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0% found this document useful (0 votes)
60 views45 pagesCSHP
Uploaded by
Danes Karlo Magpayo AlisboCopyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
/ 45
“CHECKLIST FOR EVALUATION OF CONSTRUCTION SAFETY AND HEALTH PROGRAM (CHP)
‘per requirements of 0.0. No. 13 sefes of £998
7 General Requirements
‘a. Two(2) copies of ter of ntet
Name of authorized contact person with telephone numbers.
¢Two(2) copes of the Safty and Health Program. One copy must
be erga print.
B _cSiProgram must contain the following:
1, Name of person wo prepared the program,
{please ncicate i accredited by DOLE as O54 Practtones)
2, Project Description:
1. Specfiename of projec
, Location of the project
«Project asian
4. Projectonner
fe. Name of main contactor
{. Estimated number of workers to be deroved
9, Estimated star of execution of project
Eximated duration
1 Soape of work tobe undertaken
+3, Company Safety Policy written on a company letterhead
‘Must be diy sgn bythe highest company ofl or the highest
ranking company representative who has overall contra f projet
execution.
‘4, Composition of Safety and Health Committee (Per project)
Must ped the proposed structure and membership ofthe safety and
heath committe (Specty the names)
15, Names of Site Safety and Health personnel (depending onthe
‘umber of workers tobe deployed on the construction ste)
66. Specific duties and responsibilities ofthe Safety Officer
SPECIFIC PROVISIONS ON THE FOLLOWING (1 apllcable}:
17. Ones safety and heath promotion and conning
infomation dseination
8, Acident and incident investigation 2 reporting
Protection ofthe general pubic within the vey ofthe
esnty ofthe construction ste
10 Eavrenmentl Cont
11, Guarding of hazardous machinery
12, Personal Protacive Equpment
1, Handing of Hazardous substances
14. General materials handing and storage procedures
15. Workers ls and certification (or ara ocupation)
16, Provisions for transportation faites for workers in case of
emergency
17, Temporary Fie Protection Facies and equipment
18, Fst id and heath care medicines, equpment and facies
19, Workers Welle Fctiies
20,_Proposed Hours of Work and Rest Breaks
S|
KK
ISI
KEI
s 2.
2B
Conetocton wane Bspos)
‘esting aed inspection of onstruction heavy equipment.
castro heavy equipment wil be wilzed inthe project per
requremens of Se. 10.0. No. 13)
‘Disaster and Emergency Preparedness contingency pln
24. ‘standards Operating Procedure and Job Hazard Analysis for
the following activites and other hazardous work not outlined
herein.
‘Ste eating
Excavations
Erection and smanting of safelds an other tamporery
working plo
“Temocraryeectial conectns/insaiatens
Use of sald and ote temperary working platforms
Working at unprotected elevated working pltorms or surces
se of power to and equipment
Ga and electc welding an cuting operations
Worn n confined spaces
Use of interna cambustion englnes
ene hazardous and/or tx chemical substances
Use of hand tools
Use of mechanized ing apptances for movement of matrils
Use of eensrucion heavy eqdoment
Deraltion
rslaton se and darting of hast and elevators
elelayeteeteleet ele
25, Penalties/Sanctions for violation of the provision/s ofthe CSH
nla
wa
ofa
nfa
fe
na
n/a
n/a
nla
n/a
fa
n/a
Program
ATTACHMENTS
Photocopy of Registration Fors reeved and approve by the
‘concerned DOLE Regional Ofce:
per Rule 1029 of the OSHS (one tne Registration)
‘Pretncoy of Invitation to BidsProjet Contract
Prezncapy of Certcte of Comleton on required Tranng of al
egnated OSH Personnel
= Safety Oe - Bese Ocupationa Safety and Hest Training
for Construction Site Safety Ofeer
oF Nurse = Bask Occasional Safety and Het Trnng for
‘OH Nase (29)
- Fst Aer ~ Standard Fist Ad Trang and ald PARC 1D 25,
Fst Alder.
