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CSHP TEMPLATE (Comprehensive)

1.0 Statement of Commitment to Comply with OSH Requirements

I/WE ROWENA S. ABUAN by accomplishing this Construction Safety and Health Program do
hereby commit and bind ourselves to comply with the requirements of the Department Order No.
13, series of 1998 – Guidelines Governing Occupational Safety and Health in the Construction
Industry and the applicable provisions of the Occupational Safety and Health Standards (OSHS).

We (also) acknowledge our obligation and responsibilities to provide throughout the course of the
project the appropriate Personal Protective Equipment (PPE) as added protection for our workers
and employees.

We also (hereby) commit to implement the necessary job safety and health instructions and
training to all our workers for the entire (during the) duration of the project, as well as the safety of
the general public.

________________ ROWENA S. ABUAN

Municipal Mayor Name of Contractor
LGU-NATONIN Signature over Printed Name
Signature over Printed Name

2.0 Company Safety and Health Policy

It is the general policy of RBV CONSTRUCTION to perform work in the safest manner possible
consistent with good construction practices. To fulfill the requirements of this policy, an organized
and effective Construction Safety and Health Program as described in this program and in
consonance with DOLE D.O. No. 13 and the OSH Standards must be carried out on every
project.

To achieve these objectives, we are committed to perform the following:

2.1 Identifying potential hazards that may arise from the programmed work activities;

2.2 Organizing the work activities so as to minimize the risk arising from them;

2.3 Developing and implementing project specific safety and health program;

2.4 Establishing and enforcing all necessary safe work procedures, rules & regulations;
2.5 Ensuring that all workers are given orientation/briefing or induction prior to deployment to the
site;

2.6 Establishing a site safety and health committee to act as policy making body of the project on
all issues pertaining to safety and health;

2.7 Ensuring the conduct of daily toolbox meetings;

2.8 Establishing a system of follow-up of actions and periodic assessment to check program
effectiveness.

3.0 Project Details

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i. Specific name of project and Name of Owner: ii. Location of the project:

iii. Classification of the project: iv. Name of General Constructor (constructor who has
general supervision over other constructors in the execution
of this project and who directly receives instructions from the
owner or construction project manager, if any)

□ Gen. Building Const.

□ Gen. Engineering Const. ROWENA S. ABUAN

□ Specialty Trade Const.

□ others, specify: ____________________

__________________________________

v. Name of Construction Project Manager /Consultant, if any (a vi. Name of Project Manager/Contact Number (the overall
person or entity who is hired by the project owner, to act in the technical personnel of the general constructor and or the
owner’s behalf concerning supervision and monitoring of all subcontractor in charge of the actual execution of this
matters related to the overall execution of this project. It shall be project)
a separate entity from the general constructor or any
subcontractor of the construction project

ROWENA S. ABUAN

vii. Name of Resident Engineer, if any (a duly viii. Name and Classification of Constructors (synonymous to
licensed engineer who shall be tasked to be builders who undertakes or offers to undertake or purports to
present at the construction site at all times, have the capacity to undertake or submits a bid to, or does
whenever work is being undertaken, and shall himself or by or through others, construct, alter, repair, add
have the responsibility of assuring the technical to, subtract from, improve, move, wreck or demolish any
conformance of all designs, materials, processes, building, highway, road, railroad, excavation or other
work procedures rendered for the execution of structure, project, development or improvement, or to do any
this project, including safety and health of all part thereof, including the erection of scaffolding or other
persons within the construction site) structures or works in connection with this project. The term
constructor includes subcontractor and specialty contractor.)

Name Classification

1.

2.

3.

