CONSTRUCTION SAFETY AND HEALTH PROGRAM

Template (Comprehensive)

1. Statement of Commitment to Comply with OSH Requirements

I/WE (Name o Conracor’s Auhorized Ocial and/or Projec

Owner), by accomplishing his Consrucon Saey and Healh Program,
do hereby commi and bind ourselves o comply wih he requiremens
o he Deparmen Order No. 13, series o 1998 – Guidelines Governing
Occupaonal Saey and Healh in he Consrucon Indusry and he applicable
provisions o he Occupaonal Saey and Healh Sandards (OSHS).

We (also) acknowledge our obligaon and responsibilies o

provide hroughou he course o he projec he appropriae Personal
Proecve Equipmen (PPE) as added proecon or our workers and employees.

We also (hereby) commi o implemen he necessary job sae-

y and healh insrucons and raining o all our workers or he enre (during
he) duraon o he projec, as well as he saey o he general public.

____________________________ ___________________________
Name o Projec Owner Name o Conracor
Signaure over Prined Name Signaure over Prined Name
2. Company Safety and Health Policy Gen. Building Consrucon
Gen. Engineering Consrucon
I is he general policy o (Name of Contractor/company) o perorm work Specialy Trade Consrucon
in he saes manner possible consisen wih good consrucon pracces. To ul- Ohers, speciy:
ll he requiremens o his policy, an organized and eecve Consrucon Sae- __________________
y and Healh Program as described in his program and in consonance wih
DOLE D.O. No. 13 and he OSH Sandards mus be carried ou on every projec.

To achieve hese objecves, we are commied o perorm he ollowing:

v. Name o Consrucon Projec vi. Name o Projec Manager/
2.1. Idenying poenal hazards ha may arise rom he programmed work Manager /Consulan, i any (a person Conac Number (he overall echnical
acvies; or eny hired by he projec owner), personnel o he general consrucor
2.2. Organizing he work acvies so as o minimize he risk arising rom hem; o ac in he owner’s behal concerning and or he subconracor in charge o
2.3. Developing and implemenng projec specic saey and healh program; supervision and monioring o all he acual execuon o his projec)
2.4. Esablishing and enorcing all necessary sae work procedures, rules and maers relaed o he overall execuon
regulaons; o his projec. I shall be a separae eny
2.5 Ensuring ha all workers are given orienaon/brieng or inducon prior rom he general consrucor or any sub-
o deploymen o he sie; conracor o he consrucon projec
2.6 Esablishing a sie saey and healh commiee o ac as policy-making
body o he projec on all issues peraining o saey and healh;
2.7 Ensuring he conduc o daily oolbox meengs;
2.8 Esablishing a sysem o ollow-up o acons and periodic assessmen o check
program eecveness.
3.0 Project Details
vii. Name o Residen Engineer, i any viii. Name and Classicaon o Consrucors
(a duly licensed engineer who shall be (synonymous o builders who under-
i. Specic name o projec and Name o ii. Locaon o he projec: asked o be presen a he consrucon ake or oer o underake or purpor o
Owner: sie a all mes, whenever work is being have he capaciy o underake or sub-
underaken, and shall have he responsibiliy mi a bid o, or do hemselves or by or
o assuring he echnical conormance hrough ohers, consruc, aler, repair,
o all designs, maerials, processes, work add o, subrac rom, improve, move,
procedures rendered or he execuon o wreck or demolish any building, high-
his projec, including saey and healh o way, road, railroad, excavaon or oher
iii. Classicaon o he projec: iv.NameoGeneralConsrucor(consrucorwho all persons wihin he consrucon sie) srucures, projec, developmen or im-
hasgeneralsupervisionoveroher consrucors provemen, or o do any par hereo, in-
in he execuion o his projec and who direcly cluding he erecon o scaolding or oher
receives insrucons rom he owner srucures or works in connecon wih his
or consrucon projec manager, i any) projec. The erm consrucor includes
subconracor and specialy conracor.)
 Name Classicaon xiv. Toal Projec Cos

1.

2.

