DISCIPLINARY ACTION

reference no.: DA/EHS/F/___/__-00__

Project Name: Location: Date:

Project Code: Name: Offense:

Company/Sub-Contractor: Position/Designation

Company/Sub-Contractor: Date & Time of Violation:

NON WEARING OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

[ ] Identification Card [ ] HCC Uniform [ ] Face Shield
[ ] Hard Hat [ ] Working Pants [ ] Welding Mask
[ ] Safety Glass [ ] Safety Belt [ ] Safety Shoes
[ ] Goggles [ ] Safety Gloves Others
[ ] Ear Plug [ ] Welding Gloves [ ] _________________

UNSAFE ACT DURING WORKING HOURS AND OR VIOLATION INSIDE COMPANY/

PROJECT PREMISES
[ ] Smoking on Prohibited Areas [ ] Drinking Liquor
[ ] Horse Playing [ ] Gambling of any Sort
[ ] Bringing or in Possession of any Deadly Weapon [ ] Curfew Hour
[ ] Littering Unnecessarily [ ] Others

REMARKS:

PENALTIES:

Prepared by: Checked by:

EHS Officer Construction Manager

Approved by:

Project Manager
 WORK ACCESS PERMIT

Project Name :
Project Code :
Location :

CONTRACTOR/ SUBCONTRACTOR :

DATE COVERAGE: :
Time
No. Names Activites Floor/Unit Date of Activities
Start
1
2
3
4
5
6
7

8
9
10
11
12
13
14
15
16
NAME SIGNATURE DATE
Requested by:
Contractor/ Subcontractor
Checked by:
EHS Officer

Project In Charge

Approved by:

Project Manager

Indicate Additional Required or Minimum PPE to wear: (to be filled up by PGCDC EHS Personnel)

Inspection/ Monitoring on the Effectiveness of Work Access Permit

Date/ Time of Inspection workers wearing complete PPE Inspected by:
workers wearing incomplete PPE
EHS Personnel/ Print Name & Sign
______________________
workers attended and passed thru safety orientation
Evaluation of JHA Remarks: _________________________ Conformed by:
JHA Complied ____________________________________
JHA Not Complied ____________________________________
Contractor/ Subcontractor/ Print Name & Sign
Effectivity Date: October 7, 2019 Form No.: PGCDCF-40-004-016 Revision 4
ACCESS PERMIT

Time
End

DATE

mum PPE to wear: (to be filled up by PGCDC EHS Personnel)

n the Effectiveness of Work Access Permit

 HOT WORK PERMIT
Project Name:
Project Code: Date:
Contractor/ Subcontractor: _____________
Specific Work Location:
Specific Work Process:

To be signed by company/ Subcontractor representative who will perform the said work:
Welder/s (Print Name and Sign):

IMPORTANT: THE PROJECT SAFETY OFFICER AND HIS APPOINTEE SHALL INSPECT THE WORK AREA AND CONFIRM THAT
THE PRECAUTIONARY CHECKLIST BELOW HAVE BEEN TAKEN TO PREVENT FIRE UPON APPROVING THIS PERMIT.

Y N N/A

1 Cutting and welding operated by a qualified person

2 Cutting3.1
and welding equipment is in good condition
2.1 Oxy- acetylene
2.1.1 Hoses are leak-free and properly laid out
2.1.2 Hose connections on the regulators and torch ends
are tightened.
2.1.3 Appropriate Oxy-acetylene lighter is provided.
2.1.4 Regulators are in good condition.
2.1.5 Wrench is available.
2.1.6 Cylinder cart is provided.
2.2 Welding Machine
2.2.1 Weding power sources
2.2.2 Welding cable connections
2.2.3 Welding cable extension connections
2.2.4 Electrode holder in good condition
4 Sprinkler system in service
5 Floor swept clean of combustible materials
6 Combustible floors wet down and/or shielded
7 No flammable materials stored near the working area
8 Wall and floor opening covered
9 Covers suspended beneath work to collect spark
10 Confined space entry permit secured
11 Fire extinguisher and/or water immediately available
12 Proper grounding system.

13 Fire watcher provided during, and 30 minutes after work process is completed to
verify that the work area and all adjacent areas to which sparks and heat might have
spread are fire safe.

Fire Watcher/s (Print Name and Sign)

WE HEREBY AGREED AND WILL COMPLY WITH ALL SAFETY PRECAUTIONS AND PROCEDURES AS SPECIFIED ABOVE:

PROJECT SUPERVISOR CONTRACTOR'S SAFETY PERSONNEL

(Print Name and Sign) (Print Name and Sign)

Checked by: Approved by:

EHS Officer Project Manager

(Print Name and Sign) (Print Name and Sign)
Indicate Additional Required or Minimum PPE to wear:
_________________________________________________________________________________________________________

Inspection/ Monitoring on the Hot Work Permit

Date/ Time of Inspection workers wearing complete PPE Inspected by:

workers wearing incomplete PPE

______________________ EHS Officer/Safety Officer

workers attended and passed thru safety orientation
Evaluation of JHA Remarks: _________________________ Conformed by:
JHA Complied ____________________________________ Contractor/ Subcontractor/ Print Name & Sign

JHA Not Complied ____________________________________

Effectivity Date: October 7, 2019 Form No.: PGCDCF-40-004-006 Revision 4

 GRINDING AND RECTIFICATION WORK PERMIT

Project Name : Date :

Project Code : Time :
Location :
Contractor :
Purpose/s :

NAME OF WORKERS: POSITION ACTIVITY

1
2
3
5
6
7
8
9
10

Specific Work Procedure

Requested by:

Print Name & Sign

Checked by:

EHS Officer Construction Superintendent

Print Name and Sign Print Name & Sign

Approved by:

Construction Manager
Print Name & Sign
Indicate Additional Required or Minimum PPE to wear: (to be filled up by PGCDC EHS Personnel)

Inspection/ Monitoring on the Effectiveness of Grinding & Rectification Work Permit

Date/ Time of Inspection workers wearing complete PPE
Inspected by:
workers wearing incomplete PPE

______________________ workers attended and passed thru safety

orientation
Evaluation of JHA Remarks: _________________________ Conformed by:
JHA Complied ____________________________________
JHA Not Complied ____________________________________ Noted by:
TIFICATION WORK PERMIT

ACTIVITY

Requested by:

int Name & Sign

Checked by:

Construction Superintendent

Approved by:

struction Manager
int Name & Sign
PGCDC EHS Personnel)

ification Work Permit

Inspected by:

Conformed by:

Noted by:
 HOT WORK PERMIT
Project Name:
Project Code: Date:
Contractor/ Subcontractor: _____________
Specific Work Location:
Specific Work Process:

To be signed by company/ Subcontractor representative who will perform the said work:
Welder/s (Print Name and Sign):

IMPORTANT: THE PROJECT SAFETY OFFICER AND HIS APPOINTEE SHALL INSPECT THE WORK AREA AND CONFIRM THAT
THE PRECAUTIONARY CHECKLIST BELOW HAVE BEEN TAKEN TO PREVENT FIRE UPON APPROVING THIS PERMIT.