04 Physicen - ask Corse on Occupational Medicine (ny)
Cera of Inspection and Testing of Construction Heaty
organization,
‘xgenizaton acceded by DOLE; (any)
‘Sis Certiicate of Construction Heavy Equpment operators
Issued by TESDA (any)
‘Contract vith nearby osptal/cric neu ofthe required ifmary
hosp (any)
fel
na
fel_T Evaluated by: Certified Correct/Recommended by:
GUIDO R. RECIO
Signature Over Printed Name Director It
Date: Date: NO FEES REQUIRED FOR THE FILING, EVALUATION AND APPROVAL OF CSHP
Revised Form.: CSHP-D013-98:
Date of Revision: Junet, 2011 Pay
1013
REVISED APPLICATION FORM for
Department of Labor and Employment EVALUATION! APPROVAL OF
REGIONAL OFFICE NO.__ CONSTRUCTION SAFETY & HEALTH
PROGRAM (CSHP)
Legal Basis: Section 5 of Department Order No. 13 s 1908
(Guidelines Governing Occupational Safety and Health In Construction Industry)
Instructions: This form shall be duly accomplished and submitted by the MAIN/GENERAL
CONTRACTOR in applying for an approval of a Construction Safety and Health Program intended for
specific construction project.
Note: A CHECKLIST OF REQUIREMENTS shall be used in receiving the application,
Only an application form with complete requirements and attachments will be processed.
Application found with incomplete requirements willbe given 15 calendar days to comply. Failure to
comply within the prescribed period, the application will be deemed disapproved.
‘A, Company Profile/License/Registration_of MainiGeneral Contractor
‘Complete Name of the Company! ‘Complete Address:
Main /General Contractor 136 Congressional Ave. Bahay Toro 1 Proj. 8 Q.C,
Alcon Philippines Technologies Tel. No: (+632) 85681868
and Solutions Inc.
FaxNo. n/a
‘Name of Project ManageriGontact Person: | Email:
Ms, Nida C. Dela Vega [email protected]
Business Development Director
Main Contractor PCAB License Main Contractor Total employment __12.
No.44772 Male Female_6
Date of Validity: June 30, 2021
DOLE Registration of Main Contracior (Pls. attach photo copy of Registration forms received and approved by
the concerned DOLE Regional Office)
‘Date Reaistered/Approved —_DOLE-RO
2. per DO 18-02 ( requires yearly renewal)
b._per Rule 1020, OSHS (one time registration)
‘Sub-contractors’ Profile/License
No.of | PCAB | Valdiy | Date of
Name of Subcontractor (If, any) | Scope of Work and | Workers | License | ‘Date’ | ‘DOLE
Projet Cost Registration
1 nya
z
3
7
3,
(Cae separate svat Wrecensany REVISED APPLICATION FORM for
Department of Labor and Employment EVALUATION APPROVAL OF
REGIONAL OFFICE NO.__ CONSTRUCTION SAFETY & HEALTH
PROGRAM (CSHP)
B, Project Profile/Description
‘Name of The Project’ (Please alfach copy of Invitation to Bid/other documents indicating name and details of the
project)
Earthquake Alert and Monitoring System for NYK-Fil Maritime E-Training Inc...
Complete Project Address/Location
Knowledge Avenue, Carmeltown, Canlubang
4028 Calamba City, Laguna, Philippines
Name of Project Owner
NYK-Fil Maritime E~
Tel. No: (049) 5088600
Fax No: 0/8
Email; gsmanager@ntmaeduph
Project Classification:
Estimated No. of Workers to
‘be deployed in the project:
6
Total Project Cost:_P1,218,888.88 | (Workforce of the project. to
include workers of the sub-
contractor/s)
Date of Estimated StarvExecution of
the project:
February 2, 2021
rm iv ar
Duration of the project (Pls.
state the number of calendar days
1 week
‘Briel Descriplion of Aciiviies/Work Flow (You may attach additonal sheet, necessary)
Laying of pipes and cables (if necessary), Installation of Devices, Termination,
Configuration, Testing and Commissioning, Project Supervision.
