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    Occupational Safety and Health Center: Leave Any Unanswered Items

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    Prestone Napiloy Kalang-ad
    The document is a Work Environment Measurement (WEM) request form from the Department of Labor and Employment of the Philippines. It requests information from companies such as company name and address, type of industry, number of workers, purpose of the WEM request, parameters to be measured, and provides instructions for submitting the completed form via email or fax. The form collects information to schedule and conduct a WEM, or workplace hazard assessment, to ensure occupational safety and health compliance.

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

    Occupational Safety and Health Center: Leave Any Unanswered Items

    Uploaded by

    Prestone Napiloy Kalang-ad
    662 views2 pages
    The document is a Work Environment Measurement (WEM) request form from the Department of Labor and Employment of the Philippines. It requests information from companies such as company name and address, type of industry, number of workers, purpose of the WEM request, parameters to be measured, and provides instructions for submitting the completed form via email or fax. The form collects information to schedule and conduct a WEM, or workplace hazard assessment, to ensure occupational safety and health compliance.

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    WEM-Request_rev06

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    The document is a Work Environment Measurement (WEM) request form from the Department of Labor and Employment of the Philippines. It requests information from companies such as company name and address, type of industry, number of workers, purpose of the WEM request, parameters to be measured, and provides instructions for submitting the completed form via email or fax. The form collects information to schedule and conduct a WEM, or workplace hazard assessment, to ensure occupational safety and health compliance.

    Copyright:

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

    Occupational Safety and Health Center: Leave Any Unanswered Items

    Uploaded by

    Prestone Napiloy Kalang-ad
    The document is a Work Environment Measurement (WEM) request form from the Department of Labor and Employment of the Philippines. It requests information from companies such as company name and address, type of industry, number of workers, purpose of the WEM request, parameters to be measured, and provides instructions for submitting the completed form via email or fax. The form collects information to schedule and conduct a WEM, or workplace hazard assessment, to ensure occupational safety and health compliance.

    Copyright:

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

    Republic of the Philippines

    DEPARTMENT OF LABOR AND EMPLOYMENT


    Occupational Safety and Health Center
    OSHC-QF-ECD-WEM-01
    Revision No.: 06
    Effective: January 17, 2020

    WORK ENVIRONMENT MEASUREMENT (WEM) REQUEST


     Print/write LEGIBLY.
     Mark appropriate boxes with “”.
     Write “NONE” if not present or not existing in the company.
     Incomplete request form will not be processed and be sent back to the company’s email address. Please do not
    leave any unanswered items.
    Date of Application:
    Company Name: Address: Region

    Email address: ___________________________


    Tel./Fax No: _____________________________
    Type of Industry/Nature of Business (Pls. specify) Number of Workers (including outsource personnel):
    Male: ______ Female: ______ Total: _______
    Manufacturing of _______________________
    Service/s______________________________ Risk Classification:
    Others _______________________________ Low Medium High
    Name of Safety Officer(s): Safety Officer 1 Safety Officer 3
    Safety Officer 2 Accredited Safety Officer 3
    Safety Officer 4
    Purpose of WEM Request
    Workplace Improvement OSHS Compliance Required by Labor Inspector
    Client/Customer Requirement ISO Compliance (attach notice of inspection report)
    Others: Specify ________________________________________________________________
    WEM Internal WEM Equipment owned by Conducting internal WEM?
    Monitoring company: Yes Date of Internal Monitoring ___________
    Capability Name of Personnel who conducted WEM
    __________________________________
    No
    WEM Conducted by:
    OSHC
    Date of last WEM: ______________________
    Accredited WEM Provider : ______________________________________________________
    Date of last WEM: ______________________ Conducted by: _______________________
    None (New Client)
    Note: Please attach improvements initiated / administered based on WEM recommendations

    Please select the parameters to be measured per work area based on the initial assessment of the Safety Officer:
    A. Physical Hazards
    Noise Vibration Illumination Heat
    B. Chemical Hazards
    Dust Heavy Metals Organic Solvents Acids Gases
    Others: Specify _____________________________________
    C. Ventilation
    General Ventilation Local Exhaust Ventilation
    This is to certify that the company agrees to pay all the expenses incurred during coordination and other pre-
    WEM activities such as communication, consumables, transportation expense, etc. in the event that the company
    cancels the WEM on/or 5 working days before the scheduled WEM.

    By filling out this form and signing below, I am giving my consent to the OSHC to collect, process, retain and
    store my personal data in accordance with the provisions of Republic Act 10173 – Data Privacy Act of 2012.

    ____________________________________________ __________________
    Signature over Printed Name of Requesting Personnel Position / Designation
    Instructions:

    Please send the signed and fully accomplished WEM Request Form to the email
    address below:

    To: [email protected]
    [email protected]
    Cc: [email protected] (dedicated email for WEM request)

    Or Fax to: (632) 8929-60-30; (632) 8924-24-12

    If faxed, please notify us through the email addresses provided above for proper
    acknowledgement. Otherwise request will not be processed.

    Please address the email to:

    Noel C. Binag, CE
    Executive Director
    Occupational Safety and Health Center
    Department of Labor and Employment

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