3. xv. Toal Cos on OSH (breakdown)

(Use addional shee i necessary)

ix. Esmaed maximum number o x. Work Hours (including shif) (Use addional shee i necessary)
workers
1s shif: rom ________ o_________
2nd shif: rom ________ o_________ 4. Consrucon Saey & Healh Commitee
3rd shif: rom ________ o_________
Ohers: __________________________ Secon 11 o D.O. No. 13 requires ha rules o Consrucon Saey and
Healh Program mus be observed and enorced a he projec sie, each sie
shall, a he sar o he consrucon have a consrucon saey and healh
commiee. Wih respec o his projec, he commiee will be organized in
xi.Esmaednumberoheavyequipmen: xii. Projeced daes o commencemen
accordance wih he requiremens o Rule 1040 o he Occupaonal Saey and
and compleon
Healh (OSH) Sandards o he Deparmen o Labor and Employmen (DOLE).
Backhoe: _____ Dozer: _____ Sar Dae: _______________________
Loader: _____ Dumpruck: _____ End Dae: ________________________ 4.1 Composion o Consrucon Saey and Healh Commiee (CSHC)
Crane: _____ Grader: ______ Es. Days o Complee: ______________ Our CSHC a he (Name o Projec) is composed o:
ohers, speciy: __________________
4.1.1. Projec Manager or his represenave as he chairperson ex-ocio
xiii. Name and address o Emergency Healh Provider (any person or organiza- Name: ______________________________________________
on who is cered or recognized by he Deparmen o Healh and who can pro- 4.1.2 General Consrucon Saey and Healh Ocer/s (overall in charge
vide he same or equivalen emergency healh services as an emergency hospial, in he implemenaon o he OSH program o his projec hired by he
including emergency reamen or workers on sie, emergency ranspor and care General Consrucor. Please aach cercae o raining/s prescribed by
during ranspor o injured workers o he neares hospial, wih adequae personnel, DOLE. Numbers will be dependen on he numbers o workers and heavy
supplies and acilies or he complee immediae reamen o injuries or illnesses) equipmen)
Name: ________________________________________________
Name: ________________________________________________
Name: ________________________________________________
4.1.3. Consrucon Saey and Healh Ocer/s rom Subconracors
any employee/worker rained and, in addion o heir regular dues and
responsibilies asked by his employer o implemen occupaonal saey
and healh program in accordance wih he provisions o he OSH Sandard.
Please aach cercae o raining/s prescribed by DOLE).
Name:_____________________________________________
Company: __________________________________________
 Name:_____________________________________________ 4.2.7.1 Summary o all saey and healh commiee meeng agreemens;
Company: __________________________________________ 4.2.7.2 Summary o all acciden invesgaon repors using he
Name: _____________________________________________ DOLE/BWC/ OHSD/IP-6 orm;
Company: __________________________________________ 4.2.7.3 Periodic hazards assessmen wih he corresponding remedial
Name: _____________________________________________ measures/acons or each hazard;
Company: __________________________________________ 4.2.7.4 Annual Medical Repor using he orm DOLE/BWC/HSD/OH-47-A
4.1.4. Occupaonal Healh Personnel (qualied rs-aider, nurse, dens, (i he duraon o he projec is more han one year);
or physician, engaged by he employer o provide occupaonal healh services 4.2.7.5 Iniaes and supervises saey and healh raining or employees.
in he esablishmen/underaking. Please aach cercae o raining/s (Check on he boxes or lis down he raining o be provided or
prescribed by DOLE): workers and employees).
Name: ______________________________________________ □ 40-Hour Consrucon Occupaonal Saey and Healh Course
Designaon: _________________________________________ □ 1-Day Workers Saey & Healh Orienaon
Name: ______________________________________________ ohers, speciy:
Designaon: _________________________________________ ______________________________________________
Name: ______________________________________________ ______________________________________________
Designaon: _________________________________________
4.1.5 Workers’ represenaves (minimum o 3 union members i organized, 4.3 Dues o he Saey Man/Ocer