Revised Form.: CSHP-DO 13-08
Date of Revision: Junet, 2011
Page 203 Lb Department of labor and Employment APPLICATION FORM for APPROVAL OF
REGIONAL OFFICE NO. CONSTRUCTION SAFETY AND HEALTH PROGRAM
‘OSH Person ined to the project
‘Name of Appointed Safely Offices ‘Name of Appointed First-Aiders
Nida C. Dela Vega Raymond L. Barlaan
Date of his her BOSH training Date of First Aid Training: October 27, 2019
‘September 19, 20, 26, 27 and 28, 2020
(P's, atach photo copy of Crtncate of Completion ontho | Validty of 1D: October 27, 2024
Basic OSH Course for Construction Site Safety Officers issued
Dy DOLEBWC accredited Safely Training Orgenizations or | (P's. attach photo copy of Certifcate of Firs-Ad Training
recognized institutions) Snd Valid Fest Alder © trom PNRC
‘Other OH personnel {if more than 50 workers will be deployed in the project)
‘Name Dale of BOSH Training
‘OH Nurse
n/a
OHPhysician Tq
Dentist aye
{if Heavy Equipment will be used in the Project)
Tist of Heavy Equipment to be Used in the Project ‘Name of Heavy Equipment Operators (To attach photo
(Please attach additional sheet, if necessary) copy of skis certifieation from TESDA)
nya n/a
Profile of the person who prepared the CSH Program for the abovementioned Project:
Name and Signature ‘Educational Background:
College Graduate
Nida C. Dela Vega Work Experience in OSH:
“Signature over printed name Safety Officer 1
‘iher Qualifcatons:
Business Development Director of
Alcon Philippines Technologies and Solutions Inc.
| HEREBY CERTIFY ON MY HONOR TO THE TRUTHFULLNESS OF THE ABOVEMENTIONED
INFORMATION. THE COMPANY HEREBY COMMIT TO STRICTLY IMPLEMENT THE ATTACHED
CONSTRUCTION SAFETY and HEALTH PROGRAM DESIGNED FOR THE ABOVEMENTIONED PROJECT.
‘Submitted By:
‘Signature Over Printed Nap Nida C. Defa Vega
Business Development Director
January 22, 2021
Position:
Date:
Revised Form.: CSHP-DO 13-98
Date of Revision: June, 2011 Page 30f3, January 22, 2021
‘The Manager
Department of Labor and Employment
Region 4A - Laguna Provincial Office
2/F Puregold Jr. Building, Brey. Parian
Calamba City, Laguna
Re: Earthquake Alert and Monitoring System
for NYK-Fil Maritime E-Training Inc. located at
Knowledge Avenue, Carmeltown, Canlubang
4028 Calamba City, Laguna, Philippines
‘This is to authorize Ms. Nida C. Dela Vega, our Business Development Director, to transact with your
‘good office on behalf of our company, Alcon Philippines Technologies and Solutions Inc., to process
the Application of the needed DOLE-Approved Construction Safety and Health Program (CSHP), for the
above-said project, which is one of the requirements for our Electronics Permit Application at
Philippine Economic Zone Authority (PEZA) thru the Office of the Building Official (OBO).
‘Attached herewith are the necessary documents, for your reference and perusal.
Thank you so much and more power
Very truly yours by:
Hylbert Chu:
President and Chef Executive Officer January 22, 2021
‘The Manager
Department of Labor and Employment
Region 4A - Laguna Provincial Office
2/f Puregold Ir. Building, Brgy. Parian
Calamba City, Laguna
Dear Sir/Madam
‘We, Alcon Philippines Technologies and Solutions Inc., would like to kindly request your good office to
please allow us to secure a DOLE-Approved Construction Safety and Health Program, which is one of
the requirements, in applying for the Electronics Permit at Philippine Economic Zone Authority
Office of the Building Official, in connection to the project described below:
Project Name Earthquake Alert and Monitoring System
Project Owner NYK-Fil Maritime E-Training Inc.
Project Address Knowledge Avenue, Carmeltown, Canlubang
4028 Calamba City, Laguna, Philippines
Est. No. of Workers: —_Six(6) persons
Est. Start of Execution February 2, 2020
Est. Project Duration : One(1) week
The undersigned is attaching herewith the necessary documents, for your reference and perusal.
We sincerely hope and pray that the DOLE-Approved CSHP will be processed and be released soon,
at your convenience.
Thank you so much and God bless.