Y N N/A

1 Cutting and welding operated by a qualified person

2 Cutting3.1
and welding equipment is in good condition
2.1 Oxy- acetylene
2.1.1 Hoses are leak-free and properly laid out
2.1.2 Hose connections on the regulators and torch ends
are tightened.
2.1.3 Appropriate Oxy-acetylene lighter is provided.
2.1.4 Regulators are in good condition.
2.1.5 Wrench is available.
2.1.6 Cylinder cart is provided.
2.2 Welding Machine
2.2.1 Weding power sources
2.2.2 Welding cable connections
2.2.3 Welding cable extension connections
2.2.4 Electrode holder in good condition
4 Sprinkler system in service
5 Floor swept clean of combustible materials
6 Combustible floors wet down and/or shielded
7 No flammable materials stored near the working area
8 Wall and floor opening covered
9 Covers suspended beneath work to collect spark
10 Confined space entry permit secured
11 Fire extinguisher and/or water immediately available
12 Proper grounding system.

13 Fire watcher provided during, and 30 minutes after work process is completed to
verify that the work area and all adjacent areas to which sparks and heat might have
spread are fire safe.

Fire Watcher/s (Print Name and Sign)

WE HEREBY AGREED AND WILL COMPLY WITH ALL SAFETY PRECAUTIONS AND PROCEDURES AS SPECIFIED ABOVE:

PROJECT SUPERVISOR CONTRACTOR'S SAFETY PERSONNEL

(Print Name and Sign) (Print Name and Sign)

Checked by: Approved by:

EHS Officer Project Manager

(Print Name and Sign) (Print Name and Sign)
Indicate Additional Required or Minimum PPE to wear:
_________________________________________________________________________________________________________

Inspection/ Monitoring on the Hot Work Permit

Date/ Time of Inspection workers wearing complete PPE Inspected by:

workers wearing incomplete PPE

______________________ EHS Officer/Safety Officer

workers attended and passed thru safety orientation
Evaluation of JHA Remarks: _________________________ Conformed by:
JHA Complied ____________________________________ Contractor/ Subcontractor/ Print Name & Sign

JHA Not Complied ____________________________________

Effectivity Date: October 7, 2019 Form No.: PGCDCF-40-004-006 Revision 4

 JOB HAZARD ANALYSIS
reference no.: JHA/EHS/HW/FIRESTOP/____-00__
Project Name FORDHAM TOWER, EASTBAY RESIDENCE Date of work
Project Code Time In : 7AM
Location SUCAT, MUNTINLUPA Time Out : 4PM

Type of Hazardous Operation: (Please check)

Blasting Deep Excavattion Scaffolds Erection
Chemical Use Energized Electrical Work Working at Heights
Confined Space Hot Work Others (Specify)
Demolition Grinding and Rectification
Confined Space Entry Installation/ Dismantling of Equipment
Lifting and Rigging
Specific Work Area:

WORK PROCEDURE HAZARDS IDENTIFIED RECOMMENDED CONTROL

1. Before welding is permitted the area shall Inhalation due to hazardous fumes,gases and dusts Appropiate ventilation and dust masks must be worn
be inspected by an individual responsible for
authorizing welding operations. Eye injury cause by projectiles, fumes, dusts Safety glasses w/ side shields/goggles
2. Operate equipment in strict accordance and flashes.
with manufacturer's instructions.
3. Only authorized users can operate Trauma cause by projectiles or burns Situational awareness, PPE, protective clothing,
equipment certified by TESDA. switch guards
4. Connections and machine grounding shall
be checked electrician prior to use. Foot injury cause by drop object on foot Wear safety shoes
5. Report any observed defect or safety
hazard to your supervisor immediately. Fire/explosions cause by heat, sparks, slag Placed appropiate fire extinguisher, remove all
combustibles and fire hazards from welding area.
Other:
Electric shock due to improper grounding,improper Proper grounding of the welding equipment
operations and maintenance, improper strictly followed manufacrurer's instructions,
switching device proper switching for shutting down machine.

Other: Wear appropriate Personal Protective equipment

* Welding masks, welding gloves

Provide fire blankets if necessary, to collect flux

Complied w/ the necessary or additional safety

requirements by the client or the owner.

Other:

ANALYSIS DONE: APPROVED BY:

COMPETENT PERSON/ SAFETY OFFICER RPSDC REPRESENTATIVE

(Print Name & Sign/ Position) (Print Name & Sign/ Position)

Copy received:

Supervisor :
Date :
 JOB HAZARD ANALYSIS
Project Name Date of work
Project Code Time In :
Location Time Out :

Type of Hazardous Operation: (Please check)

Blasting Deep Excavattion Scaffolds Erection
Chemical Use Energized Electrical Work Working at Heights
Confined Space Hot Work Others (Specify)
Demolition Grinding and Rectification
Confined Space Entry Installation/ Dismantling of Equipment
Lifting and Rigging
Specific Work Area:

WORK PROCEDURE HAZARDS IDENTIFIED RECOMMENDED CONTROL

* CHECK WORK AREA * FOREIGN MATERIALS SEGREGATE * SECURE WORKING AREA
IN WORKING AREA

* PREPARATION OF MATERIAL * USE CONNECTION INEFFICIENT * CHECK WIRE CONNECTION

TOOLS NEEDED

* INSTALLATION OF PIPES * HAND INJURIES LIKE * USE PROPER PPE LIKE

* CUTS WORKING GLOVES
* SPRAIN * PROPER HAND POSITIONING
* FENCE POINTS IN BETWEEN FROM FENCE POINT
FIX STRUCTURE & PIPES

* HOUSE KEEPING * MINOR AND MAJOR INCIDENT * PROPER HOUSEKEEPING

CAN CAUSE ACCIDENT

ANALYSIS DONE: APPROVED BY:

COMPETENT PERSON/ SAFETY OFFICER EHS OFFICER

(Print Name & Sign/ Position) (Print Name & Sign/ Position)

Copy received:

Supervisor :
Date :
 PHENIX GARUDA CONSTRUCTION AND DEV'T
CORP.
# 66 Felix Manalo St. Brgy. Pinagkaisahan Quezon City
JOB HAZARD ANALYSIS
Project Name PROSCENIUM PHASE 2 Date of work
Project Code PE-16-005 Time In
Location ROCKWELL CENTER MAKATI CITY Time Out

Type of Hazardous Operation: (Please check)

Blasting Deep Excavattion
Chemical Use Energized Electrical Work
Confined Space Hot Work
Demolition Grinding and Rectification
Confined Space Entry Inst./Dismantling of Equipment
Lifting and Rigging
Specific Work Area:

WORK PROCEDURE HAZARDS IDENTIFIED

Formworks
Installation of formworks materials and Loss of control or mishandle of accessories and Tied
accessories hand tools that may injured to self or others Ensu
Use of hand tools or hammer on tightening or Falling of materials Wear
fixing of tie rods, double waller pipes, wing nuts, Hand injury, caught in, on or between objects
screw jacks, base jacks, adjustable turnbackels, Head injury Lim
and other accessories Struck against rigid structure, sharp or rough objects
Nailing phenolic boards to alluma beams Tripping hazards
Assembly of Cast- in place formworks Prolonged exposure to noise Admi
Installation and Conventional formworks Nail puncture / Eye irritation
Installation and Column formworks Physical injury/ partial/permanent disability Watc
Laceration, abrasion, fracture, skin bruise Secu
Incomplete formworks supports and bracing Follo
Collapse on the install formworks structures Insta
Con