(Use additional sheet if necessary)

ix. Estimated maximum number of workers x. Work Hours (including shift)

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1st shift: from__8 am__to__5 pm___

2nd shift: from__n/a___to_________

3rd shift: from_n/a___to_________

Others: ______n/a________________

xi. Estimated number of heavy equipment: xii. Projected dates of commencement and completion

□ Backhoe: ___1__ □ Dozer: _____ Start Date: ___________________

□ Loader: _____ □ Dumptruck: ____1_ End Date: ____________________

□ Crane: _____ □ Grader: 1 Est. Days to Complete: _________

□ others, specify: 1 Transit Mixer

xiii. Name and Address of Emergency Health Provider (any person or organization who is certified or recognized by the
Department of Health and who can provide the same or equivalent emergency health services as an emergency hospital,
including emergency treatment or workers on site, emergency transport and care during transport of injured workers to the
nearest hospital, with adequate personnel, supplies and facilities for the complete immediate treatment of injuries or illnesses)

SOUTHERN ISABELA GENERAL HOSPITAL

xiv. Total Project Cost

xvi. Total Cost on OSH (breakdown)

20,000 FOR EMERGENCY SUCH AS FIRST AID AND OTHER MEDICINE AND OTHER

(Use additional sheet if necessary)

4. Construction Safety & Health Committee

Section 11 of D.O. No. 13 requires that rules of Construction Safety and Health Program must be
observed and enforced at the project site, each site shall, at the start of the construction have a
construction safety and health committee. With respect to this project, the committee will be
organized in accordance with the requirements of Rule 1040 of the Occupational Safety and
Health (OSH) Standards of the Department of Labor and Employment (DOLE).

4.1 Composition of Construction Safety and Health Committee (CSHC)

Our CSHC at the MARIIS-DRD-2021-DRD-CCAW-DIADI-RIS-INFRA-002 Sediment Catchment

Structures:

4.1.1 Project Manager or his representative as the chairperson ex officio

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Name: ROWENA S. ABUAN

4.1.2 General Construction Safety and Health Officer/s (overall in charge in the implementation
of the OSH program of this project hired by the General Constructor. Please attach certificate
of training/s prescribed by DOLE. Numbers will be dependent on the numbers of workers and
heavy equipment)43

Name: ROWENA S. ABUAN

Name: _________________
Name: _________________

4.1.3 Construction Safety and Health Officer/s from Subcontractors (any employee/worker
trained and, in addition to their regular duties and responsibilities tasked by his employer to
implement occupational safety and health program in accordance with the provisions of the
OSH Standard. Please attach certificate of training/s prescribed by DOLE).

Name: ROWENA S. ABUAN

Company Name: RBV CONSTRUCTION

Name: ___________________
Company Name: RBV CONSTRUCTION

Name: __________________
Company Name: RBV CONSTRUCTION

4.1.4 Occupational Health Personnel (qualified first-aider, nurse, dentist, or physician, engaged
by the employer to provide occupational health services in the establishment/undertaking.
Please attach certificate of training/s prescribed by DOLE):

Name: _______________
Designation SAFETY OFFICER:

Name:
Designation: FIRST AIDER

4.1.5 Workers’ representative (minimum of 3 union members if organized, not necessarily from one
employer)
Name: ___________
Designation: FOREMAN

Name: ___________
Designation: LEADMAN

Name: _____________
Designation: CARPENTER
4.2 Duties of the CSH Committee shall include but are not limited to the following:

4.2.1 Plans, develops and oversees the accident prevention programs for the construction
project;

4.2.2 Directs the accident prevention efforts of the establishment in accordance with the safety
programs and performance and government regulations in order to prevent accidents from
occurring in the worksite;

4.2.3 Conducts safety meetings at least once a month. The committee will hold a safety
meeting every FIRST WEEK of the month;

4.2.4 Submits reports to the project manager (is this pm of the owner or pm of the gen con?)
on its meetings and activities one day after the meeting;
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4.2.5 Reviews reports of inspection, accident investigation and implementation of program;

4.2.6 Provides necessary assistance to government inspecting authorities in the proper

conduct of their activities specifically on the enforcement of the provision of DOLE’s OSHS;

4.2.7 Submits the monthly the following safety and health reports to the DOLE Regional Office
having jurisdiction over the project:

4.2.7.1 Summary of all safety and health committee meetings agreements;

4.2.7.2 Summary of all accident investigation reports using DOLE/BWC/ OHSD/IP-6 form;

4.2.7.3 Periodic hazards assessment with the corresponding remedial measures/actions for
each hazard;

4.2.7.4 Annual Medical Report using the form DOLE/BWC/HSD/OH-47-A (if the duration of the
project is more than one (1) year);

4.2.7.5 Initiates and supervises safety and health training for employees. (Check on the boxes
or list down the training to be provided for workers and employees).

