Construction Safety & Health Org

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Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT


Regional Office No. 9
3 Floor, QNS Building, Veterans Avenue Extension
rd

Tumaga Road, Zamboanga City

CONSTRUCTION SAFETY& HEALTH COMMITTEE

Date:
Regional Labor Office No. IX
File No.:________

Name of Establishment : __________________________________________________


Address : __________________________________________________
Nature of Business : __________________________________________________
Number of Persons Employed (Including Management): ______________________________

1st Shift: Male____________ Female____________


2nd Shift: Male____________ Female____________
3rd Shift: Male____________ Female____________
TOTAL: Male____________ Female____________

A. POLICY ON SAFETY AND HEALTH:


(See attached Details)

B. COMPOSITION OF SAFETY AND HEALTH COMMITTEE:

NAME POSITION IN COMPANY

Chairman: 1- Project Manager

Secretary 1- Designated Safety Officer

Members: 1- Project Engineer


2- Foreman
3- Nurse/First Aider
4- Worker’s Representative
5- Worker’s Representative

C. TECHNICAL INFORMATION (Brief description of operations/process and list of


equipment utilize)
.

Submitted by:

_____________________
Owner/Project Manager

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