Cutting of phenolic boards using hand saw Hand injury, caught in, on or between objects Insta
Cutting of phenolic boards using portable Loss of control or mishandle of hand tools that
circular saw that may injured to self or others
Pinching of holes on phenolic boards using Electrocution, Tool malfunction Wear
hole saws and elctric drills Inhalation of sawdust or wood shaving
Physical injury/ partial/permanent disability
Laceration,abrasion,fracture,skin bruise eye irritation

Tower crane will be used to lift and install the Failure to follow procedure Ensur
 necessary panels formworks materials (gang forms) Struck by or caught in between formworks materials Follo
for the construction of cast-in-place Fall from heights
peripheral walls Falling formworks materials and accessories
Fly out of table forms Physical injury/ partial/permanent disability Prov
Damage to property and loss of life Mon
Malfunction of the lifting equipments
Poor housekeeping Insta
Other: Other: Ensu
Con
.Ob

Other:

ANALYSIS DONE:

COMPETENT PERSON/ SAFETY OFFICER

(Print Name & Sign/ Position)

Copy received:

Supervisor :
Date :
 STRUCTION AND DEV'T
isahan Quezon City
ARD ANALYSIS
reference no.: JHA/EHS/FW/___/____-00__
:
:
:

Scaffolds Erection
Working at Heights
Formworks
Rebarworks
Working at Heights
Others (Specify)

RECOMMENDED CONTROL

Tied all tools to be use to prevent accidental falling

Ensure the area is clear of other workers
Wear complete basic Personal Protective Equipments
and secondary PPE like earplugs, gloves, goggles, harness
Limiting workers exposure by taking breaks
Assign workers that are equipped with skills, knowledge
and familiarity on installation of formworks
Administrative Control-strict enforcement of Incomplete
PPE No Work Policy and to install warning signages
Watch for tripping hazards, especially at edges.
Secure and comply on SCAFFOLDS INSPECTION CHECKLIST
Follow necessary requirements by the drawings and plans
Install safe working platfrorms with railings (if needed)
Constant supervision by a competent person

Install machine guards on circular saw

Assign workers that are equipped with skills, knowledge
and familiarity on using the hand and electric tools
Wear complete basic Personal Protective Equipments
and secondary PPE like dust masks, gloves and goggles
Regular checking of hand and electric tools and replace
all defective tools

Ensure to accomplished safety requirements on critical lift

 Follow the safety requirements when working at heights
Engineering control- installation of debris nets to wrap
around the scaffoldings to prevent any materials from falling
Provision and use of lifeline, rope grab, full body harness
Monitoring and assessment of weather conditions
Ensure that slings, shackles, clamps, hooks are inspected
Install safe working platfrorms with railings (if needed)
Ensure compliance on working at heights requirements
Constant supervision of the formworks engineer
.Observe proper houskeeping, Clean work area as
needed during the day pick up excess materials
Other:

APPROVED BY:

EHS OFFICER
(Print Name & Sign/ Position)
 JOB HAZARD ANALYSIS
Project Name Date of work
Project Code Time In
Location Time Out

Type of Hazardous Operation: (Please check)

Blasting Deep Excavattion
Chemical Use Energized Electrical Work
Confined Space Hot Work
Demolition Grinding and Rectification
Confined Space Entry Inst./Dismantling of Equipment
Lifting and Rigging
Specific Work Area:

WORK PROCEDURE HAZARDS IDENTIFIED

Delivery of reinforcement bar and its Falling rebars and accessories Ensure
accessories and placing it on staging area Loss of control or mishandlingthat may injured to No per
Lifting and positioning the assorted rebars self or others
on fabrication or on working areas will it be install Hand injury, caught in, on or between objects Use tag
Rebars will be transfer area by area lifted Struck against rigid structure, sharp or rough objects
manually or using cranes for heavy and larger Head injury
members Tripping hazards Admini
Puncture
Physical injury/ partial/permanent disability Watch
Laceration, abrasion, fracture, skin bruise Crane o
Malfunction of the lifting equipments and it's lifting always
accessories Install
Isolate
During
Ensure
operators an

Fabrication of reinforcement bar to specific Hand injury, caught in, on or between the bar
shapes and dimensions based on the cutting list bender and bar cutter
Rebar cold fabrication using mechanical bar Electrocution, malfunction of the machine
bender and bar cutter Physical injury/ partial/permanent disability
Laceration,abrasion,fracture,skin bruise eye irritation Wear c
Struck by or caught in between rebars
Exposed on hot weather and or rainfall
Other person may hit by bending rebars
 Always
Isolate
Provide

Installation of rebars for footing and tie ,beams Failure to follow procedure Ensure
Installation of stirrups Struck by or caught in between rebars Follow
Installation rebars for columns Fall from heights
Installation of rebars for beams Falling rebars and accessories
Installation of rebars for slab Physical injury/ partial/permanent disability
Working at heights Damage to property and loss of life Watch
Using of cranes during rebar installation Malfunction of the lifting equipments
Pinch points Monit
Collapse or bending of install collumn rebars
especially when hit by strong winds Install
Poor housekeeping, scattered rebars and tie wires
Other: Make
Provi
Instal
Wear c
Const
.Obse

Install
Other: Other:

ANALYSIS DONE:

COMPETENT PERSON/ SAFETY OFFICER

(Print Name & Sign/ Position)

Copy received:

Supervisor :
Date :
ARD ANALYSIS
:
:
:

Scaffolds Erection
Working at Heights
Formworks
Rebarworks
Working at Heights
Others (Specify)

RECOMMENDED CONTROL
Ensure compliance on the critical lifting permit/procedure
No personnel walking or standing underneath suspended
or lifted rebars
Use tag-lines to control load movements
Assign workers that are equipped with skills, knowledge
and familiarity on the task
Administrative Control-strict enforcement of Incomplete
PPE No Work Policy and to install warning signages
Watch for tripping hazards, especially at edges.
Crane operator must operate with caution, alertness and
always have coordination with riggers and spotteers
Install safe working platfrorms with railings (if needed)
Isolate work area using barricade and provide signages
During manual handling observe buddy system
Ensure that all required certificate of equipments and the
operators and riggers are valid and readily available

Assign workers that are equipped with skills, knowledge

and familiarity on rebar fabrication
Only authorized person equipped with skills, knowledge
are allowed to operate the bar bender and bar cutter
Wear complete basic Personal Protective Equipments
and secondary PPE like fitted safety gloves and goggles
Regular checking and inspection of the bar bender and
bar cutter,report and replaced all seen defectivity
 Provide tent or presentable temporary shelters for workers
Always observed and practice buddy system
Isolate fabrication area and provide safety signages
Provide safe drinking water readily available on the area