□ 40-Hour Construction Occupational Safety and Health Course

□ 1-Day Workers Safety & Health Orientation
□ others, specify:
_______________________________________________________
40-Hour Construction Occupational Safety and Health Course

4.3 Duties of the Safety Man/Officer

The principal function of the Safety Man assigned to this project is to act as the employer’s
(needs identification) principal assistant and consultant in the application of programs to
remove the hazard from the workplace and to correct unsafe work practices. For this purpose,
the Safety Man has the following duties:

4.3.1 Serves as Secretary to the SHC, as such will perform the following:

4.3.1.1 Prepare minutes of meetings;

4.3.1.2 Report status of recommendations made;

4.3.1.3 notify members of the meetings; and

4.3.1.4vsubmit (needs identification) to the employer a report of the activities of the committee,
including recommendations made.

4.3.2 Acts as an advisory capacity on all matters pertaining to health and safety for guidance of
the employer and the workers.

4.3.3 Conducts investigation of accident as member of the Health and Safety Committee and
submits his separate report and analysis of accident to the employer (needs
identification).

4.3.4 coordinates all health and safety training programs for the workers/employees and
employer (needs identification).

4.3.5 Conduct health and safety inspection as member committee.

4.3.6 Maintains or helps in the maintenance of an efficient accident record system and
coordinates actions taken by supervisors to eliminate accident causes.

4.3.7 Provide assistance to government agencies in the conduct of safety and health
inspection, accident investigation or any other related program.
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4.3.8 For the purpose of effectiveness in the project site, the Safety Man is to report directly to
the employer (needs identification).

4.4 Dangerous Occurrence or Major Accident

In case of any dangerous occurrence or major accident resulting to death or permanent total
disability, we will notify the DOLE Regional Office within twenty four (24) hours from occurrence.
After the conduct of investigation by our concerned safety and health officer, we will report all
permanent total disabilities to the DOLE Regional Office on or before the 20 th of the month
following the date of occurrence of accident using the DOLE/BWC/HSD-IP-6 form.

5.0 Emergency Occupational Health Personnel and Facilities

Section 8 of D.O. No. 13 states that the construction project owner or his representative shall
provide competent emergency health personnel within the worksite duly complemented by
adequate medical supplies, equipment and facilities based on the total number of workers in the
site.

5.1 Emergency Health Personnel and Facilities

Our number of workers COSH/ FIRST AIDER

Construction Stages during this stage NAME
Health Facilities
Personnel
Nurse First Aid
Medicine
Nurse First Aid
Medicine
Nurse First Aid
Medicine
Nurse First Aid
Medicine
Nurse First Aid
Medicine
Nurse First Aid
Medicine

(Use additional sheet if necessary and attach all required training certificates in this section.)
6.0 Safety & Health Promotion & Education

The RBV CONSTRUCTION is committed at ensuring that all workers or employees are given
orientation/briefing or induction prior to deployment to the site. It is our continuing effort to
promote safety and health consciousness to all people involved in this project by providing them
with the necessary safety and health training and education to enhance their knowledge and
skills to enable us to attain a safe and healthful project site.

6.1 Workers Safety and Health Orientation/Trainings

We require new workers to attend our Safety & Health Orientation before they are deployed to
this project site in consonance to Section 12 of the D.O. 13. The assigned Safety Officer,
Mr./Ms ____________ will coordinate the conduct of this orientation.
We ensure that they receive instruction and training regarding the general safety and health
measures we plan to implement for this project, specifically:

6.1.1 basic rights and duties of workers at the jobsite;

6.1.2 means of access and egress both during normal work and in emergency situation;

6.1.3 measures for good housekeeping;

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6.1.4 location and proper use of welfare amenities and first –aid facilities;

6.1.5 proper care of PPEs and other protective clothing;

6.1.6 general measures for personal hygiene and health protection;

6.1.7 fire precautions to be taken;

6.1.8 action to be taken in case of any emergencies;

6.1.9 requirements of relevant health and safety rules and regulations.