no necessarily rom one employer) The principal uncon o he Saey Man assigned o his projec is o ac as he
Name: ______________________________________________ employer’s (needs idencaon) principal assisan and consulan in he
Designaon: _________________________________________ applicaon o programs o remove he hazard rom he workplace and o correc
Name: ______________________________________________ unsae work pracces. For his purpose, he Saey Man has he ollowing dues:
Designaon: _________________________________________ 4.3.1 Serves as Secreary o he SHC, as such will perorm he ollowing:
Name: ______________________________________________ 4.3.1.1 prepare minues o meengs;
Designaon: _________________________________________ 4.3.1.2 repor saus o recommendaons made;
4.3.1.3 noy members o he meengs; and
4.2 Dues o he CSH Commiee shall include bu are no limied o he ollowing: 4.3.1.4 submi (needs idencaon) o he employer a repor o he
4.2.1 Plans, develops and oversees he acciden prevenon programs or he acvies o he commiee, including recommendaons made.
consrucon projec; 4.3.2 Acs as an advisory capaciy on all maers peraining o healh and
4.2.2 Direcs he acciden prevenon eors o he esablishmen in accordance saey or guidance o he employer and he workers.
wih he saey programs and perormance and governmen regulaons in 4.3.3 Conducs invesgaon o acciden as member o he Healh and
order o preven accidens rom occurring in he worksie; Saey Commiee and submis his separae repor and analysis o acciden
4.2.3 Conducs saey meengs a leas once a monh. The commiee will o he employer (needs idencaon).
hold a saey meeng every _____________ o he monh; 4.3.4 Coordinaes all healh and saey raining programs or he wokers/
4.2.4 Submis repors o he projec manager on is meengs and acvies employees and employer (needs idencaon).
one day afer he meeng: 4.3.5 Conduc healh and saey inspecon as member commiee.
4.2.5 Reviews repors o inspecon, acciden invesgaon and implemenaon 4.3.6 Mainains or helps in he mainenance o an ecien acciden record
o program; sysem and coordinaes acons aken by supervisors o eliminae acciden
4.2.6 Provides necessary assisance o governmen inspecng auhories causes.
in he proper conduc o heir acvies specically on he enorcemen 4.3.7 Provide assisance o governmen agencies in he conduc o saey
o he provision o DOLE’s OSHS; and healh inspecon, acciden invesgaon or any oher relaed program.
4.2.7 Submis he monhly he ollowing saey and healh repors o he 4.3.8 For he purpose o eecveness in he projec sie, he Saey Man
DOLE Regional Oce having jurisdicon over he projec: is o repor direcly o he employer (needs idencaon).
 4.4 Dangerous Occurrence or Major Acciden insrucon and raining regarding he general saey and healh measures we
In case o any dangerous occurrence or major acciden resulng o deah or plan o implemen or his projec, specically:
permanen oal disabiliy, we will noy he DOLE Regional Oce wihin 24 6.1.1 basic righs and dues o workers a he jobsie;
hours rom occurrence. Afer he conduc o invesgaon by our concerned 6.1.2 means o access and egress boh during normal work and in emergency
saey and healh ocer, we will repor all permanen oal disabilies o he siuaons;
DOLE Regional Oce on or beore he 20h o he monh ollowing he dae 6.1.3 measures or good housekeeping;
o occurrence o acciden using he DOLE/BWC/HSD-IP-6 orm. 6.1.4 locaon and proper use o welare amenies and rs–aid acilies;
6.1.5 proper care o PPEs and oher proecve clohing;
5.0 Emergency Occupaonal Healh Personnel and Facilies 6.1.6 general measures or personal hygiene and healh proecon;
6.1.7 re precauons o be aken;
Secon 8 o D.O. No. 13 saes ha he consrucon projec owner or his rep- 6.1.8 acon o be aken in case o any emergencies;
resenave shall provide compeen emergency healh personnel wihin he acilies 6.1.9 requiremens o relevan healh and saey rules and regulaons.
based on he oal number o workers in he sie.
Below are he lis o workers who have undergone he DOLE prescribed saey
5.1 Emergency Healh Personnel and Facilies and healh rainings and orienaon:
Consrucon Number of Healh Personnel & Facilies Name Title of training Remarks
Stages workers during atended
this stage Health Personnel Facilies