Business Development Director
Globe : 0916-4416849
‘Smart: 0998-4556519 /0918-9511968
Email; [email protected] e8a, ejaq ‘D epIN Alc..N
OCCUPATIONAL HEALTH AND SAFETY POLICY
It is our policy to provide a safe, accident-free, and healthy work environment for everyone. However,
excellent safe and healthy conditions do not occur by chance. They are the result of diligent work and careful
attention to all company policies by everyone.
Safety demands cooperation on everyone's part. Thus, it is important that communication be kept open
at all times between the management and employees. Workers who notice hazards or other safety
problems, or feel that they need additional training, must notify their supervisor. Supervisors and
management must address these concerns and take corrective action when warranted.
Everyone is obligated to know the safety requirements and standards for their area or job, and just as
important, to abide by them. Supervisors mustinstill a positive attitude and safety awareness in their workers
through personal adherence, personal contact, training, and regularly scheduled safety meetings. It is the
duty of all employees to perform their work with maximum regard for the safety of themselves and co-
workers,
Our safety policies are based on past experience and current standards, and are also an integral part of the
company's personnel policies. This means that compliance with the policies is a condition of employment
and must be taken seriously. Failure to comply is sufficient grounds for disciplinary action or for termination
of employment.
Safety and health are every bit as important in this organization as productivity and quality. In fact,
they go hand in hand. Of course the best reason for you to observe these policies is because it's in your own
self-interest to do so. Conscientiously following them can help you stay safe, healthy, and able to work, play,
and enjoy life to its fullest.
ida C. Dela Veg
Business Development Director
Globe : 0916-4416849
Smart : 0998-4556519 /0918-9511968,
Email: nida.alconph@gmallcom
www.alconphis.com COMPANY COMPREHENSIVE
HEALTH AND SAFETY
PROGRAM SAFETY AND HEALTH PROGRAM
It is the policy of this Company to provide an accident-free and comfortable work environment by
eliminating recognized hazards from the workplace. Our health and safety program, and specific individual
programs, have been developed to assure compliance with federal, state, and local regulations with
particular emphasis on the Wyoming Occupational Health and Safety Rules and Regulations that apply
the safety standards desired by our company, it is necessary to actively
pursue an accident prevention program through all levels of our company, from management through
all employees.
Health and safety are functional responsibilities of each supervisor. Health and safety are of vital
interest to everyone in the company: each level of our organization is accountable for safe performance.
Compliance with this program and safety and health rules is taken very seriously. This means that
failure to comply is sufficient ground for disciplinary action or for termination of employment. These policies
are an integral part of the company's personnel policies. Construction Safety and Health Program
forthe
Earthquake Alert and Monitoring System
Project
for
NYK-Fil Maritime E-Training Inc.
located at
Knowledge Avenue, Carmeltown, Canlubang
4028 Calamba City, Laguna, Philippines
by:
Alcon Philippines Technologies and Solutions Inc. 4.0 Statement of Commitment to Comply with OSH Requirements
1 WE, NYK-Fil Maritime E-Training Inc. and Alcon Philippines Technologies and Solutions Inc.,
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 fo 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.
Ms. Josephine J. Francisco Ms. Nida C. Dela Vega
President Business Development Director
NYK-Fil Maritime E-Training Inc. Alcon Philippines Technologies and Solutions Inc.
2.0 Company Safety and Health Policy
It is the general policy of Alcon Philippines Technologies Inc. to perform work in the safest manner
possible consistent with good construction practices. To fulfil 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.
www.alconphis.co] LC°N
PHILIPPINES,
3.0 Project Details
1. Specfic name of project and Name of Owner:
T Locaon ofthe project
Earthquake Alert and Monitoring System
Knowledge Avenue, Carmeltown, Canlubang
4028 CAlamba City, Laguna, Philippines
Ti Classification ofthe project
Tv Name of General Constuclor (consiucior who fas general
supervision over other constructors‘ the execution of this
project and who directly receives instructions from the owner or
‘constuction project manager, any)
“n Gen. Buidding Const.
13 Gen. Engineering Cons
0 Specaty Trade Const
others, specify: Electronics
Alcon Philippines Technologies and
Solutions Inc.