Below are the list of workers who have undergone the DOLE prescribed safety and health
trainings and orientation

Name Title of training Remarks

attended

40 - HOUR COSH COMPLETED

FIRST AID AND LIFE COMPLETED

SUPPORT

(Use additional sheet if necessary)

6.2 Specialized Instruction and Trainings

Section 12.6 of the D.O. No. 13 requires specialized instruction and training be given to any
person holding critical occupation.

The inventory lists of our workers who hold critical occupation and attended the specialized
trainings are listed below. (Please attach training certificates)

Name Title of training attended Remarks

NONE

(Use additional sheet if necessary)

7.0 Toolbox Meeting

D.O. No. 13 define toolbox meeting or gang meeting as a daily meeting among workers and their
respective supervisors for the purpose of instruction, discussion and proper briefing on the
planned work, the assessment of past work, the possibility or actual occurrence of accidents at
the site, tips and suggestions on how to prevent possible accidents and other related matters.

7.1 Responsible for the Toolbox Meeting

The following supervisor or any designated person (e.g. foreman, lead man, gang boss, etc.) is
required to conduct daily toolbox or similar meetings prior to starting the tasks for the day to
discuss with the workers and anticipate safety and health problems related to every task and the
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potential solutions to those problems. The supervisor will remind the workers on the necessary
safety precautions that need to be undertaken.

Name of Supervisor Time of Toolbox Meeting Means of

(indicate shift, e.g. 1st, 2nd, 3rd ) Documentation
(attach sample
instrument)

FIRST SHIFT ATTENDANCE

(Use additional sheet if necessary)

8.0 Accident/Incident/Illnesses Investigation & Reporting

We consider accident/incident/illnesses investigation and reporting as our responsibility.

Absenteeism can greatly affect our work schedule. Looking for replacement can be costly for the
company, the hiring effort, training of new workers, the loss of job momentum affect our
productivity. We involve our supervisors in this program because they are more familiar with the
people involved, they have better understanding of the operation, and they have personal interest
in the investigation since it’s their people who are involved. For this reason, the RBV
CONSTRUCTION is committed to include this responsibility to all supervisors and made them
aware about it.

8.1 Persons responsible for conducting investigation

In this project the following person/s will be assigned to conduct accident/incident investigation:

All accidents All incidents/near miss Illnesses

SAFETY OFFICER

FIRST AIDER

8.2 Conducting and documenting the accident/illnesses investigation

In conducting the accident/illness investigation, we gather facts, analyze them and make the
necessary recommendation. (Please attach sample forms that will be used to document your investigation)

8.3 Compliance with Government Requirements

We will submit the following reports to the DOLE Regional Office concerned:

8.3.1 In case of any dangerous occurrence or major accidents resulting to death or

permanent total disability using the form (DOLE/BWC/OHSD/IP – 6). Notification of major
accidents to DOLE Regional Office concerned within 24 hours.

8.3.2 Summary of Work Accident/Illness Exposure Data Report will be submitted on or before
the 20th of the month following the date of occurrence of accident (for those projects with
short duration or less than one year duration).

8.3.3 Annual Work Accident/Illness Report using the form DOLE/BWC/OHSD/IP – 6B for
those construction projects with more than one year duration.

9.0 Personal Protective Equipment (PPE)

Section 6 of D.O. No. 13 requires that every employer shall, at his own expense, furnish his
workers with protective equipment for eyes, face, hands, feet, lifeline, safety belt/harness,
protective shields and barriers whenever necessary by reason of the hazardous work process or
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environment, chemical or radiological or other mechanical irritants or hazards capable of causing

injury or impairment in the function or any part of the body through absorption, inhalation or
physical agent.

Provision of PPE shall be in accordance with Rule 1080 of the OSHS (must include Rule 1070 for
noise). The equivalent cost for the provision of PPE (life span, depreciation, replacement, etc.) shall
be an integral part of the project cost.

Ite Type of PPE Quantity Unit Total

m needed Price cost
No.