Ensure to accomplished safety requirements on critical lift

Follow the safety requirements when working at heights
Use proper lifting techniques and avoid over extending
Use clear communication when working in teams most
especially when erecting heavy vertical rebars
Watch out for ends of tie wires and sharp edges on rebar
Provision and use of lifeline, rope grab, full body harness
Monitoring and assessment of weather conditions
Ensure that slings, shackles, clamps, hooks are inspected
Install safe working platfrorms with railings when needed
Make sure that trained workers are climbing on columns
Make sure that vertical and horizontal bars are tied
Provide sufficient bracings and support
Install scaffoldings and safe working platforms if needed
Wear complete PPE especially gloves and safety harness
Constant supervision of the rebar engineer or supervisors
.Observe proper houskeeping, Clean work area as
needed during the day pick up tie wires and excess materials
Install rebar caps or bend protruding rebars
Other:

APPROVED BY:

EHS OFFICER
(Print Name & Sign/ Position)
 LIST OF DAILY MANPOWER AND EQUIPMENT
Project Name:
Project Code:
Location:
Date:
Contractor:

Day Shift : 7:00 am- 4: 00 pm Night Shift : 6:00 pm-

Safety Officer : Safety Officer :

Engineer : Engineer :
Foreman/Leadman : Foreman/Leadman :
Timekeeper : Timekeeper :
Warehouseman : Warehouseman :
Carpenter : Carpenter :
Electrician : Electrician :
Mason : Mason :
Welder/Steelman : Welder/Steelman :
Laborer/Helper : Laborer/Helper :
Plumber : Line & Grade :
Other/s : Other/s :

TOTAL : TOTAL :

Scope of Work
Activities w/ Location

LIST OF EQUIPMENT USED

Welding Machine :
Acetylene :
Hand Drill :
Jack Hammer :
Oxygen :
Others
:
:
:

TOTAL :

Prepared by:
POWER AND EQUIPMENT

QUIPMENT USED
 ENVIRONMENTAL, HEALTH and SAFETY INSPECTION CHECKLIST

Project Name: Date: _________________

Project Code:

Location:

ITEMS OF CONCERN YES NO N/A REMARKS

I. FIRE PROTECTION
1 FIRE DRUMS W/ WATER & PAIL IN PROPER LOCATIONS [ ] [ ] [ ]
2 SIGNAGES INSTALLED ON SPECIFIED LOCATIONS [ ] [ ] [ ]
3 HOT WORK WITH PERMIT/FIRE EXTIGUISHER & WATCHER [ ] [ ] [ ]
4 ABSENCE OF ACCUMULATING FIRE HAZARDS [ ] [ ] [ ]
5 FIRE EXTIGUISHERS SUFFICIENT [ ] [ ] [ ]
6 NO SMOKING ON SPECIFIED AREAS IMPLEMENTED [ ] [ ] [ ]

II. PROPERTY PROTECTION

1 FENCE WELL MAINTAINED [ ] [ ] [ ]
2 USE OF I.D. IMPLEMENTED [ ] [ ] [ ]
3 ADEQUATE LIGHTING PROVIDED [ ] [ ] [ ]

III. ELECTRICAL SAFETY

1 TEMPORARY WIRING IN GOOD CONDITION [ ] [ ] [ ]
2 TEMPORARY WIRES PROPERLY INSTALLED [ ] [ ] [ ]
3 TEMPORARY ELECTRIC WIRES AT ACCESS AREAS ARE ELEVATED BY
ATLEAST 10 FT OR 3 METERS [ ] [ ] [ ]
4 PROPER RATED FUSE PROVIDED [ ] [ ] [ ]

IV. HEALTH & SANITATION

1 HOUSEKEEPING WELL MAINTAINED [ ] [ ] [ ]
a OUTSIDE PERIMETER FENCE [ ] [ ] [ ]
b TEMFACIL AREA [ ] [ ] [ ]
2 ABSENCE OF WATER PONDING [ ] [ ] [ ]
3 FUMIGATION IMPLEMENTED [ ] [ ] [ ]
4 PORTABLE TOILETS SUFFICIENT [ ] [ ] [ ]
5 DISPOSAL OF GARBAGE, REGULAR [ ] [ ] [ ]
6 MESS HALL ADEQUATE & CLEAN [ ] [ ] [ ]
7 WORKER'S WASHING AREA PROVIDED [ ] [ ] [ ]
8 AVAILABILITY OF POTABLE DRINKING WATER ON ACTIVE FLOOR OR ON
AREA THAT IS EXTREMELY HOT [ ] [ ] [ ]

V. SAFE WORKING CONDITIONS

1 STAIRS & WALKWAYS UNOBSTRUCTED [ ] [ ] [ ]
2 CONSTRUCTION AREA PROPERLY ILLUMINATED [ ] [ ] [ ]
3 ABSENCE OF TRIPPING HAZARDS [ ] [ ] [ ]
4 ABSENCE OF PROTRUDING OBJECTS (NAILS, REBARS, ETC.) [ ] [ ] [ ]
5 SHORING SUFFICIENT [ ] [ ] [ ]
6 RAILING ADEQUATE [ ] [ ] [ ]
7 TWO WAY LADDER SYSTEM IN PLACE [ ] [ ] [ ]
8 EMERGENCY LIGHTINGS FULLY CHARGED AND AVAILABLE [ ] [ ] [ ]
9 PROVISION OF ADEQUATE VENTILATION AT BASEMENT LEVELS [ ] [ ] [ ]

VI. PERSONAL PROTECTIVE EQUIPMENT

1 HARD HAT [ ] [ ] [ ]
2 SAFETY SHOES [ ] [ ] [ ]
 3 SAFETY BELTS/FULL BODY HARNESS [ ] [ ] [ ]
4 SAFETY GOGGLES [ ] [ ] [ ]
5 GLOVES [ ] [ ] [ ]
6 DUST MASK [ ] [ ] [ ]
7 EAR PLUG [ ] [ ] [ ]
8 WEARING OF REFLECTORIZED VEST BY QA/QC & SAFETY
PERSONNEL DURING INSPECTIONS & WALK THRU [ ] [ ] [ ]

VII. FIRST AID

1 FIRST AID KIT AVAILABLE [ ] [ ] [ ]
2 FIRST AIDER ON DUTY [ ] [ ] [ ]
3 EMERGENCY TRANSPORTATION AVAILABLE [ ] [ ] [ ]
4 LIST OF MEDICINES INDICATING THE EXPIRATION DATES IS AVAILABLE [ ] [ ] [ ]

VIII. RIGGING EQUIPMENT Type: _________________

1 EQUIPMENT SERIAL NO. [ ] [ ] [ ]
2 CABLES AND WIRES IN GOOD CONDITION [ ] [ ] [ ]
3 CHAIN NOT DEFORMED [ ] [ ] [ ]
4 LIFTING BELT IN GOOD CONDITION [ ] [ ] [ ]
5 HOOK IN GOOD CONDITION [ ] [ ] [ ]
7 LINKS IN GOOD CONDITION [ ] [ ] [ ]
8 HOOK SAFETY LATCH PROVIDED [ ] [ ] [ ]

