CSHP Form_T1
CSHP Form_T1
I/We Caryl S. Lambonao do hereby commit and bind myself/ourselves to comply with
the applicable provisions of the Occupational Safety and Health Standards (OSHS) governing Occupational
Safety and Health in the Construction Industry.
I/We hereby commit to implement a suitable Construction Safety and Health Program in the
construction of my/our residential house/small commercial building.
I/We also acknowledge our responsibilities to provide the appropriate personal protective equipment
(PPE) and job safety and health instructions and training to all our workers during the duration of the
construction.
In order to ensure the safety and health of the workers hired to construct my/our residential house/ in
the safest manner possible, I/We will implement the following:
Physical Hazards
Physical hazards are the most common in most workplaces. The physical hazards that i/we
identified for this project include but are not limited to the following: (please check on the box all that
applies)
Chemical Hazards
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NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP
Revised Form: CSHP Form 2B- 2023
Date of revision: April 30, 2023
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 limited to the following:
(please check on the box all that applies)
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)
Ergonomic Hazards
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)
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NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP
Revised Form: CSHP Form 2B- 2023
Date of revision: April 30, 2023
□ exertion of force □ awkward movement
□ others (please specify) _______________________
b. Owner/s responsibilities
To achieve the objectives of ensuring the safety and health of all the workers, the following shall be
enforced throughout the duration of the construction activity:
o Responsible for the operation, safety, and health of all workers in the entire project;
o Ensure that all workers are given orientation/briefing prior to the start of the construction activities;
o Explain the control measures for the above identified hazards;
o Conducts toolbox meetings and ensure that all workers understand their responsibility/ies;
o Closely monitor the compliance of workers with the declared safety procedures;
o Ensure that all workers will use the proper PPEs as provided;
o Act without delay in addressing all hazards and unsafe conditions or actions of workers in the
construction site;
o Consistently observe work conditions, operation, equipment, and tools for the purpose of accident
prevention;
o Corrects any unsafe practices within the scope of work operations and unsafe conditions; and
o Report to DOLE Field/Provincial Office having jurisdiction, in 24 hours, any disabling injury and/or
fatality that happen during the duration of the construction activity.
1. Ensure that the construction wastes are segregated from that of domestic waste.
2. All domestic wastes are to be collected on a daily basis.
3. Construction debris (broken hollow blocks, spoiled concrete, loose concrete, etc) should be
taken out on the staging area.
4. Oil spills and spoiled grease should be wrapped in the black garbage bag and will be
properly disposed of.
5. Application of good housekeeping.
Prepared by:
CARYL S. LAMBONAO
Signature over printed name of the building owner
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