Occupational Safety and Health (OSH) Program of LGU Polomolok- Municipal Engineer’s

Office

I. Complete Company Profile/ Project details

 Company Name: LGU Polomolok- Municipal Engineer’s Office_

 Date Established: ___ August 21, 1957_________________________________
 Complete Address: ______Pioneer Avenue, Polomolok, 9504, South Cotabato
 Phone and fax numbers __ 225-2033___________________________________
 Website URL/Email address _____ https://polomolok.gov.ph/homepage____
 Name of Company Owner/Manager/President: ___Engr. Ronelio J. Diaz
 Total Number of Employees; ____35_____ Male ___21__ Female __14__
 Description of the business Pls specify
o Kindly check:
o Manufacturing: ______________________________
o Service: ______________________________
o Agri/fishing: ______________________________
o Wholesale/retail ______________________________
o Utilities ______________________________
o Banks and financial institution _______________________
o Security Agency
o Maintenance
o Construction
o Others: Local Government Agency

 Product descriptions: Engineering Services (ie. Investigationd and Survey,

Engineering designs, feasibility studies, and project management.

 Description of services: Administer, coordinate, supervise, and control the

construction, maintenance, improvement, and repair of roads, bridges, and other
engineering and public works projects of the LGU concerned.

Basic Components of Company OSH Program and Policy

(DO 198-18, Chapter IV, Section 12)

1.0 Company Commitment to Comply with OSH Requirements

2.0 General Safety and Health Programs
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 -Medical Surveillance for early detection and management of occupational and
work-related diseases
-First-aid and emergency medical services
3.0 Promotion of Drug Free workplace, Mental health Services in the Workplace,
Healthy lifestyle
4.0 Prevention and Control of HIV-AIDS, Tuberculosis, Hepatitis B
5.0 OSH Personnel and Facilities
6.0 Toolbox/Safety Meetings, job safety analysis
7.0 Safety signages
8.0 *Dust control and management and regulation on activities such as building of
temporary structures and lifting and operation of electrical, mechanical,
communications system and other requirements
9.0 Welfare Facilities
10.0 Emergency and disaster preparedness and response plan to include the organization
and creation of disaster control groups, business continuity plan, and updating the
hazard, risk and vulnerability assessment (as required)
11.0 Solid waste management system
12.0 *Prohibited Acts and Penalties for Violations
13.0 *Cost of Implementing Company OSH program

*(Applicable for medium to high risk establishments with 10 to 50 workers and low to high
risk establishments with 51 workers and above)

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1.0 Company Commitment to Comply with OSH Policy

______LGU Polomolok –_Municipal Engineer’s Office____ do hereby commit

Name of the Company)

to comply with the requirements of RA 11058 and DOLE Department Order 198-18 (its

Implementing Rules and Regulations) and the applicable provisions of the Occupational

Safety and Health Standards (OSHS).

We acknowledge the company’s obligation and responsibilities to provide appropriate funds

for implementing this OSH program including orientation and training of its employees on

OSH, provision and dissemination of IEC materials on safety and health, provision of

Personal Protective Equipment (PPE) when necessary and other OSH related requirements

and activities, to ensure the protection for our workers and employees against injuries,

illnesses and death through safe and healthy working conditions and environment.

We commit to conduct risk assessment as required to prevent workplace accidents as well as

comply with other provisions of this OSH program. That we are also fully aware of the

penalties and sanctions for OSH violations as provided for in RA 11058 and its Implementing

Rules and Regulations.

[Signature] ______________________________

[Name] _Engr. Ronelio J. Diaz____

Municipal Engineer’s Office Head
[Date] ;_____May 4, 2023______

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 2.0 General Safety and Health Programs
2.1 Conduct of Risk Assessment

Kindly accomplish. Pls use additional pages if needed. You may also wish to attach your
Company’s Risk Assessment Matrix as substitute

Risk Assessment Matrix

Priority: likelihood
of injury and illness
Risk to occur Control
Task Hazard Identified
Description (low, medium, Measures
high)

Excavation work can Workers may fall  Provide

Risk cause cave-ins, falls, into the excavation proper
assessment for and struck-by injuries. site, be struck by safety
construction falling objects or equipment
site excavation equipment, or such as hard
suffer injuries due hats, safety
to cave-ins. glasses, and
steel-toed
boots.
 Ensure that
the
High
excavation
site is
properly
stored and
sloped.
 Conduct
regular
safety
inspections
and training
for workers.
Risk Working at heights can Workers may fall High  Use
assessment result in falls, slips, or from heights, appropriate
for working trips. resulting in serious personal
at heights injuries or death. protective
equipment
such as
harnesses,
lanyards,
and anchor
points.
 Ensure that
all fall
protection

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 equipment is
properly
maintained
and
inspected
regularly.
 Conduct
regular
safety
training for
workers and
ensure that
they are
familiar with
the safety
procedures.
 Establish
proper work
platforms or
scaffolds
that have
been
properly
installed and
secured.