IX. TRAFFIC CONTROL /ROAD SIDE

1 ROAD DETOURS [ ] [ ] [ ]
2 WARNING SIGNS AND BARRIERS [ ] [ ] [ ]
3 SITE ACCESS ROAD SIGNS [ ] [ ] [ ]
4 LIGHTS [ ] [ ] [ ]
5 FLAGMAN [ ] [ ] [ ]
6 WORK PERMIT [ ] [ ] [ ]
7 REFLECTORIZED VEST [ ] [ ] [ ]

X. TRENCHING/EXCAVATION & SHORING

1 SHORING/TRENCH BOX/SLOPING/BENCHING/SHIELDING [ ] [ ] [ ]
2 CROSS OVER RAMPS [ ] [ ] [ ]
3 SPOIL CLEARANCE [ ] [ ] [ ]
4 BARRIERS/WARNING SIGNS/LIGHTS [ ] [ ] [ ]
5 ACCESS/EGRESS( LADDER) [ ] [ ] [ ]
6 BARRICADES [ ] [ ] [ ]
7 PUBLIC WALKWAY [ ] [ ] [ ]
8 STANDBY MAN MONITORING [ ] [ ] [ ]

XI. HAND AND POWER TOOLS

1 PROPERLY GUARDED [ ] [ ] [ ]
2 OVERALL CONDITIONS [ ] [ ] [ ]
3 CORRECT GRINDER DISC SPEEDS [ ] [ ] [ ]
4 CABLE/HOSE CONNECTION [ ] [ ] [ ]
5 OPERATORS PERSONAL PROTECTIVE EQUIPMENT [ ] [ ] [ ]
6 DAMAGED HAND TOOLS [ ] [ ] [ ]
7 ELECTRICAL TOOL IS RATED AT 220V [ ] [ ] [ ]

XII. CRANE AND LIFTING DEVICES

1 CURRENT INSPECTION STICKERS [ ] [ ] [ ]
2 CERTIFICATION OF OPERATORS [ ] [ ] [ ]
3 LOAD RADIUS INDICATION [ ] [ ] [ ]
4 SAFETY LATCHES (HOOKS) [ ] [ ] [ ]
5 CONDITION OF SLING [ ] [ ] [ ]
6 SAFE LOAD CHART [ ] [ ] [ ]
7 LATTICE/BOOM DAMAGE [ ] [ ] [ ]
8 ANTI TWO BLOCK DEVICE [ ] [ ] [ ]
9 PROPER USE OF OUTRIGGERS [ ] [ ] [ ]
10 TAG LINES USED [ ] [ ] [ ]
 11 SIGNAL MAN/RIGGER [ ] [ ] [ ]
12 FIRE EXTINGUISHER [ ] [ ] [ ]
13 REFLECTORIZED VEST [ ] [ ] [ ]

XIII. WORKING AT HEIGHTS/SCAFFOLDS/MOBILE TOWER/WORKING FLATFORM(GONDOLA)

1 SCAFFOLDS ARE ERECTED BY COMPETENT SCAFFOLDERS [ ] [ ] [ ]
2 SCAFFOLDS ARE SECURED TO THE BUILDING IN ENOUGH [ ] [ ] [ ]
PLACES TO PREVENT SCAFFOLD FROM COLLAPSE [ ] [ ] [ ]
3 THERE IS A IDENTIFIED PASSAGEWAY AND CLEAR FROM ANY OBSTRUCTION
ON THE AREA WHERE SCAFFOLDS ARE ERECTED. [ ] [ ] [ ]
4 BASE AND SOLE PLATES [ ] [ ] [ ]
5 PROPER WHEELS/CONDITIONS/LOCKS [ ] [ ] [ ]
6 SCAFFOLD ACCESS [ ] [ ] [ ]
7 PROPER COUPLERS AND TUBING [ ] [ ] [ ]
8 PLANKING [ ] [ ] [ ]
9 TOE BOARDS/GUARD RAILS [ ] [ ] [ ]
10 CHECKLIST COMPLETED [ ] [ ] [ ]
11 SCAFFOLDING SIGNED/TAGGED [ ] [ ] [ ]
12 FULL BODY HARNESS [ ] [ ] [ ]
13 INDEPENDENT LIFELINE [ ] [ ] [ ]
14 ROPE GRAB [ ] [ ] [ ]
15 MAINTAIN MAXIMUM WEIGHT (LOAD) 450 KG [ ] [ ] [ ]
16 STRICTLY 3 PASSENGER ONLY [ ] [ ] [ ]
17 CHECK MOTOR & CABLES [ ] [ ] [ ]

XIV. HEAVY EQUIPMENT

1 ROLL OVER PROTECTION ( WHERE REQUIRED) [ ] [ ] [ ]
2 BACK -UP ALARMS [ ] [ ] [ ]
3 OVERALL CONDITIONS (360 DEGREE CLEAR VISION) [ ] [ ] [ ]
4 HEAVY EQUIPMENT LICENSED OPERATORS [ ] [ ] [ ]
5 FIRE EXTINGUISHER [ ] [ ] [ ]
6 PERIODIC MAINTENANCE LOG [ ] [ ] [ ]
7 PROTECTIVE GUARD IN PLACE [ ] [ ] [ ]
8 SAFE DISTANCE OF EQUIPMENT [ ] [ ] [ ]

XV. GAS/ELECTRIC WELDING

1 ACETYLENE PRESSURE BELOW 15 PSI [ ] [ ] [ ]
2 ACETYLENE ON/OFF WRENCH [ ] [ ] [ ]
3 GAUGES/HOSES CONDITIONS/CLAMPS [ ] [ ] [ ]
4 OPERATORS PROTECTIVE EQUIPMENT [ ] [ ] [ ]
5 CABLE CONDITION ( NO SPLICES ) [ ] [ ] [ ]
6 ELECTRODE HOLDER/GROUND CLAMP CONDITION [ ] [ ] [ ]
7 VENTILATION [ ] [ ] [ ]
8 GROUNDING ROD [ ] [ ] [ ]
9 ANTI FLASH SCREEN [ ] [ ] [ ]
10 FLASH BACK ARRESTOR [ ] [ ] [ ]
11 FIRE EXTINGUISHER [ ] [ ] [ ]

XVI. OXY-ACETYLENE
1 Hoses are leak-free and properly laid out. [ ] [ ] [ ]
2 Hose connections on the regulators and torch ends
are tightened. [ ] [ ] [ ]
3 Warning signs are properly provided. [ ] [ ] [ ]
4 Appropriate Oxy-acetylene lighter is provided. [ ] [ ] [ ]
5 PPE’s are provided to the operator (gloves, safety
belts, goggles, etc.) [ ] [ ] [ ]
6 Regulators shall be in good condition. [ ] [ ] [ ]
7 Keeping wrench available. [ ] [ ] [ ]
8 Compatible fire extinguisher on site. [ ] [ ] [ ]
9 Crews have attended the EHS orientation. [ ] [ ] [ ]
10 Cylinder cart provided [ ] [ ] [ ]
XVII. CONCRETE FORMWORK [ ] [ ] [ ]
1 TIMBERS ADEQUATE STRENGTH [ ] [ ] [ ]
2 SUPPORT PLUMB & LEVEL/TIED OFF [ ] [ ] [ ]
3 PROTECTIVE CLOTHING & EQUIPMENT [ ] [ ] [ ]
4 FIRM FOOTING FOR SUPPORT [ ] [ ] [ ]
5 SLIDE SLOPE BRACING [ ] [ ] [ ]
` 6 SHORING LAY OUT ON SITE [ ] [ ] [ ]
7 WORK FLATFORM/GUARD RAILS [ ] [ ] [ ]
8 TRUCK SUPPORTER [ ] [ ] [ ]