(Use addional shee i necessary and aach all required raining cercaes in his secon.)
(Use addional shee i necessary)

6.0 Saey and Healh Promoon & Educaon

7.0 Toolbox Meeng
The (Name of Company) is commied a ensuring ha all workers or employees
D.O. No. 13 dene oolbox meeng or gang meeng as a daily meeng among
are given orienaon/brieng or inducon prior o deploymen o he sie. I is our
workers and heir respecve supervisors or he purpose o insrucon, discussion and
connuing eor o promoe saey and healh consciousness o all people involved his
proper brieng on he planned work, he assessmen o pas work, he possibiliy or
projec by providing hem wih he necessary saey and healh raining and educaon o
acual occurrence o accidens a he sie, ps and suggesons on how o preven
enhance heir knowledge and skills o enable us o aain a sae and healhul projec
possible accidens and oher relaed maers.
site.
7.1 Responsible or he Toolbox Meeng
6.1 Workers Saey and Healh Orienaon/Trainings
The ollowing supervisor or any designaed person (e.g. oreman, leadman, gang
We require new workers o aend our Saey and Healh Orienaon beore
boss, ec.) is required o conduc daily oolbox or similar meengs prior o sarng
hey are deployed o his projec sie in consonance o Secon 12 o he D.O. 13.
he asks or he day o discuss wih he workers and ancipae saey and
(Complee Name) healh problems relaed o every ask and he poenal soluons o hose
The assigned Saey Ocer, Mr./Ms _____________________________________
problems. The supervisor will remind he workers on he necessary saey
will coordinae he conduc o his orienaon. We ensure ha hey receive
precauons ha need o be underaken.
 Name of Supervisor Time o Toolbox Meeng Means o Documenaon used o documen your invesgaon)
(indicae shif, e.g. 1s, (atach sample
2nd, 3rd ) instrument) 8.3 Compliance wih Governmen Requiremens
We will submi he ollowing repors o he DOLE Regional Oceconcerned:

8.3.1 In case o any dangerous occurrence or major accidens resulng o deah

or permanen oal disabiliy using he orm (DOLE/BWC/OHSD/IP – 6).
Nocaon o major accidens o DOLE Regional Oce concerned will
be made wihin 24 hours.
8.3.2 Summary o Work Acciden/Illness Exposure Daa Repor will be
submied on or beore he 20h o he monh ollowing he dae o
occurrence o acciden (or hose projecs wih shor duraon or less han
(Use addional shee i necessary)
one year duraon).
8.3.3 Annual Work Acciden/Illness Repor using he orm DOLE/BWC/
8.0 Acciden/Inciden/Illnesses Invesgaon & Reporng OHSD/IP – 6B or hose consrucon projecs wih more han one year
duraon.
We consider acciden/inciden/illnesses invesgaon and reporng as our
responsibiliy. Abseneeism can grealy aec our work schedule. Looking or replacemen 9.0 Personal Proecve Equipmen (PPE)
can be cosly or he company, he hiring eor, raining o new workers, he loss o
job momenum aec our producviy. We involve our supervisors in his program because Secon 6 o D.O. No. 13 requires ha every employer shall, a his own expense,
hey are more amiliar wih he people involved, hey have beer undersanding o he urnish his workers wih proecve equipmen or eyes, ace, hands, ee, lieline, saey
operaon, and hey have personal ineres in he invesgaon since i’s heir people bel/harness, proecve shields and barriers whenever necessary by reason o he
who are involved. For his reason, he (Name of Company) is commied o include his hazardous work process or environmen, chemical or radiological or oher mechanical
responsibiliy o all supervisors and made hem aware abou i. irrians or hazards capable o causing injury or impairmen in he uncon or any par
o he body hrough absorpon, inhalaon or physical agen.
8.1 Persons responsible or conducng invesgaon
In his projec he ollowing person/s will be assigned o conduc acciden/ Provision o PPE shall be in accordance wih Rule 1080 o he OSHS (mus include Rule 1070
inciden invesgaon: or noise). The equivalen cos or he provision o PPE (lie span, depreciaon, replacemen,
ec.) shall be an inegral par o he projec cos.
All accidents All incidents/near miss Illnesses

