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    COVID19 Monitoring Form

    Uploaded by

    Mitch Alegayda
    This document is an establishment report on COVID-19 from Excellent Building Care & General Services in Quezon City, Philippines. It reports that the establishment has temporarily closed from March 23, 2020, affecting all 10 of its employees, including 1 manager, 1 supervisor, and 9 rank-and-file workers. The main reason for closure is listed as "building lockdown". Contact information and certification from the company manager is provided.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    COVID19 Monitoring Form

    Uploaded by

    Mitch Alegayda
    24 views1 page
    This document is an establishment report on COVID-19 from Excellent Building Care & General Services in Quezon City, Philippines. It reports that the establishment has temporarily closed from March 23, 2020, affecting all 10 of its employees, including 1 manager, 1 supervisor, and 9 rank-and-file workers. The main reason for closure is listed as "building lockdown". Contact information and certification from the company manager is provided.

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    Page-1-of-ER-on-COVID19-Monitoring-Form

    Original Title

    COVID19-Monitoring-Form

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    This document is an establishment report on COVID-19 from Excellent Building Care & General Services in Quezon City, Philippines. It reports that the establishment has temporarily closed from March 23, 2020, affecting all 10 of its employees, including 1 manager, 1 supervisor, and 9 rank-and-file workers. The main reason for closure is listed as "building lockdown". Contact information and certification from the company manager is provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views1 page

    COVID19 Monitoring Form

    Uploaded by

    Mitch Alegayda
    This document is an establishment report on COVID-19 from Excellent Building Care & General Services in Quezon City, Philippines. It reports that the establishment has temporarily closed from March 23, 2020, affecting all 10 of its employees, including 1 manager, 1 supervisor, and 9 rank-and-file workers. The main reason for closure is listed as "building lockdown". Contact information and certification from the company manager is provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Republic of the Philippines

    DEPARTMENT OF LABOR AND EMPLOYMENT


    +
    Intramuros, Manila
    Certificate Number: AJA15-0048
    ESTABLISHMENT REPORT ON COVID-19 Certificate Number: AJA15-0048

    _______________________________________
    (Region-PO/FO-Year-Month-Count)
    Instructions:
    1. Accomplish this form in two copies when filing a notice of: a) Flexible Work Arrangement or b) Temporary Closure.
    The report is considered as duly filed when the complete list of workers affected is made part of the submission.
    Fields with asterisks (*) should be accomplished by the company representative for COVID-19 Adjustment Measures
    Program applications.
    2. This form should be submitted to the DOLE Regional/Provincial/Field Office as soon as possible.
    3. Page 1 should contain general information about the establishment and the number of workers affected.
    4. Page 2 should enumerate the names of workers affected, their addresses and contact numbers, position title and
    salary.
    5. Total number of workers listed should equal the total number of workers affected as reported in this page.

    A. Establishment Data
    Name of Establishment*: (Please indicate registered name as reflected in the business permit)
    Excellent Building Care & General Services

    Floor/Bldg/No/Street/Subdivision*: No. 30 E.U. State Tower


    Barangay/City/Municipality*: Quezon Avenue, Quezon City
    Kind of Business/Economic
    Activity/Principal Product: Service Provider (Detailed in Hall of Justice Bacolod City)
    Number of Workers*: Male: 8 Managerial Employees:
    Female: 2 Supervisory: 1
    Total: 10 Rank and File: 9
    Total: 10
    Date of Filing*: (mm/dd/yyyy) March 25, 2020

    B. Summary of Affected Workers due to


    B.1 Flexible Work Arrangement*
    Type of Flexible Work Arrangement
    No. of Workers Effectivity Date
    to be Implemented
    Covered/Affected (mm/dd/yyyy)
    (Use code below, select only one)

    Codes for Flexible Work Arrangement Scheme:


     RW - Reduction of Workdays  FL - Forced Leave
     RE - Rotation of Employees  OTH - Others (Specify) ____________

    B.2 Temporary Closure*


    No. of Workers Effectivity Date Main Reason of Temporary Closure
    Covered/Affected (mm/dd/yyyy) (Use code below, select only one)
    10 03/23/2020 OTH

    Codes for Main Reason for Temporary Closure:


     LM - Lack of Market/Slump in Demand  I - Infection (COVID-19)
     LRM - Lack of Raw Materials  OTH - Others (Specify) Building Lockdown

    CERTIFICATION
    This is to certify as to the accuracy of the data provided in this report.
    Name and Signature of Owner/Company Representative*:
    Engr. EDGAR M. DE VERA
    Designation: Fax No.:
    Manager 02-8741-3727
    Contact No.: Email Address:
    +63 917-552-2435 [email protected]

    FOR DOLE (Regional/Provincial/Field Office) USE ONLY:


    Updates/Remarks, if any:
    Received/Verified by: a) Provision of assistance (please specify)
    ________________________________________________
    b) Estimated date of resumption of normal business operations:
    ______________________________________ ________________________________________________
    Name and Signature of DOLE Representative c) Others (please specify)
    ________________________________________________
    Name and Signature of DOLE Representative:
    Date: ______________

    Date: ______________

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