XVIII. COMPRESSED GAS

1 CYLINDER SECURED [ ] [ ] [ ]
2 PROPER STORAGE(SHADE SEPERATION) [ ] [ ] [ ]
3 PROTECTIVE CAPS IN PLACE [ ] [ ] [ ]
4 CONDITION OF CYLINDERS/CONNECTION [ ] [ ] [ ]
5 PROPER HANDLING [ ] [ ] [ ]
6 PROPER COLOR CODING [ ] [ ] [ ]
7 GAS CYLINDER RETESTED WITHIN THE PAST 10 YEARS [ ] [ ] [ ]

XIX. AIR COMPRESSOR

1 PRESSURE RELIEF VALVE OPERATIONAL [ ] [ ] [ ]
2 AIR PRESSURE GAUGES [ ] [ ] [ ]
3 HOSE AND CONNECTION/DRAINS [ ] [ ] [ ]
4 COUPLING SAFETY WIRED [ ] [ ] [ ]
5 GENERAL CONDITION [ ] [ ] [ ]
6 GUARD [ ] [ ] [ ]
7 FIRE EXTINGUISHER [ ] [ ] [ ]

XX. TRANSPORTATION
1 BUSES/PICK-UP TRUCK VEHICLE CONDITION [ ] [ ] [ ]
2 USE OF SEAT BELTS [ ] [ ] [ ]
3 LICENSED OPERATORS [ ] [ ] [ ]
4 OVERALL OPERATING CONDITION [ ] [ ] [ ]
5 TIRES/LIGHTS/BRAKES/SIGNALS/MIRRORS [ ] [ ] [ ]
6 REFUELING/PORTABLE CONTAINERS [ ] [ ] [ ]
7 WINDOWS CONDITIONS [ ] [ ] [ ]
8 FIRE EXTINGUISHER [ ] [ ] [ ]

XXI. STATISTICS & ADMINISTRATION

1 INCIDENT REPORT/NEAR MISS LOG [ ] [ ] [ ]
2 ACCREDITED SAFETY OFFICER [ ] [ ] [ ]
3 SITE SAFETY PROGRAM [ ] [ ] [ ]
4 SAFETY PERSONNEL CONTACT POSTED & UPDATED [ ] [ ] [ ]
5 HAZARD IDENTIFICATION PLAN ON SITE [ ] [ ] [ ]
6 EMERGENCY RESPONSE PLAN [ ] [ ] [ ]
7 WEEKLY/MONTHLY MANPOWER STATISTICS [ ] [ ] [ ]
8 COPY OF COMPLETE LEGAL & STATUTORY REQUIREMENTS [ ] [ ] [ ]
9 ECC NUMBER POSTED ON STRATEGIC AREA [ ] [ ] [ ]

XXII. CHEMICAL HANDLING

1 CHEMICAL STORAGE [ ] [ ] [ ]
2 REMOTE STORAGE [ ] [ ] [ ]
3 MATERIAL SAFETY DATA SHEET [ ] [ ] [ ]
4 WARNING SIGNS [ ] [ ] [ ]
5 AREA FENCE /LOCKED [ ] [ ] [ ]
6 CONTAINERS LABELED [ ] [ ] [ ]
7 EMERGENCY PROCEDURE [ ] [ ] [ ]
8 PERSONAL PROTECTIVE EQUIPMENT [ ] [ ] [ ]
9 FIRE EXTINGUISHER [ ] [ ] [ ]

XXIII. DEMOLITION WORK

1 SECURE DEMOLITION PERMIT [ ] [ ] [ ]
 2 PROTECTIVE CLOTHING & EQUIPMENT [ ] [ ] [ ]
3 FALL PROTECTION [ ] [ ] [ ]
4 SIGNAGES [ ] [ ] [ ]
5 BARRICADES [ ] [ ] [ ]
` 6 CHECK ALL DEMOLITION TOOLS & EQUIPMENT [ ] [ ] [ ]

XXIV. FALL PROTECTION

1 RAILINGS [ ] [ ] [ ]
2 INVERTED UMBRELLA (DEBRIS GUARD) [ ] [ ] [ ]
3 DEBRIS NET/SAFETY NET [ ] [ ] [ ]
4 COVERED WALKWAYS [ ] [ ] [ ]
5 SIGNAGES [ ] [ ] [ ]
6 FULL BODY HARNESS [ ] [ ] [ ]

XXV. CANTEEN AND KITCHEN

1 EMPLOYEES WEAR PROPER UNIFORM INCLUDING PROPER SHOES. [ ] [ ] [ ]
2 HAIR RESTRAINT IS WORN. [ ] [ ] [ ]
3 FINGERNAILS ARE SHORT, UNPOLISHED AND CLEAN. [ ] [ ] [ ]
4 HANDS ARE WASHED REGULARLY [ ] [ ] [ ]
5 OPEN SORES,AND WOUNDS ON HANDS ARE COMPLETELY COVERED
WHILE HANDLING FOODS. [ ] [ ] [ ]
6 NO SMOKING IS OBSERVED [ ] [ ] [ ]
7 ALL FOODS AND PAPER SUPPLIES ARE 6 TO 8 INCHES RAISED
FROM THE FLOOR. [ ] [ ] [ ]
8 ALL FOODS IS LABLED WITH THE NAME AND DELIVERY DATE. [ ] [ ] [ ]
9 FIRST IN, FIRST OUT METHOD IS BEING PRACTICED. [ ] [ ] [ ]
10 FOOD IS PROTECTED FROM CONTAMINATION. [ ] [ ] [ ]
11 EXPIRED AND SPOILED SUPPLIES ARE BEING SEPERATED [ ] [ ] [ ]
12 ALL SURFACE AND FLOORS ARE CLEAN. [ ] [ ] [ ]
13 CHEMICALS ARE STORED AWAY FROM FOOD AND OTHER
RELATED SUPPLIES. [ ] [ ] [ ]
14 SUPPLIES STORED IN THE REFRIGERATOR ARE PROPERLY
WRAPPED, LABLED AND DATED. [ ] [ ] [ ]
15 FROZEN FOODS IS THAWED UNDER REFRIGERATION OR IN COLD
RUNNING WATER. [ ] [ ] [ ]
16 FOOD IS NOT ALLOWED TO BE IN THE "TEMPERATURE DANGER
ZONE" FOR MORE THAN 4 HOURS. [ ] [ ] [ ]
17 FOODS IS NOT ALLOWED TO BECOME CROSS CONTAMINATED. [ ] [ ] [ ]
18 UTENSILS ARE HANDLED TO AVOID TOUCHING PARTS THAT WILL
BE IN DIRECT COTACT WITH FOOD. [ ] [ ] [ ]
19 SINKS ARE BEING REGULARLY CLEANED. [ ] [ ] [ ]
20 CLEANING WATER IS FREE FROM GREASE AND FOOD PARTICLES. [ ] [ ] [ ]
21 UTENSILS ARE ALLOWED TO DRY. [ ] [ ] [ ]
22 GRABAGE CANS ARE CLEAN. [ ] [ ] [ ]
23 GARBAGE CANS ARE EMPTIED AS NECESSARY. [ ] [ ] [ ]
24 REGULAR DISPOSAL OF GARBAGE [ ] [ ] [ ]
25 PROPER WASTE SEGREGATION IS BEING PRACTICED.
26 VERMINS ARE NOT PRESENT. [ ] [ ] [ ]