Item No. Type of PPE Quany Unit Price Total Cost

8.2 Conducng and documenng he acciden/illnesses invesgaon

In conducng he acciden/illness invesgaon, we gaher acs, analyze hem and (Use addional shee i necessary)
make he necessary recommendaon. (Please aach sample orms ha will be
 9.1 Cleaning and Proper Mainenance o PPEs 11.0 Safety Signages
I is imporan ha all PPE be kep clean and properly mainained. Cleaning is
parcularly imporan or eye and ace proecon where diry or ogged lenses Our saey signages provides warning o workers and employees and he public
could impair vision. Our workers or employees inspec, clean, and mainain abou he hazards around he projec sie. These will be posed in prominen posions
heir PPE according o he manuacurers’ insrucons beore and afer each a sraegic locaon visible as ar as possible in a language undersandable o mos o
use. Our supervisors are responsible or ensuring ha users properly mainain he workers and employees as well as he public.
heir PPEs in good condion.
11.1 The specic saey signages we inend o se-up or his projec include
We enorce our rule ha PPEs mus no be shared beween workers or employees bu no limied o:
unl i has been properly cleaned and sanized. PPEs are disribued or individual
use whenever possible. 11.1.1 Mandaory requiremen on he usage o PPE prior o enry o he
projec sie (aach sample picure o his signage ha you plan o use or
I workers or employees provide heir own PPEs, we make sure ha i is adequae his projec);
or he work place hazards, and ha i is mainained in a clean and sored in 11.1.2 Areas where here are poenal risks o alling objecs (i applicable,
a conducive condion. aach sample picure o his signage ha you plan o use or his projec);
11.1.3 Areas where here are poenal risks o alling (i applicable, aach
We never allow he use o deecve or damaged PPEs. We immediaely discard sample picure o his signage ha you plan o use or his projec);
and replace hem o avoid any uninenonal use. 11.1.4 Areas where explosives and ammable subsances are used or sore
(i applicable, aach sample picure o his signage ha you plan o use
We also consider he imporance o ensuring ha any conaminaed PPE which or his projec);
canno be deconaminaed is disposed o in a manner ha proecs workers 11.1.5 Areas where here are ripping or slipping hazards (i applicable,
or employees rom exposure o hazards aach sample picure o his signage ha you plan o use or his projec);
11.1.6 Approaches o working areas where danger rom oxic or irrian
10.0 Proecon o he General Public airborne conaminans/subsance may exis which should indicae he
name o he conaminan/subsance involved and he ype o respiraory
We comply wih Rule 1412.09 o he DOLE OSH sandard in providing a sae equipmen o be worn (i applicable, aach sample picure o his signage
covered walkway over he sidewalk or use by pedesrians in a building consrucon ha you plan o use or his projec);
work less han 2.3 meer (7f.) rom a side walk or public road. 11.1.7 All places where conac wih or proximiy o elecrical/aciliy
We comply wih Rule 1412.10 o he OSH Sandard, Proecon rom Falling Maerials. equipmen can cause danger (i applicable, aach sample picure o his
We observe he ollowing: signage ha you plan o use or his projec);
11.1.8 All places where workers may come in conac wih dangerous moving
10.1 We will ake he seps o proec worker rom alling maerials, such as pars o he machineries or equipmen (i applicable, aach sample picure
he provisions o saey helmes and saey shoes. o his signage ha you plan o use or his projec);
10.2 We will ensure ha ools, objecs and maerials including wase maerials) 11.1.9 Locaon o he re alarms and re-ghng equipmen (aach
will no be hrown or pped rom a heigh, bu will be properly lowered by sample picure o his signage ha you plan o use or his projec);
crane, hois or chues. I such is no praccable, he area where he maerial 11.1.10 Insrucons on he usage o specic consrucon equipmen (i
is hrown will be enced and no person will be allowed in he enced area. applicable, aach sample picure o his signage ha you plan o use or
his projec);
The person responsible or his program: 11.1.11 Periodic updang o man-hours los.

Name: ______________________________________________ 11.2 Inspecon and Mainenance o Saey Signages

Designaon: _________________________________________ We will regularly inspec and mainain in good condion all saey signages
ha we will be providing or his projec. The person/s in charge in inspecng
 is/are (Complee Name/s) , he/she/they is/are our 14.2 Hazards Idened
(designaon/s) . Inspecon will be carried ou on a (daily/ weekly/
monhly) basis. Based on he lis o acvies or his projec, we ound he ollowing poenal
hazards ha we may possibly encouner in he course o projec implemenaon:
Our _______________________will remove and replace any signages ha
are damaged, illegible, or no longer apply wih he curren hazard. 14.2.1 Physical Hazards

