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Wem Client Request Form V.3

The document is a workplace environment monitoring request form that collects information from a company requesting an environmental assessment. It collects details about the company, type of industry, risk classification, safety officers, number of workers, purpose of the request, documents provided, areas to be monitored, and is signed by the requesting official.

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Sam Lovendino
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24 views

Wem Client Request Form V.3

The document is a workplace environment monitoring request form that collects information from a company requesting an environmental assessment. It collects details about the company, type of industry, risk classification, safety officers, number of workers, purpose of the request, documents provided, areas to be monitored, and is signed by the requesting official.

Uploaded by

Sam Lovendino
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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Category 1A Category 1B Category 1C

Gases Using Multi

Local Exhaust Ventilation


Gas Meter

General Ventilation
Sources of Physical & Chemical Hazard; Type of

Air Change
Areas for Measurement
Ventilation Used

Total

Prepared by:

Name
OSHC-DOLE ACCREDITED WEM PROVIDER

WORKPLACE ENVIRONMENT MONITORING REQUEST FORM

Please fill-up both Sheet 1 - "Request Form" and Sheet 2 - "Parameters"


Date:
Company Name Tel. No.

Address

Manufacturing
Type of Industry
(provide brief description Services
of process/product)
Others
Risk Classification Low Risk Medium Risk High Risk

Name/s Designation Accreditation (if any)


(SO1, SO2, SO3, SO4)

Safety Officer/s

No. of Workers (include


Total: Male: Female:
outsource personnel|)
OSHS Compliance

Purpose of the Request of ISO Compliance


WEM Client / Customer Requirement
Others: (Please specify)
Documents Provided* Plant Layout SDS
Internal WEM Capability
Date of Previous WEM: Service Provider:
Changes / Improvements Initiated After Previous WEM

Area's Quarantine Status GCQ MGCQ Others:


Operating Capacity
Signature over Name Designation Contact Details
Requesting Official

*Please provide on or before sampling schedule


WEM REQUEST FORM V3
10-FEB-2022 / KPV
Temp & RH
Illumination

Ventilation
Admin Building
Powerhouse Basement
Workshop
Laydown & Fabrication
Warehouse and Tool Room
Laboratory
Fuel Pump House
Fuel Injection Room
Engine Control Room
Engine Room
Electrical Room & Workshop
Switch Board Office

Total

Prepared by:

Name

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