Mumbai: The Director of Industrial Safety and Health (DISH) in its inquiry report on the Tarapur MIDC fire has found serious lapses on the part of Novaphene Specialities Pvt Ltd, the factory from where a blaze spread to four other units last week.

It found that Novaphene had not appointed a qualified chemical engineer, which is mandatory in a hazardous unit. The worker, Raju Raote, who is said to be uneducated and has no knowledge about the properties of the chemicals he handled, was given the task of increasing the reactor’s steam.

On Thursday, the day of the fire, Raote was handling the task of increasing the reactor’s steam. He panicked after the raw material crossed the boiling point and called manager Hemraj Paratne, who was at home. Paratne asked Raote and the workers to leave the factory immediately. Raote and the workers of Novaphene escaped unhurt as they left before the glass-lined reactor exploded and caught fire.

Soon the fire had spread to the adjoining Aarti Drugs, killing three of its workers and leaving 14 persons injured. Nachched Singh (62), a security guard with the adjoining Prachi Pharmaceuticals who was injured in one of the 40 blasts during the fire, died on Monday.

A day later, on Tuesday, the police arrested one of the owners, Saral Shah, manager Paratne, chemist Gyandeep Mhatre and the worker Raote under sections 304 (a) (causing death by negligence), 337 (causing hurt by act endangering life or personal safety of others), 338 (causing grievous hurt by act enartdangering life or personal safety of others), 285, 286, 287 (negligence) and 427 (mischief) of the Indian Penal Code. They were released on bail on a personal bond and cash surety of Rs 15,000 each by the Palghar court.

Novaphene manufactures Grignard reagents, which are formed by the reaction of magnesium metal with alkyl or alkenyl halides, a hazardous process. On Tuesday, a separate offence was registered by DISH under the Factories Act before the chief judicial magistrate, Thane, against Dinesh Shah, another owner and the person in whose name the factory is registered. The charge was that Novaphene was making chemicals for which it did not have permission.

The DISH report also said that Novaphene had not conducted the mandatory safety audit since 2015. DISH Joint Director (Safety) H Dhawad, who prepared the report, was himself issued a showcause notice asking why action should not be taken against him for the lapses.

Besides Novaphene, Aarti Drugs and Prachi Pharmaceuticals, the other units affected by the fire were Bharat Rasayan and Unimax. There are some 1,100 chemical units in Tarapur MIDC. After a recent meeting with district officials, DISH was directed to inspect all the chemical units but no check was undertaken.