12.0 Consrucon Workers Skills Cercaon Physical hazards are he mos common in mos workplaces. The physical
hazards ha we idened or his projec include bu are no limied o
The company will ensure ha all workers assigned in he crical occupaons he ollowing: (please check on he box all ha applies)
as dened in Secon 15 o D.O. No. 13 and hose who will be assigned in he operaon
o consrucon heavy equipmen (CHE) will undergo mandaory skills esng or cercaon
by TESDA (Aach TESDA cercaes o hose workers cered by TESDA.) Machineries Power and Hand Tools
Elecrical Ladders and Scaolds
13.0 Tesng & Inspecon o Consrucon Heavy Equipmen Noise Venlaon
Exposure o Hea Tripping
All consrucon heavy equipmen will be esed and inspeced in accordance Fall Hazards Collapse
wih he requiremens o Secon 10 o D.O. No. 13. The company will ensure ha all Ohers (please speciy)___________________________________
heavy equipmen will be operaed by qualied and cered operaors. (Aach Cercae _____________________________________________________
o Tesng and Inspecon o CHE used issued by DOLE Accredied Tesng Organizaons _____________________________________________________
or CHE and TESDA cercae o CHE operaor/s).
14.2.2 Chemical Hazards
14.0 Conrol Measures on Consrucon Acvies
Chemical hazards are presen workers handle chemical preparaons in
To ensure sae and healhy working condions hroughou he duraon o any orm (solid, liquid or gas). Some are saer han ohers, however, some
he projec he ollowing conrol measure acvies will be enorced and disseminaed workers are more sensive o chemicals, even he common soluons
o all he workers in he sie: causing illness, skin irriaon or breahing problems.

14.1 Major Acvies The chemical hazards ha we idened or his projec include bu are
Major acvies or his projec includes bu no limied o he ollowing: no limied o he ollowing: (please check on he box all ha applies)
(please mark all ha applies)
solvens pain producs
Demolion Excavaon acids cleaning producs
Earhmoving Piling aceylene propane
Scaold Formwork gasoline explosive chemical
Srucural Seel Crane Operaon welding umes ohers (please speciy)
Concreng Rebarworks _______________________________________________________
Welding Elecrical _______________________________________________________
HVAC Plumbing _______________________________________________________
Painng Inerior Decoraon
Ohers (please speciy)__________________________________ 14.2.3 Biological Hazards
_____________________________________________________
_____________________________________________________ Biological hazards come rom working wih inecous people, plans, and
 oher living maerials. The biological hazards ha we have idened or order each step in a process.
his projec includes bu no limied o he ollowing: (please check on he
box all ha applies) (Enumerae he sae work pracces ha you inend o perorm relave o he hazards you have
idened above.)
blood or oher body uids ungi ______________________________________________________________
baceria and viruses plans ______________________________________________________________
insec bies animal and bird droppings
ohers (please speciy)___________________________________ 15.0 Firs-Aid, Healh Care Medicines and Equipmen Facilies
_____________________________________________________
_____________________________________________________ The company will provide rs-aid ki and healh care medicines and acilies
or workers in he sie in accordance wih he requiremens o Rule 1960 o he OSHS.
14.2.4 Ergonomic Hazards
16.0 Workers Welare Facilies
Ergonomic hazards occur when he ype o work, body posion and working The ollowing welare acilies will be provided in he sie o ensure human
condions pu srain on he body. They are he hardes o spo since one working condions:
does no immediaely noce he srain on your body or he harm hese
hazards pose. Shor-erm exposure may resul in “sore muscles” on he 16.1 Adequae supply o sae drinking waer
days ollowing exposure, bu long erm exposure can resul in serious
16.2 Adequae saniary, washing and sleeping acilies separae or men and
musculoskeleal injuries. women workers
The ergonomic hazards ha we idened or his projec includes bu 16.3 Adequae acilies or changing and or he sorage and drying o work
no limied o he ollowing: (please check on he box all ha applies) clohes.
16.4 Adequae accommodaon or aking meals.
poor lighng requen lifing
poor posure repeve moon To assure ha he company provides adequae welare acilies or he workers in
exeron o orce awkward movemen he sie he company will implemen he provision o oiles and oher acilies in
ohers (please speciy)_________________________________ accordance wih he requiremens o he Saniaon Code
_____________________________________________________
_____________________________________________________ 17.0 Medical Surveillance
(Enumerae conrol measures o address idened hazards, use addional shee i necessary)
The company will require all employees o undergo a baseline or inial medical
14.3 Sae Work Pracces healh examinaon prior o assigning o a poenally hazardous acviy. The examinaon
will include bu no limied o he ollowing:
Sae work pracces are procedures adoped or carrying ou specic asks ha
ensure ha worker exposure o hazardous siuaons, subsances, and physical 17.1 Complee medical and work hisory;
agens is conrolled. Sae work pracces are generally wrien mehods oulining 17.2 Physical examinaon (Pre-employmen, During employmen and Separaon);
how o perorm a ask wih minimum risk o people, equipmen, maerials, 17.3 Oher special examinaon (Pulmonary uncon es, blood panel, ECG >40
environmen, and processes. I should be developed as a resul o compleng years o age, audiogram);
a hazard assessmen and should closely reec he acvies in his projec. 17.4 Random drug esng.

