhanpur Chhatarpur Chhindwara Damoh Datia Dewas Dhar Dindori Guna Gwalior Harda Hoshangabad Indore Jabalpur Jhabua Katni Khandwa Khargone Maihar Malanpur Mandideep Mandla Mandsaur Mauganj Morena Narsinghpur Neemuch Niwari Pandhurna Panna Pithampur Raisen Rajgarh Ratlam Rewa Sagar Satna Sehore Seoni Shahdol Shajapur Sheopur Shivpuri Sidhi Singrauli Tikamgarh Ujjain Umaria Vidisha

State

Address*

Authorized Person Name*

Authorized Person Email Id*

Authorized Person Mobile No*

License/Registration No

Industry Type Select Industry Type Shop Factory

Risk Category Select Risk Category High Medium Low

Category Select Category Major Hazordous Hazordous Non Hazordous

Employee Count

Department Name
Directorate Of Industrial Health and Safety Directorate of Boilers, DIPIP Labour Department Pollution Control Board Weight & Measures