XXVI. DEPARTMENT ORDER #13 (D.O 13) CHECKLIST

Section 5. Construction Safety and Health Program
1 Does the CSHP include the composition of the [ ] [ ] [ ]
Construction Safety and Health Committee?
2 Does the CSHP state the specific safety policies which
the General Constructor undertakes to observe and [ ] [ ] [ ]
maintain in the construction site?
3 Does the CSHP provide for penalties and sanctions for [ ] [ ] [ ]
for safety and health violations?
Does the CSHP state the frequency and content of,
and persons responsible for orienting, instructing and
training all workers? [ ] [ ] [ ]
4 Does the CSHP provide for a proper construction waste disposal system?
 waste disposal system? [ ] [ ] [ ]

Section 6. Personal Protective Equipment

1 Does the employer provide all his workers the
necessary personal protective equipment (PPE) at his
own expense? [ ] [ ] [ ]
2 Are specialty construction workers provided with special PPE? [ ] [ ] [ ]
3 Are all other persons who are either authorized or
allowed to be at the construction site required to
wear appropriate PPE? [ ] [ ] [ ]
4 Are the PPE furnished to workers or required of other
persons in the construction site adequate and of
approved type (with test certificate/result)? [ ] [ ] [ ]

Section 7. Safety Personnel

1 Does the General Constructor have a full-time safety
officer assigned as the general construction safety
and health officer? [ ] [ ] [ ]
2 Is the number of construction safety and health officers
depending on the total number of workers as required
by Rule 1033 of the OSHS adequate? [ ] [ ] [ ]
3 Is the number of construction safety and health officers
based on the number of heavy equipment adequate? [ ] [ ] [ ]
4 Do the subcontractors have their own representatives
/safety officers to oversee the implementation of the
CSHP for their respective workforce? [ ] [ ] [ ]
5 Have the representatives/safety officers of the
subcontractors undergone the basic forty (40)-hour
mandated course on Construction Safety and Health? [ ] [ ] [ ]
6 Are all the full-time safety personnel accredited by DOLE? [ ] [ ] [ ]

Section 8. Emergency Occupational Health Personnel and Facilities

1 Does the owner provide competent emergency health
personnel within the worksite depending on the total
number of workers as required by Department
Order No. 13 (DO 13)? [ ] [ ] [ ]
2 Are the medical facilities based on the requirements of
DO 13 adequate? [ ] [ ] [ ]
3 If only a treatment room is provided, do the workers
have access to the nearest medical/dental clinic within
five (5) kilometer radius from the workplace and can be
reached in twenty five (25) minutes? [ ] [ ] [ ]
4 Is there a written contract with the medical/dental
clinic to attend to workplace emergencies? [ ] [ ] [ ]
5 In the absence of a nearby hospital, is an Emergency
Health Provider engaged to provide services to the
construction site? [ ] [ ] [ ]
6 Is the required minimum inventory of medicines,
medical supplies and equipment as indicated in Table
47 of the Occupational Safety and Health Standards
(OSHS) available? [ ] [ ] [ ]

Section 9. Construction Safety Signages

1 Are construction safety signages provided to warn the
workers and the public of hazards in the site? [ ] [ ] [ ]
1.2 on mandatory PPE usage even prior to entry to the site? [ ] [ ] [ ]
1.3 on potential risks of falling objects? [ ] [ ] [ ]
1.4 on potential risks of falling? [ ] [ ] [ ]
1.5 on presence of explosives and flammable substances? [ ] [ ] [ ]
1.6 on potential tripping/falling hazards? [ ] [ ] [ ]
1.7 on potential toxic or irritant airborne contaminants? [ ] [ ] [ ]
1.8 on potential risks of coming in contact with electricity? [ ] [ ] [ ]
 1.9 on presence of machineries and equipment? [ ] [ ] [ ]
1.10 on locations of fire alarms and firefighting equipment? [ ] [ ] [ ]
1.11 on instructions on the usage of specific construction equipment? [ ] [ ] [ ]
1.12 on periodic safe man-hours update? [ ] [ ] [ ]
2 Are the signages posted/placed in prominent positions
or strategic locations? [ ] [ ] [ ]
3 Are the signages regularly inspected and maintained in
good condition? [ ] [ ] [ ]
4 Number of Safety signages are sufficient and posted
on conspicuous and strategic area. [ ] [ ] [ ]
5 There are safety signages posted prohibiting removal of
primary and/or secondary PPE in the PPE work areas. [ ] [ ] [ ]
6 Is there are safety signages that are written in Filipino
language? [ ] [ ] [ ]

Section 10. Safety on Construction Heavy Equipment

1 Are all the heavy equipment operators assigned at the
project site tested and certified by Technical Education
and Skills Development Authority (TESDA)? [ ] [ ] [ ]
2 Does the General Constructor have a system of
authorizing the heavy equipment operators in its project? [ ] [ ] [ ]
Are only duly certified and authorized operators allowed
3 to operate their designated heavy equipment? [ ] [ ] [ ]
4 Are all heavy equipment tested and certified by DOLE or
its recognized organizations?
5 Are all heavy equipment regularly inspected and maintained in good condition?
maintained in good condition? [ ] [ ] [ ]
6 Is daily routine inspection of all heavy equipment
deployed at the site conducted by duly certified
mechanics and operators? [ ] [ ] [ ]
7 Does the General Constructor or the equipment owner
maintain a separate logbook for data on maintenance,
repairs, tests and inspections for each heavy equipment? [ ] [ ] [ ]
8 Do the operators and riggers wear the necessary PPE? [ ] [ ] [ ]

