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    Bureau of Working Conditions: Application Form For Approval of Construction Safety and Health Program

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    Ruel Baria
    This document is an application form for approval of a Construction Safety and Health Program from the Department of Labor and Employment. It requires information about the applicant company, proposed project, assigned safety personnel, and a certification that an attached Construction Safety and Health Program has been prepared for the specific construction project. If approved, the program would be intended to ensure occupational safety and health standards are followed for the duration of the project.

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    Bureau of Working Conditions: Application Form For Approval of Construction Safety and Health Program

    Uploaded by

    Ruel Baria
    41 views2 pages
    This document is an application form for approval of a Construction Safety and Health Program from the Department of Labor and Employment. It requires information about the applicant company, proposed project, assigned safety personnel, and a certification that an attached Construction Safety and Health Program has been prepared for the specific construction project. If approved, the program would be intended to ensure occupational safety and health standards are followed for the duration of the project.

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    This document is an application form for approval of a Construction Safety and Health Program from the Department of Labor and Employment. It requires information about the applicant company, proposed project, assigned safety personnel, and a certification that an attached Construction Safety and Health Program has been prepared for the specific construction project. If approved, the program would be intended to ensure occupational safety and health standards are followed for the duration of the project.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    41 views2 pages

    Bureau of Working Conditions: Application Form For Approval of Construction Safety and Health Program

    Uploaded by

    Ruel Baria
    This document is an application form for approval of a Construction Safety and Health Program from the Department of Labor and Employment. It requires information about the applicant company, proposed project, assigned safety personnel, and a certification that an attached Construction Safety and Health Program has been prepared for the specific construction project. If approved, the program would be intended to ensure occupational safety and health standards are followed for the duration of the project.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Form No.

    : CSHP 13-98:
    Date of Effectivity: May 2008 Page 1of 2

    Department of labor and Employment APPLICATION FORM for APPROVAL OF


    BUREAU OF WORKING CONDITIONS CONSTRUCTION SAFETY AND HEALTH PROGRAM

    Legal Basis: Section 5 of Department Order No. 13 s 1998 (Guidelines Governing


    Occupational Safety and Health In Construction Industry)

    Instructions: This form shall be duly accomplished and submitted by a contractor in applying for an
    approval of a Construction Safety and Health Program intended for a specific construction project.

    Note: Only application form with complete information and attachment may be received, but shall only
    be processed upon submission of complete information and attachment. If no complete submission
    was done within fifteen (15) working days upon initial submission, the application will be deemed
    disapproved.

    A. Company Profile
    Complete Name of Company/Contractor Complete Address:

    Please check if:


    ( ) main contractor ( ) sub-contractor Tel. No/Fax No. Email address

    Name of President/Manager:

    Company License/Registration
    1. PCAB License No. Validity Date Approved

    2. DOLE Registration ( Pls. attach photo copy of Registration forms received and approved by the concerned
    DOLE Regional Office)
    Date Registered
    a. per DO 18-02 ( requires yearly renewal) __________________

    b. per Rule 1020, OSHS (one time registration) __________________

    B. Project Profile/Description
    Name of the Project: (Please attach copy of Invitation to Bid.)

    Complete Address/Location of the Project Name of Project Owner


    Tel. No: _____________

    Fax No: _____________

    Email : _____________

    Project Classification: Duration of the project Date of Estimated Start/Execution of the


    (Pls. state the number of project:
    calendar days ________________________
    Month Day Year

    Estimated no. of Workers to be


    deployed in the
    project
    Brief Description of Activities/Work Flow
    Form No.: CSHP 13-98:
    Date of Effectivity: May 2008 Page 2of 2

    Department of labor and Employment APPLICATION FORM for APPROVAL OF


    BUREAU OF WORKING CONDITIONS CONSTRUCTION SAFETY AND HEALTH PROGRAM

    OSH Personnel assigned to the project

    Name of Appointed Safety Officer/s: Name of Appointed First-Aider/s:

    _________________________________________ ______________________________________

    Date of his/her BOSH training: _________________ Date of First –Aid Training: __________________

    (Pls. attach photo copy of Certificate of Completion on the Validity of ID: __________________
    Basic OSH Course for Construction Site Safety Officers)
    (Pls. attach photo copy of Certificate of First-Aid Training
    and Valid First Aider ID from PNRC

    Other OH personnel (if more than 50 workers will be deployed in the project)
    Name Date of Training
    OH Nurse
    OH Physician
    Dentist
    (If Heavy Equipment will be used in the Project)
    List of Heavy Equipment to be Used in the Project Name of Heavy Equipment Operator/s (To attach photo
    (Please attach addition sheet, if necessary) copy of skills certification from TESDA)

    Profile of person who prepared the program:


    Name and Signature Educational Background:

    ___________________-________ Work Experience in OSH:


    Signature over printed name
    Other Qualifications:

    I HEREBY CERTIFY ON MY HONOR TO THE TRUTHFULLNESS OF THE ABOVEMENTIONED


    INFORMATION. Attached is a copy of the CONSTRUCTION SAFETY AND HEALTH PROGRAM FOR THE
    ABOVEMENTIONED PROJECT.

    Submitted By:

    Signature Over Printed Name

    Position: _________________

    Date: ________________

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