1 SAFETY HELMET 12 300 3,600

2 SAFETY SHOES 12 1200 14,400

3 SAFETY GLOVES (DENIM) 12 50 600

4 RUBBER BOOTS 12 250 3000

medicines 4500

(Use additional sheet if necessary)

9.1 Cleaning and Proper Maintenance of PPEs

It is important that all PPE be kept clean and properly maintained. Cleaning is particularly important
for eye and face protection where dirty or fogged lenses could impair vision. Our workers or
employees inspect, clean, and maintain their PPE according to the manufacturers’ instructions before
and after each use. Our supervisors are responsible for ensuring that users properly maintain their
PPEs in good condition.

We enforce our rule that PPEs must not be shared between workers or employees until it has been
properly cleaned and sanitized. PPE are distributed for individual use whenever possible.

If workers or employees provide their own PPEs, we make sure that it is adequate for the work place
hazards, and that it is maintained in a clean and stored in a conducive condition.

We never allow the use of defective or damaged PPEs. We immediately discard and replace them to
avoid any unintentional use.

We also consider the importance of ensuring that any contaminated PPE which cannot be
decontaminated is disposed of in a manner that protects workers or employees from exposure to
hazards

10.0 Protection of the General Public

We comply with Rule 1412.09 of the DOLE OSH standard in providing a safe covered walkway over
the sidewalk for use by pedestrians in a building construction work less than 2.3 meter (7ft.) from a side
walk or public road.

We comply with Rule 1412.10 of the OSH Standard, Protection from Falling Materials. We observe the
following:

10.1 We will take the steps to protect worker from falling materials, such as the provisions of safety
helmets and safety shoes.

10.2 We will ensure that tools, objects and materials including waste materials) will not be thrown or
tipped from a height, but will be properly lowered by crane, hoist or chutes. If such is not
practicable, the area where the material is thrown will be fenced and no person will be allowed in
the fenced area.

The person responsible for this program:

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Name: RBV CONSTRUCTION

Designation: GENERAL MANAGER/AMO

11.0 Safety Signages

Our Safety Signages provides warning to workers and employees and the public about the
hazards around the project site. These will be posted in prominent positions at strategic location
visible as far as possible in a language understandable to most of the workers and employees as
well as the public.

11.1 The specific safety signages we intend to set-up for this project include but not limited to:

11.1.1 Mandatory requirement on the usage of PPE prior to entry to the project site (attach sample
picture of this signage that you plan to use for this project);

11.1.2 Areas where there are potential risks of falling objects (if applicable, attach sample picture of
this signage that you plan to use for this project);

11.1.3 Areas where there are potential risks of falling (if applicable, attach sample picture of this
signage that you plan to use for this project);

11.1.4 Areas where explosives and flammable substances are used or stored (if applicable, attach
sample picture of this signage that you plan to use for this project);

11.1.5 Areas where there are tripping or slipping hazards (if applicable, attach sample picture of this
signage that you plan to use for this project);

11.1.6 Approaches to working areas where danger from toxic or irritant airborne
contaminants/substance may exist which should indicate the name of the
contaminant/substance involved and the type of respiratory equipment to be worn (if
applicable, attach sample picture of this signage that you plan to use for this project);

11.1.7 All places where contact with or proximity to electrical/facility equipment can cause danger
(if applicable, attach sample picture of this signage that you plan to use for this project);

11.1.8 All places where workers may come in contact with dangerous moving parts of the
machineries or equipment (if applicable, attach sample picture of this signage that you plan to use for
this project);

11.1.9 Location of the fire alarms and fire-fighting equipment (attach sample picture of this signage
that you plan to use for this project);

11.1.10 Instructions on the usage of specific construction equipment ( if applicable, attach sample
picture of this signage that you plan to use for this project);

11.1.11 Periodic updating of man-hours lost.

11.2 Inspection and Maintenance of Safety Signages

We will regularly inspect and maintain in good condition all safety signages that we will be
providing for this project. The person in charge in inspecting is/are ___________ he/she is/are
our PROJECT ENGINEER Inspection will be carried out on a MONTHLY.

Our COMPANY will remove and replaced any signages that are damaged, illegible, or no longer
apply with the current hazard.