Name of Constrcton Projet Manager Consultant, any (a
person or entiy who is hire bythe project owner, fo actin he
‘owner’ behalf conceming sypervsion and manring ofall
matters related to the overall execution ofthis projec. It sal be @
separate en rom the general constuctror any subcontractor
ofthe construction project
‘i Name of Projct ManageriContact Number (the overall
technical personne! ofthe general constructor and or the
-subooniracor in charge ofthe actual execution of his projet)
Engr. Armando L.
Structural Engineer
ii. Name of Resident Engineer, any (a dy ioensed engineer
who shallbe tasked fo be present atthe constuction stata!
times, whenever work is being undertaken, and skal have the
responsi of essurng the technical conformance ofl designs,
‘materials, processes, work procedure rendered forthe execution
ofthis project, incuding safety and heath ofal persons within the
constuction sit)
Ms. Nida C. Dela Vega
Business Development Director
Vi Name and Cassiicaon of Constucors (Synonymous fo
uiders who undertakes or ofes to undertake or puports to
‘have the capaci to undertake or submits abid fo, or does
himself or by or trough others, conshuet, ar, epa, ad to,
subtract for, improve, move, wreck or demolish any buldng,
highway, road, ralroad, excavation or ober structure, projec,
development or improvement, orto do ry par thereof,
Including te erecton ofscaffoing or ther stuctres or works
in connection with his project The fem constructor includes
subcontractor nd specialty contractor)
Engr. Jigo Joshua Pascual
Electronnics & Communications Engineer|
Name Ciassicaton
1. Alcon Philippines
Technologies an
2. Solutions Inc.
Communication
Facilities - C
a. LC°N
PHILIPPINES
ix. Estimated maximum number of workers 3. Work Hous (ring hit)
Six (6) workers ‘shits fom_ 8:00 5:00
2eshit rom 2/8
shit: fom_9/___
| Others: n/a
‘x Estimated number ofheavy equipment 7k Projected dates of commencement and completion
‘a Backhoe: 978 oDarer NZS Sart Date: February 2, 2021
loader 2/8 oDumptuk 1/8 End Date; February 9, 2024
pre N/A Grader, 1/2 Est Days to Complete: 4 week
coher, speoty: 1/2
THE. Name and Adress of Emergency Heath Provider (any person or organization who is ceifed or recognized bythe Deparment
‘of Heath and who can provide the sare or equivalent emergency heal services as an emergency hospital, nludng emergency
treatment or workers on sie, emergency transport and care during anspor of nured worker the nearest hospi wih adequate
personnel, supplies and faites forth complete mediate eamentof ures or nesses)
Mr. Raymond L. Barlaan
BW, Toll Project Cost
P1,218,888.88
Yai, Total Coston OSH (breakdown)
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),
Picci oon ALCe
PHILIPPINES
4.1 Composition of Construction Safety and Health Committee (CSHC)
e E-Training Inc. Project) consist of:
‘Our CSHC at the (NYK-Fil Marit
4.1.1 Project Manager or his representative as the chairperson ex officio
Name Ms. Nida C. Dela Vega
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)
Name: Ms. Nida C. Dela Vega
Name: n/a
Name: nfa
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: n/a
Company Name:
Name: nia
Company Name:
n/a
Name: ——
Company Name:
Name: n/a
Company Name: LC°N
HILIBPINES
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: Mr. Raymond L. Barlaan
Designation: Certified First
Name: n/a
Designation:
Fics: RSuIE Cav ETE SEasESaEISnSINESSEEEESOESEssDEEESESESBDESEESETES
Designation: n/a
4.1.5 Workers’ representative (minimum of 3 union members if organized, not necessarily from one employer)
Name: Engr. Jigo Joshua Pascual
Designation: Project Engineer
Name Mr. Arlel Resos
Designation; Technician
Nay Mr, Daniel Nacion
Designation; Technician ALC;.N
ILIPPIN
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 projec
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
Monday, AM 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;
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:
4.2.7.4 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;
4.2.73 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);
4.2.75 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).