All sae work pracces should be kep in a locaon cenral o he work being
perormed and readily available o he workorce. Some sae work pracces
will require specic job procedures, which clearly se ou in a chronological
18.0 Working Hour & Break Time policy on penales, i here are any).

The work schedule will be on ( please check on he boxes ha apply):
Monday Tuesday Wednesday Thursday Friday Saurday Sunday Saey Violaon 1s oense 2nd oense 3rd oense
1. No helme, no saey shoes, no saey warning 3-day 5-day
Check on he shif and indicae he work hours or he shif ha applies. bel/harness suspension suspension

1s Shif rom ________(am/pm) o __________ (am/pm) 2. No ID, Uniorm, working atre, goggles, warning 3-day 5-day
gloves & apron suspension suspension
2nd Shif rom ________(am/pm) o __________ (am/pm)
3rd Shif rom ________(am/pm) o __________ (am/pm)
3. Eang a prohibied area warning 3-day 5-day
suspension suspension
Check on he shif and indicae he break or he shif ha applies.
4. Liering and loiering warning 3-day 5-day
1s Shif rom ________(am/pm) o __________ (am/pm) suspension suspension
2nd Shif rom ________(am/pm) o __________ (am/pm)
3rd Shif rom ________(am/pm) o __________ (am/pm) 5. Smoking a prohibied area warning 3-day 5-day
suspension suspension
19.0 Consrucon Wase Disposal
6. Urinang a prohibied area warning 3-day 5-day
The company including subconracors will be responsible or minimizing wase generaed suspension suspension
during he implemenaon o he projec. The ollowing procedures or disposal o wases 7. Illegal dismanling o saey signages warning 3-day 5-day
will be implemened in he sie: and paraphernalia suspension suspension

19.1 Ensure ha he consrucon wases are segregaed rom ha o domesc 8. Illegal gambling 3-day 5-day Dismissal
waste. suspension suspension
19.2 All domesc wases are o be colleced on a daily basis. 9. Overnigh say w/o permission 3-day 5-day
19.3 Consrucon debris (broken hollow blocks, spoiled concree, loose concree, suspension suspension
ec) should be aken ou on he saging area.
19.4 Oil spills and spoiled greases should be wrapping in he black garbage bag and 10. Fighng & provoking ohers 5-day Dismissal
suspension
will be properly disposed.
19.5 Applicaon o good housekeeping. 11. Working under he inuence o Dismissal
drugs and liquor
20.0 Emergency Preparedness
12. Possession o illegal drugs, deadly Dismissal
weapon & gambling paraphernalia
The objecves o his are o ensure ha he company has developed and
communicaed plans ha will allow or he eecve managemen o emergencies.
Aach copy o company emergency preparedness plan. 13. Pilerage and robbery Dismissal

21.0 Penales/Sancons 14. Illegal enry/exi Dismissal

For every oenses and violaon o any saey rules, regulaons and general 15. Reusal o surrender ID & giving alse Dismissal
represenaon
pracces promulgaed by he projec and/or he company, he company recommended
he ollowing penales and sancons or violaon o CSH program: (Please aach company
22.0 Atachmens

Aached are he ollowing:

22.1 Cercae o DOLE Company regisraon under Rule 1020 o he OSHS
22.2 DTI – PCAB License
22.3 Noce o Award/conrac
22.4 Cercaes o rainings compleed o appoined saey and healh personnel
22.5 CHE cercae o esng and inspecon (i heavy equipmen will be used)
22.6 Skills cercaon o workers (crical occupaons)
22.7 OSH Repororial requiremens
22.8 Others ___________________________________________