12.0 Construction Workers Skills Certification

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The company will ensure that all workers assigned in the critical occupations as defined in
Section 15 of D.O. No. 13 and those who will be assigned in the operation of construction heavy
equipment (CHE) will undergo mandatory skills testing for certification by TESDA (Attach TESDA
certificates of those workers certified by TESDA.)

13.0 Testing & Inspection of Construction Heavy Equipment

All construction heavy equipment will be tested and inspected in accordance with the
requirements of Section 10 of D.O. No. 13. The company will ensure that all heavy equipment will
be operated by qualified and certified operators. (Attach Certificate of Testing and Inspection of CHE
used issued by DOLE Accredited Testing Organizations for CHE and TESDA certificate of CHE operator/s).

14.0 Control Measures on Construction Activities

To ensure safe and healthy working conditions throughout the duration of the project the following
control measure activities will be enforced and disseminated to all the workers in the site:

14.1 Major Activities

Major activities for this project includes but not limited to the following: (please check on the box all
that applies)

□ Demolition □ Excavation
□ Earthmoving □ Piling
□ Scaffold □ Formwork
□ Structural Steel □ Crane Operation
□ Concreting □ Rebar works
□ Welding □ Electrical
□ HVAC □ Plumbing
□ Painting □ interior Decoration
□ Others (please specify)

14.2 Hazards Identified

Based on the list of activities for this project, we found the following potential hazards that we may
possibly encounter in the course of project implementation:

14.2.1 Physical Hazards

Physical hazards are the most common in most workplaces. The physical hazards that we
identified for this project include but are not limited to the following: (please check on the box all
that applies)
□ machineries □ power and hand tools
□ electrical □ ladders and scaffolds
□ noise □ ventilation
□ exposure to heat □ tripping
□ fall hazards □ collapse
□ others (please specify)
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14.2.2 Chemical Hazards

Chemical hazards are present workers handle chemical preparations in any form (solid, liquid
or gas). Some are safer than others, however, some workers are more sensitive to chemicals,
even the common solutions causing illness, skin irritation or breathing problems.

The chemical hazards that we identified for this project include but are not limited to the
following: (please check on the box all that applies)

□ solvents □ paint products

□ acids □ cleaning products
□ acetylene □ propane
□ gasoline □ explosive chemical
□ welding fumes □ others (please specify)

14.2.3 Biological Hazards

Biological hazards come from working with infectious people, plants, and other living
materials. The biological hazards that we have identified for this project includes but not
limited to the following: (please check on the box all that applies)

□ blood or other body fluids □ fungi

□ bacteria and viruses □ plants
□ insect bites □ animal and bird droppings
□ others (please specify)

14.2.4 Ergonomic Hazards

Ergonomic hazards occur when the type of work, body position and working conditions put
strain on the body. They are the hardest to spot since one does not immediately notice the
strain on your body or the harm these hazards pose. Short-term exposure may result in "sore
muscles" on the days following exposure, but long term exposure can result in serious
musculoskeletal injuries.

The ergonomic hazards that we identified for this project includes but not limited to the
following: (please check on the box all that applies)

□ poor lighting □ frequent lifting

□ poor posture □ repetitive motion
□ exertion of force □ awkward movement
□ others (please specify)

(Enumerate control measures to address those hazards identified, Use additional sheet if necessary)
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14.3 Safe Work Practices

Safe work practices are procedures adopted for carrying out specific tasks that ensures
workers' exposure to hazardous situations, substances, and physical agents is controlled in a
safe manner. Safe work practices are generally written methods outlining how to perform a
task with minimum risk to people, equipment, materials, environment, and processes. It
should be developed as a result of completing a Hazard Assessment and should closely
reflect the activities in this project.

All safe work practices should be kept in a location central to the work being performed and
readily available to the workforce. Some safe work practices will require specific job
procedures, which clearly set out in a chronological order each step in a process.

(Enumerate below the safe work practices that you intend to perform relative to the hazards you
previously identified above.)

15.0 First-Aid, Health Care Medicines and Equipment Facilities

The company will provide first-aid kit and health care medicines and facilities for workers in the
site in accordance with the requirements of Rule 1960 of the OSHS.

