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CSHP Form T2 T3

This document is a checklist used by DOLE evaluators to assess contractor safety and health programs (CSHPs) for construction projects. It outlines the general requirements for CSHP submission including the application form, safety program, and letter of intent. The safety program must address specific elements such as project description, safety policy, safety committee, site safety personnel, and standards for hazardous activities. Supporting documents like registrations, licenses, training certificates, and equipment inspections are also required. The evaluator recommends approval, disapproval, or notes incomplete documents.

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Abby Bayatan
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198 views6 pages

CSHP Form T2 T3

This document is a checklist used by DOLE evaluators to assess contractor safety and health programs (CSHPs) for construction projects. It outlines the general requirements for CSHP submission including the application form, safety program, and letter of intent. The safety program must address specific elements such as project description, safety policy, safety committee, site safety personnel, and standards for hazardous activities. Supporting documents like registrations, licenses, training certificates, and equipment inspections are also required. The evaluator recommends approval, disapproval, or notes incomplete documents.

Uploaded by

Abby Bayatan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Revised Form: CSHP Form 1-2023

Date of Revision: 30 April 2023

Name of Contractor: _________________________________________________________________________________________


Project name: _______________________________________________________________________________________________
Project location: ____________________________________________________________________________________________

DOLE Evaluator's Checklist of Requirements (per Project)


Yes No
A. General Requirements
1. Duly accomplished application form for CSHP evaluation (2 copies)
2. Safety and Health Program. 2 copies, 1 copy must be original
3. Letter of intent addressed to the PO/FO Head, indicating the name of authorized
contact person with telephone number/s (1 copy)
B. CSHProgram must contain the following:
1. Name of person who prepared the program.
(please indicate if accredited by DOLE as OSH Practitioner)
2. Project Description:
a. Specific name of project
b. Location of the project
c. Project classification
d. Project owner
e. Name of main contractor
f. Estimated number of workers to be deployed
g. Estimated start of execution of project
h. Estimated duration
i. Scope of work to be undertaken
3. Company Safety Policy written on a company letterhead
Must be duly signed by the highest company official or the highest ranking
company representative who has over-all control of project execution
4. Composition of Safety and Health Committee (Per project).
Must specify the proposed structure and membership of the safety and health
committee (please specify the members)
5. Names of Site Safety and Health personnel
Depending on the number of workers to be deployed in the construction site
6. Specific duties and responsibilities of the designated Safety Officer
7. SPECIFIC PROVISIONS ON THE FOLLOWING (if applicable):
a. On-site safety and health promotion and continuing information dissemination
b. Accident and incident investigation and reporting system
c. Protection of the general public within the vicinity of the construction site
d. Environmental control
e. Guarding of hazardous machinery
f. Personal protective equipment
g. Handling of hazardous substances
h. General materials handling and storage procedures
i. Workers skills and certification (for critical occupation)
j. Provisions for transportation facilities for workers in case of emergency
k. Temporary fire protection facilities and equipment
l. First aid and health care medicines, equipment and facilities
m. Workers welfare facilities
n. Proposed hours of work and rest breaks
o. Construction
p. waste disposal
Testing and inspection of construction heavy equipment.
(if construction heavy equipment will be utilized in the project)
q. Disaster and emergency preparedness contingency plan
r. Pandemic control plan, if applicable
8. Standards Operating Procedure and Job Hazard Analysis for any of the following activities or other hazardous work
not outlined herein.
a. Site clearing
b. Excavations
c. Erection and dismantling of scaffolds and other temporary working plarforms
d. Temporary electrical connections/installations
e. Use of scaffolds and other temporary working platforms
f. Working at unprotected elevated working platforms or surfaces
g. Use of power tools and equipment
h. Gas and electric welding and cutting operations
i. Working in confined spaces
j. Use of internal combustion engines
k. Handling hazardous and/or toxic chemical substances
l. Use of hand tools
m. Use of mechanized lifting appliances for movement of materials
n. Use of construction heavy equipment
o. Demolition
p. Installation, use and dismantling of hoist and elevators
9 Penalties/Sanctions for violation of the provision/s of the Safety and Health
Program
C. ATTACHMENTS
1. Photocopy of registration forms received and approved by the
concerned DOLE Regional Office:
a. per DO 174-17 of other engaged subcontractors not performing construction
activity, if applicable (renewed every 2 years)
b. per Rule 1020 of the OSHS (one time registration)
2. a. DPWH Projects - photocopy of Notice of Award with the wining bidder's signed
the "conforme" portion
b. Other construction projects - Notice of Award or any documentary proof/s
showing that the company/contractor is the chosen/winning bidder
3. Photocopy of the valid PCAB license

For a joint venture (JV)- Contractor's PCAB Special JV License and JV Agreement
4. Photocopy of certificate of completion on required training of all designated OSH
Personnel
a. Safety Officer - Basic Occupational Safety and Health Training for Construction
Site Safety Officer (COSH)
b. First Aider - Standard First Aid Training and valid ID as a First Aider
c. OH Nurse - BOSH Training for OH Nurse, if applicable
d. OH Physician - Basic Course on Occupational Medicine, if applicable
5.
Certificate of Inspection and Testing of Construction Heavy Equipment (CHE)
conducted by a DOLE- accredited inspection and testing organization, if applicable
6. Skills Certificate of Construction Heavy Equipment operators issued by TESDA, if
applicable
7. Contract with nearby hospital/clinic in lieu of the required infirmary/hospital, if
applicable
8. Documents to prove that the project is not yet complete/finished, if needed
RESULT OF EVALUATION:
Complete. Recommended for concurrence/approval
Recommended for disapproval
Reasons:
Completed project
CSHP for bidding purposes only
Incomplete documents, please specify: ______________________________________
Invalid documents, please specify;__________________________________________________

Evaluated by: __________________________________________________ Date:


Signature over printed name

Noted by: ___________________________________________________ Date:


PO/FO Head
_____________________
_____________________
____________________

Remarks
other hazardous work

____

______________

______________

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