Section 11. Construction Safety and Health Committee

1 Is there an existing and functional Construction Safety and Health Committee (CSHC)? [ ] [ ] [ ]
2 Chairperson is the Project Manager [ ] [ ] [ ]
3 Co- chaiman is the Construction Manager [ ] [ ] [ ]
4 Secretary is the Safety officer in charged [ ] [ ] [ ]
5 Is there Safety Representatives from each Sub-Contractor [ ] [ ] [ ]
6 Is there a Occupational Health Doctors [ ] [ ] [ ]
7 Is there a Occupational Health Nurses [ ] [ ] [ ]
8 Is there a regular schedule of meeting by the
Construction Safety and Health Committee? [ ] [ ] [ ]
9 Does the Construction Safety and Health Committee
perform the following functions: [ ] [ ] [ ]
9.1 plan, develop and oversee the implementation of
accident prevention programs for the construction project? [ ] [ ] [ ]
9.2 direct the accident prevention efforts for the construction
project in accordance with these rules and the CSHP? [ ] [ ] [ ]
9.3 initiate and supervise the conduct of brief safety meetings
or toolbox meetings everyday? [ ] [ ] [ ]
9.4 review reports of safety and health inspections and
accident investigations? [ ] [ ] [ ]
9.5 prepare and submit to DOLE reports on committee
meetings? [ ] [ ] [ ]
9.6 provide necessary assistance to government inspecting
authorities in the proper conduct of their enforcement and [ ] [ ] [ ]
9.7 other activities?
initiate and supervise safety and health training for
employees? [ ] [ ] [ ]
 9.8 develop and maintain a disaster contingency plan and
organize such emergency service units as may be necessary
to handle disaster situations? [ ] [ ] [ ]
9.9 perform all duties provided in the CSHP or those that are
necessary and incidental to the fulfillment of their duties
herein described? [ ] [ ] [ ]

Section 12. Safety and Health Information

1 Does the General Constructor conduct the following
methods of providing safety and health information to the
workers with regards to construction site hazards and
control measures? [ ] [ ] [ ]
1.2 Training [ ] [ ] [ ]
1.3 Orientation [ ] [ ] [ ]
1.4 Toolbox Meeting [ ] [ ] [ ]
1.5 Have all workers deployed in the construction site [ ] [ ] [ ]
undergone a one-day safety and health awareness
seminar/orientation conducted by the Occupational Safety
and Health Center (OSHC), Bureau of Working Conditions
(BWC) or other concerned offices of DOLE or by safety
training organizations or other institutions DOLE has
accredited or recognized? [ ] [ ] [ ]
2 Do trainings and instructions provided to the workers
regarding general safety and health measures include: [ ] [ ] [ ]
2.1 basic rights and duties of workers at the construction site? [ ] [ ] [ ]
2.2 means of access and egress both during normal work and
in emergency situations? [ ] [ ] [ ]
2.3 measures for good housekeeping? [ ] [ ] [ ]
2.4 location and proper use of welfare amenities and
first-aid facilities? [ ] [ ] [ ]
2.5 proper care and use of PPE and protective clothing
provided the workers? [ ] [ ] [ ]
2.7 general meaures for personal hygiene and health protection? [ ] [ ] [ ]
2.8 fire precautions to be taken? [ ] [ ] [ ]
2.9 action to be taken in case of any emergency? [ ] [ ] [ ]
2 requirements of relevant health and safety rules and regulations?
regulation. [ ] [ ] [ ]
3 Are toolbox meetings conducted daily? [ ] [ ] [ ]
3.1 Are documents such as attendance records available? [ ] [ ] [ ]
4 Does the General Constructor provide specialized
instruction and training to: [ ] [ ] [ ]
4.1 operators of lifting appliances? [ ] [ ] [ ]
4.2 drivers of transport equipment? [ ] [ ] [ ]
4.3 operators of earth moving and materials-handling
equipment and machinery? [ ] [ ] [ ]
4.4 any equipment of specialized or dangerous nature? [ ] [ ] [ ]
4.5 workers engaged in erection or dismantling of scaffolds? [ ] [ ] [ ]
4.6 workers engaged in excavations? [ ] [ ] [ ]
4.7 workers handling explosives or engaged in
blasting operations? [ ] [ ] [ ]
4.8 workers engaged in pile-driving? [ ] [ ] [ ]
4.9 workers engaged in compressed air, cofferdams
and caissons? [ ] [ ] [ ]
4 workers engaged in the erection of prefabricated parts of [ ] [ ] [ ]
4.11 steel structural frames and tall chimneys, and in concrete
work, form work and other such work? [ ] [ ] [ ]
4.12 workers handling hazardous substances and materials? [ ] [ ] [ ]
4.13 workers as signalers? [ ] [ ] [ ]
4.14 other workers as may be categorized by TESDA? [ ] [ ] [ ]

Section 13. Construction Safety and Health Training

1 Have all safety personnel in the construction project
 attended and completed the forty (40)-hour training course? [ ] [ ] [ ]
2 Do all full-time safety personnel attend a minimum of sixteen (16) hours of
continuing construction safety and health training per year? [ ] [ ] [ ]

Section 14. Construction Safety and Health Reports

1 Does the General Constructor submit the required monthly
construction safety and health report to the BWC or DOLE
Regional Office concerned? [ ] [ ] [ ]
1.1 monthly summary of all safety and health committee
meeting agreements? [ ] [ ] [ ]
1.2 a summary of all accident investigations/reports? [ ] [ ] [ ]
1.3 periodic hazards assessment with corresponding remedial
measures/actions for each hazard? [ ] [ ] [ ]
2 In case of any dangerous occurrence or major accident
resulting in death or permanent total disability, did the
employer notify the DOLE Regional Office within twenty-four
(24) hours from the time of occurrence? [ ] [ ] [ ]
2.1 After the conduct of investigation of such accident, did the
employer submit a report to the DOLE Regional Office using
the DOLE/BWC/HSD-IP-6 form? [ ] [ ] [ ]

Section 15. Construction Workers' Skills' Certificates

1 Have all construction workers involved in critical
construction operations as qualified in Section 15 of DO 13
undergone mandatory skills testing and certification
from TESDA? [ ] [ ] [ ]

Section 16. Workers' Welfare Facilities

1 Does the employer provide the following welfare facilities in
order to ensure humane working conditions: [ ] [ ] [ ]
1.1 adequate supply of safe drinking water? [ ] [ ] [ ]
1.1.1 Is the drinking water stored in closed containers from which the
water is dispensed through taps or cocks? [ ] [ ] [ ]
1.1.2 Is the container of the drinking water cleaned and
disinfected at regular intervals not exceeding fifteen (15) days? [ ] [ ] [ ]
1.1.3 Are notices or signage conspicuously posted in locations where
water sources are not fit for drinking purposes? [ ] [ ] [ ]
1.2 adequate facilities for changing and for the storage and drying
of work clothes? [ ] [ ] [ ]
1.3 adequate accommodation for taking meals and shelter? [ ] [ ] [ ]
1.4 suitable living accommodation for workers, and as may be
applicable, for their families? [ ] [ ] [ ]
1.5 separate sanitary, washing and sleeping facilities for men
and women workers? [ ] [ ] [ ]

Prepared by: Noted by:

__________________________
EHS Officer Project Manager
Applicable to IQA findings last May 16, 2019 EHS NC with
ARF No.: 2019-EHS-001
 SAFETY ORIENTATION ATTENDANCE
Project Name: Project Location:
Project Code: _________________________________________ Company: _____________________________________

Brgy. Police/ NBI Medical

Company Date Oriented Name Position Signature ID CTRL. NO.

Clearance

Effectivity Date: October 7, 2019 Form No.: PGCDCF- 40-004-

ATION ATTENDANCE

Company: _________________________________________________

ID RECEIVED
BY:

Form No.: PGCDCF- 40-004-014 Revision 3