16.0 Workers Welfare Facilities

The following welfare facilities will be provided in the site to ensure human working conditions:

16.1 Adequate supply of safe drinking water

16.2 Adequate sanitary, washing and sleeping facilities separate for men and women workers

16.3 Adequate facilities for changing and for the storage and drying of work clothes.

16.4 Adequate accommodation for taking meals.

To assure that the company provides adequate welfare facilities for the workers in the site the
company will implement the provision of toilets and other facilities in accordance with the
requirements of the Sanitation Code.

17.0 Medical Surveillance

The company will require all employees to undergo a baseline or initial medical health
examination prior to assigning to a potentially hazardous activity. The examination will include but
not limited to the following:

17.1 Complete medical and work history;

17.2 Physical examination (Pre-employment, During employment and Separation);

17.3 Other special examination (Pulmonary function test, blood panel, ECG >40 years of age,
audiogram);

17.4 Random drug testing.

18.0 Working Hour & Break Time

The work schedule will be on ( please check on the boxes that apply):
□ Mon. □ Tue. □ Wed. □ Thur. □ Fri. □ Sat. □ Sun

Check on the shift and indicate the work hours for the shift that applies.
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□ 1st Shift from ___8___(am/pm) to ____5_____ (am/pm)

□ 2nd Shift from ________(am/pm) to __________ (am/pm)
□ 3rd Shift from ________(am/pm) to __________ (am/pm)

Check on the shift and indicate the break for the shift that applies.
□ 1st Shift from ___12___(am/pm) to ____1_____ (am/pm)
□ 2nd Shift from ________(am/pm) to __________ (am/pm)
□ 3rd Shift from ________(am/pm) to __________ (am/pm)

19.0 Construction Waste Disposal

The company including subcontractors will be responsible for minimizing waste generated during
the implementation of the project. The following procedures for disposal of wastes will be
implemented in the site:

19.1 Ensure that the construction wastes are segregated from that of domestic waste.
19.2 All domestic wastes are to be collected on a daily basis.

19.3 Construction debris (broken hollow blocks, spoiled concrete, loose concrete, etc) should be
taken out on the staging area.

19.4 Oil spills and spoiled greases should be wrapping in the black garbage bag and will be
properly disposed.

19.5 Application of good housekeeping.

20.0 Emergency Preparedness

The objectives of this are to ensure that the company has developed and communicated plans
that will allow for the effective management of emergencies. Attach copy of company emergency
preparedness plan.

21.0 Penalties/Sanctions

For every offenses and violation of any safety rules, regulations and general practices
promulgated by the project and/or the company, the company recommended the following
penalties and sanctions for violation of CSH program: (Please attach company policy on penalties, if
there are any).

Safety Violation 1st offense 2nd offense 3rd offense

1. No helmet, no safety shoes, no warning 3 day suspension 5 day suspension
safety belt/harness
2. no ID, Uniform, working attire, warning 3 day suspension 5 day suspension
goggles, glove & apron
3. eating at prohibited area warning 3 day suspension 5 day suspension
4. littering and loitering warning 3 day suspension 5 day suspension
5. smoking at prohibited area warning 3 day suspension 5 day suspension
6. urinating at prohibited area warning 3 day suspension 5 day suspension
7. illegal dismantling of safety warning 3 day suspension 5 day suspension
signages and paraphernalia
8. illegal gambling 3 day 5 day suspension Dismissal
suspension
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9. overnight stay w/o permission 3 day 5 day suspension dismissal

suspension
10. fighting & provoking others 5 day Dismissal
suspension
11. working under the influence of Dismissal
drugs and liquor
12. possession of illegal drugs, deadly Dismissal
weapon & gambling paraphernalia
13. pilferage and robbery Dismissal
14. illegal entry/exit Dismissal
15. refusal to surrender ID & giving Dismissal
false representation

22.0 Attachments

Attached are the following:

22.1 Certificate of DOLE Company registration under Rule 1020 of the OSHS
22.2 DTI – PCAB License
22.3 Notice of Award/contract
22.4 Certificates of trainings completed of appointed safety and health personnel
22.5 CHE certificate of testing and inspection (if heavy equipment will be used)
22.6 Skills certification of workers (critical occupations)
22.7 OSH Reportorial requirements
22.8 Others ___________________________________________