We are Empowering your Journy Self-Reporting Form Self-Reporting FormOrganization NameRegistration NoSector- Select Sector-Manufacturing & ProcessingEnergy producers and utilities Service ProvidersAgro-Based & Natural Resource SectorsSize of Enterpriseby Annual turnover?Micro Enterprise – 1–9 employeesSmall Enterprise – 10–49 employeesMedium Enterprise – 50–249 employeesLarge Enterprise – 250+ employeesNo. of EmployeesAddressContact Person NameDesignationEmailPhoneAll required environmental approvals obtained? Yes NoList approvals held Any violations in last 3 years? Yes NoIf Yes: DescriptionCompliance Declaration Accept RejectWritten environmental policy or commitment Yes Partly NoAssigned environmental responsibility Yes Partly NoEmployee awareness or training Yes Partly NoMonitoring of environmental aspects Yes Partly NoMain energy sources Item 1 Item 2 Item 3Water sources Item 1 Item 2 Item 3Any efficiency measures implemented? Waste types generated Item 1 Item 2 Item 3Waste segregation practiced? Yes NoLicensed disposal used? Yes NoPollution control measures in place? Yes NoClimate risk awareness Yes NoAny mitigation/adaptation actionsPlanned improvement 1 Planned improvement 2Planned improvement 3Target yearAuthorized name DesignationSubmit