‘9.40-Hour Construction Occupational Safety and Health Course
1-Day Workers Safety & Health Orientation
Gothers, specify: 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
4.3.1.4 Submit (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.
4.3.8 For the purpose of effectiveness in the project site, the Safety Man is to report directly to the
employer (needs identification), LC e
PHILIPPINES
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" 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 faciliies based on the total number of workers in the site.
5.1 Emergency Health Personnel and Facilities
Our number of Health Personnel & Facies
Construction Stages workers during this Health Facilities
stage Personnel
(Use addiional sheet if necessary and attach all required training certificates in this section. )
6.0 Safety & Health Promotion & Education
The Safety Officer is committed at ensuring that all workers or employees are given
“drlentaon/brifing or induction prior to deployment to the site It is our continuing effort to promote safety
sm with the necessary safety
‘and health consciousness to all people involved in this projact by providing the
and health training and education to enhance thelr knowledge and skills to eal
healthful project site.
ble us to attain a safe and
\www.alconphils.com 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 0.0. 13. The assigned Safety Officer, Mr./Ms.
Ms. Nida C. Dela Vega 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;
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 attended Remarks
Ms. Nida C, Dela Vega _|Construction Safety & Health Certified
(Use additional sheet if necessary) 6.2 Specialized Instruction and Training:
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
n/a
[Use additonal sheet necessary)
7.0 Toolbox Meeting
D.0. 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.
7.4 Responsible for the Toolbox Meeting
‘The following supervisor or any designated person (e.g. foreman, leadman, gangboss, 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 potential solutions to those
problems. The supervisor will remind the workers on the necessary safety precautions that need to be
undertaken, Nameof Supervisor | ‘Time of Toolbox Meeting Means of
(indicate shift, e.g. 1", 2%, 3") Documentation
(attach sample
instrument)
_
Pe Jigo Joshua Pascual _8:00 AM, 1st Shift Record Book
[Use additional sheet ifnecessory)
8.0 Accident/incidentilinesses 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 __Project Manager 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 Allincidents/near miss Winesses
Ms. Nida C. Dela Vega vo v
Engr. Jigo Joshua Pascual ov cv 8.2 Conducting and documenting the accidentilinesses 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/Iliness Exposure Data Report will be submitted on or before the 20”
of the month following the date of occurrence of accident (for those projects with short duration or less than
cone year duration).
8.3.3 Annual Work Accident/llIness Report using the form DOLE/BWC/OHSD/IP ~ 68 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 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.
\wwwalconphis.con Item] Type of PPE Quantity Unit | Total
No. needed Price cost
1 Hard Hat, Safety Googles 6
2 Safety Shoes, Safety Gloves 6
3 Reflectorized Vest 6 |
4 Face Mask, Face Shield 6 |
5 Alcohol and Alcohol Spray _ 6
(Use additional sheet iFnecessary)
9.1 Cleaning and Proper Maintenance of PPES
Itis 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 afler 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 itis adequate for the work place hazards,
and that itis 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 1442.10 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 willbe 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.
www.dl ‘The person responsible for this program:
Name:__Ms. Nida C. Dela Vega
Designation: Safety Officer
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
ina 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 opplicable, attach somple 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 ofthis signage thot you
‘plan to use fo this project)
11.1.4 Areas where explosives and flammable substances are used or stored (ifapplicable, attach sample picture
of this signage thot you plan to use for this project)
11.1.5 Areas where there are tripping or slipping hazards (if applicable, attach sample picture ofthis 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 (ifappicabe, attach sample pleture 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
‘opplicable, attach sample picture ofthis signage that you plan to use for ths project);
11.1.8 All places where workers may come in contact with dangerous moving parts of the machineries or
‘equipment (i applcable, attach sample peture ofthis sianage that you plan to use for this project;
11.1.9 Location of the fire alarms and fire-fighting equipment (attach sample picture ofthis signage that you plan
to.use for this project); 11.1.10 Instructions on the usage of specific construction equipment (ifapplicable, attach sample picture of this
signage that you plan to use for this project);
1.1.11 Periodic updating of man-hours lost.
11.2 Inspection and Maintenance of Safety Signages
‘good condition all safety signages that we will be providing for
We will regularly inspect and maintai
this project. The person in charge in inspecting is/are Ms. Nida C. Dela Vega he/she
our Safety Officer Inspection will be carried out on a
Our Safety Officer will remove and replaced any signages that are damaged, illegible, or
no longer apply with the current hazard.