Risk High  Conduct a

assessment thorough
for working risk
in confined assessment
spaces in a before any
municipal work is done
engineering in a confined
department space,
including
Working in confined Workers may be checking for
spaces such as tanks, exposed to harmful potential
pipes, or manholes can substances, such as hazards and
result in hazards due to toxic gases or lack the presence
limited space, poor of oxygen, of toxic
ventilation, and resulting in serious gases.
potential exposure to injury or death.  Use
toxic gases. appropriate
personal
protective
equipment
such as full-
body
harnesses,
respiratory
protection,
and
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 emergency
communicati
on devices.
 Develop and
implement a
confined
space entry
program that
includes
proper
training for
workers,
permit
systems, and
proper
rescue
procedures.
 Ensure that
all workers
are properly
trained in
confined
space entry
procedures,
and that they
are familiar
with the
hazards and
safety
procedures.
 Ensure that
there is
proper
ventilation
and air
quality
monitoring
in place to
protect
workers
from toxic
gases or lack
of oxygen.

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 2.2 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:

a. Routine: ( / ) CBC ( / ) Chest X-ray ( / ) Urinalysis ( / ) stool exam

b. Special: ( ) Blood Chemistry ( / ) ECG ( ) others, please specify
c. Schedule of Annual medical examination: ( ) Q1 ( )Q2 ( )Q3 ( / )Q4

d. Is random drug testing conducted? Yes ( / ) when Annual Physical Exam ) No

______

2.3 First-Aid, Health Care Medicines and Equipment Facilities

 How may treatment rooms/first aid rooms are existing in your company?
___1___
 How many Clinics in the workplace? ____0___
 What hospital (s) are you affiliated with? All hospitals accredited
hospitals of HMO Provider

3.0 And 4.0 - Health Programs for the promotion, prevention and control

This refers to : Drug-free Workplace in compliance to RA 9165, Human Immunodeficiency

Syndrome (HIV/AIDS) in compliance to (RA 8504) RA 11166, Tuberculosis in compliance to
EO 187-03, Hepatitis B in compliance to DOLE Advisory No. 05 Series of 2010, Mental
Health in compliance to RA 11036.

Kindly accomplish the policy template in Annex A.

(*you may attach individual policy statements)

5.0 OSH Personnel and Facilities

5.1 Emergency Occupational Health Personnel and Facilities

List of competent emergency health personnel within the worksite duly complemented by
adequate medical supplies, equipment and facilities based on the total number of workers.
(Use additional sheet if necessary and attach all required training certificates in this section.)
Emergency Health Personnel and Facilities

Total number of Health Personnel & Facilities

Shift/Area/unit/ workers/area Health Personnel (First- Facilities
Department aider, Nurse, Physician, (Treatment Room/
Dentist) Clinic/ Hospital)

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6.0 Conduct of Tool Box Meetings/ Safety Meetings if applicable

Conduct of Safety Meetings/Tool Box Meetings Date

7.0 Safety Signage

The safety signages include warning to workers and employees and the public about the
hazards within the workplace.

Type of Safety Signage: Kindly attach picture.

8.0 *Dust control and management and regulation on activities such as building of
temporary structures and lifting and operation of electrical, mechanical,
communications system and other requirements *(Applicable for medium to high risk
establishments with 10 to 50 workers and low to high risk establishments with 51 workers
and above)

Kindly attach dust control procedures, plans on temporary structures, permits applicable
for the operation of electrical, mechanical, communications systems and other
requirements

9.0 Workers Facilities Provided:

FACILITIES PROVIDED? REMARKS

YES NO
a. Adequate supply of drinking water /
b. Adequate sanitary and washing /
facilities
c. Suitable living accommodation (if /
applicable)
d. Separate sanitary, washing and sleeping /
facilities (if applicable)
e. Lactation station (in consonance with /
DOLE D.O. 143-15)
f. Ramps, railings, and the like
g. Other workers’ welfare facilities as / Pantry
prescribed by OSHS and other related
issuances

10.0 Emergency and Disaster Preparedness:

13.1 Written Emergency and Disaster Program Yes____ No_____

13.2 Types and number of Drills conducted

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 Type of Drills (fire, Date Responsible
earthquake) person/position

11.0 Solid Waste Management System

Written Pollution Control Program: Yes:____ No: _____

Name of Pollution Control Officer:__________________________

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ANNEX A:

WORKPLACE POLICY AND PROGRAM ON PROMOTING WORKERS HEALTH

AND ENSURING PREVENTION AND CONTROL OF HEALTH-RELATED ISSUES
AND ILLNESS

_____________________________________ company is committed to promote and

ensure a healthy and safe working environment through its various health programs for its
employees. We shall conform to the all issuances and laws that guarantee workers health and
safety at all times.

The company shall ensure that worker’s health is maintained through the following
company programs and activities:
a) Orientation and education of employees
b) Access to reliable information on illness and hazards at work
c) Referral to medical experts for diagnosis and management of illness or health-
related concerns
d) Provide health-related programs such proper nutrition and exercise activities are
made available to the workers

The above-mentioned programs shall comply with the Government’s issuances on

promoting healthy lifestyle, addressing mental health in the workplace and preventing
and controlling substance abuse.

In addition, company policies to protect workers’ rights arising from illness shall be
guaranteed. The company shall promote the following workers’ rights:
a) Confidentiality of information
b) Non-discrimination including non-termination
c) Work accommodation following a course of illness
d) Assistance to compensation

This policy is formulated for everybody’s information. The company is committed to

ensuring workers’ health and providing a healthy and safe workplace.

______________________ ___________________________
Owner /Manager Employees’ Representative

DATE: ______________

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