C1 Simplified CSHP Application Form
C1 Simplified CSHP Application Form
C1 Simplified CSHP Application Form
09-F-03
Regional Office: DOLE-NCR
Application No: ________
Application for
CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)
(Intended only for residential project/s (2 storey and below) or minor repair works with less than 10 workers.)
Project Name: ______________________________________________________________________
Project Complete Address/Location: ___________________________________________________________
_________________________________________________________________________________________
Project Duration: _____________ Project Start: ________________ Completion Date: _________________
(No. of Calendar days) (Date of estimated start) (Date of project completion)
Estimated Project Cost: ______________________ Number of Workers: _______________________
Name of Contractor (if any):___________________________________________________________________
Contractor’s Address: ________________________________________________________________________
____________________________________________________________ Fax No.:_______________________
PCAB License No.______________ Date of Validity: ____________ Email address: _______________________