12.0 Construction Workers Skills Certification
‘The company will ensure that all workers assigned in the critical occupations as defined in Section 15 of
1.0. 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 certifcotes 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: (pea
2 Demolition
2 Earthmoving
Scaffold
Structural Stee!
‘a Concreting
9 Welding
HVAC
Painting
wOthers (please specify)
se checkon the box all that opplies)
1 Excavation
oPiling
1 Formwork
1 Crane Operation
1a Rebarworks
a Electrical
Plumbing
interior Decoration
Possible Electrocution during
‘Termination, Configuration,
Testing and Commissioning
Eng’g. Use proper tools on each
corresponding task.
Admin.: Do Orientation & Training
PPE: Always use proper PPES
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 onthe box al that applies}
ca machineries
f
elec
onoise
exposure to heat
ofall hazards
others (please specify)
sZpower and hand tools
ladders and scaffolds
1a ventilation
tripping
collapse
Possible release of the drill bit
Eng'g.: Check & tighten the tools.
which might damage the eye
_|Admin.: Do Orientation & Training
of the worker.
PPE __: Always use proper PPES
14.2.2 Chemical Hazards n/a
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 li
(please check on the box al that apples)
assolvents
acids
acetylene
gasoline
o welding fumes
1 paint products
1 cleaning products
0 propane
explosive chemical
others (please specify)
nfa 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)
a blood or other body fluids fungi
wacteria and viruses ooplants
insect bites animal and bird droppings
others (please specify)
Undergo Covid-19 Test
Possible Spread of Covid-19 | Eng’g-
Do Orientation & Training
\dmin,
virus, which can infect the |
worker(s) and make them sick, [PPE
Always use PPEs & alcoho!
14.2.4 Ergonomic Hazards n/a
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 10 frequent lifting
a poor posture repetitive motion
exertion of force co awkward movement
others (please specify)
n/a
(Enumerate contral measures to address those havards identified, Use additional sheet if necessany) 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.
AAll 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 relate tothe 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.
47.0 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);
417.3 Other special examination (Pulmonary function test, blood panel, ECG >40 years of age, audiogram);
17.4 Random drug testing.
17.5 Covid-19 Testing
18.0 Working Hour & Break Time
The work schedule will be on ( please check on the boxes that apply)
vMon. vTue. vWed. “Thur. vFri. WSat. Sun
Check on the shift and indicate the work hours for the shift that applies.
¥ 2*shift from_8:00_(am/pm) to_5?00_(am/pm)
1D 2" Shift from _"/@_(am/pm) to (am/pm)
3 Shift from_/@_(am/pm) to (am/pm)
Check on the shift and indicate the break for the shift that applies.
¥_ V*Shift from _12:00 (am/pm) to_1:00 _(am/pm)
2 2% Shift from (am/pm) to__(am/pm)
3 3% 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:
leone soos 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 Cil 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 penatties, if there are any).
Violation 1 offense 2" offense 37 offense
7. No helmet, no safely shoes, no | warning Sday Bday
safety belharness suspension _| suspension
2 no 1D, Uniform, working attire, | warming Tday Bday
‘goggles, glove & apron suspension —_| suspension
3, eating al prohibited area warning Seay Bday
suspension —_| suspension
7 littering and Toltering warning Sday Bday
suspension —_| suspension
®, smoking al prohiblied area warning day Bday
suspension _| suspension 6. urinating at prohibited area ‘warning Sday ‘5 day
suspension —_| suspension
7. legal dismantling of safety | warning 3 day Bday
signages and paraphernalia suspension _| suspension
[8 illegal gambling ’ 3day ~~ | Sday ~~ | Dismissal
suspension _| suspension
9. overnight stay wio permission Bday 5 day dismissal
suspension _| suspension
10. fighting & provoking others | Bday Dismissal
suspension
17. working under the influence of | Dismissal
drugs and liquor
72, possession of llegal drugs, deadly | Dismissal
weapon & gambling paraphernalia
13, pilferage and robbery Dismissal
74. illegal entry/exit | Dismissal
75, 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
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