Revised Form 1B-2023

Date of Revision: 07 March 2024

CSHP TEMPLATE

1.0 Statement of Commitment to Comply with OSH Requirements

I/WE Patrick Balagtas by accomplishing this Construction Safety and Health Program do hereby commit
and bind ourselves to comply with the requirements on the 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 responsibility/ies 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 to 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.

______________________________ _________________________________
Signature Over Printed of Project Owner Signature Over Printed Name of Contractor

2.0 Company Safety and Health Policy

It is the general policy of Macro Industrial Packaging Product Corporation to perform work in the safest
manner possible consistent with good construction practices. To fulfill the requirements of this policy, an
organized and effective Construction Safety and Health Program as described in this program and in
consonance with DOLE 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 assessments to check program effectiveness.

3.0 Project Details

i. Specific name of project and Name of Owner: ii. Location of the project:

One Ayala Avenue Hotel Edsa Corner Ayala Avenue Makati City

iii. Classification of the project: iv. Name of General Constructor (constructor who has
general supervision over other constructors in the execution
of this project and who directly receives instructions from the
owner or construction project manager, if any)

□ Gen. Building Const.

□ Gen. Engineering Const.
□ Specialty Trade Const.
□ others, specify:
_________________________________________
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Revised Form 1B-2023
Date of Revision: 07 March 2024

v. Name of Construction Project Manager vi. Name of Project Manager/Contact Number

/Consultant, if any (the overall technical personnel of the general constructor
(a person or entity who is hired by the project owner, to act in and or the subcontractor in charge of the actual execution
the owner’s behalf concerning supervision and monitoring of of this project)
all matters related to the overall execution of this project. It
shall be a separate entity from the general constructor or any
subcontractor of the construction project

Jose Bacbac Jr 0917 – 113 – 2623

vii. Name of Resident Engineer, if any viii. Name and Classification of Constructors
(a duly licensed engineer who shall be tasked to be present at (synonymous to builders who undertake or offer to
the construction site at all times, whenever work is being undertake or purport to have the capacity to undertake or
undertaken, and shall have the responsibility of assuring the submit a bid to, or does himself or by or through others,
technical conformance of all designs, materials, processes, construct, alter, repair, add to, subtract from, improve,
work procedures rendered for the execution of this project, move, wreck or demolish any building, highway, road,
including safety and health of all persons within the railroad, excavation or other structure, project,
construction site) development or improvement, or to do any part thereof,
including the erection of scaffolding or other structures or
works in connection with this project. The term constructor
includes subcontractor and specialty contractor.)

John Tan Jr. Name Classification

1.

(Use an additional sheet if necessary)

ix. Estimated maximum number of workers x. Work Hours (including shift)

1st shift: 50 1st shift: from 7:00 am to 6:00 pm

2nd shift: _____________________ 2nd shift: from________to_________

3rd shift: ______________________ 3rd shift: from________to___________

xi. Estimated number of heavy equipment: xii. Projected dates of commencement and
completion

□ Backhoe: _____ □ Dozer: _____

□ Loader: _____ □ Dump truck: _____ Start Date: February 17, 2025
□ Crane: _____ □ Grader: ______ End Date: December 17, 2025
□ others, specify: ____________________ Est. Days to Complete: 339 days
__________________________________
xiii. Name and Address of Emergency Health Provider (any person or organization who is certified or recognized
by the Department of Health and who can provide the same or equivalent emergency health services as an emergency
hospital, including emergency treatment or workers on site, emergency transport and care during transport of injured
workers to the nearest hospital, with adequate personnel, supplies, and facilities for the complete immediate treatment of
injuries or illnesses)

xiv. Total Project Cost

Php 86,200,000.00

xvi. Itemized cost on OSH (Use additional sheet if necessary)

Php 115,000.00

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4. Construction Safety & Health Committee

DOLE guidelines require that the rules of the 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).

4.1 Composition of Construction Safety and Health Committee (CSHC)

Our CSHC at the One Ayala Avenue Hotel consist of:

4.1.1 Project Manager or his representative as the chairperson ex officio

Name: _Patrick Balagtas

4.1.2 General Construction Safety and Health Officer/s (overall in charge of the implementation of the
OSH program of this project hired by the General Constructor. Please attach a certificate of training/s
prescribed by DOLE. Numbers will be dependent on the number of workers and heavy equipment)

Name: _____ Alfredo G. Calub Jr._

Name: _____Michael P. Jala_______
Name: ___________________________

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 a certificate of
training/s prescribed by DOLE).

Name: _____________________________________________
Company Name: ______________________________________

Name: _____________________________________________
Company Name: ______________________________________

Name: ______________________________________________
Company Name: _______________________________________

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 a certificate
of training/s prescribed by DOLE):

Name: James Bryan K. Casal

Designation: Oh Nurse____________

Name: Lourdes C. Medalla

Designation: Oh Physician________

Name: ____Jay Dorigo_________

Designation: _____First Aider_______

Name: Mark John Pamplona_______

Designation: First Aider_______

Name: _Jhielhoney Ramos____

Designation: __First Aider_______

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4.1.5 Workers’ representative (minimum of 3 union members if organized, not necessarily from one
employer)
Name: Victor Rodesma_______________________
Designation: __Foreman______________________________

Name: ______________________________________________
Designation: _________________________________________

Name: ______________________________________________
Designation: _________________________________________

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 project;

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 5TH
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 the 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. Submits monthly the following safety and health reports to the DOLE Regional Office having jurisdiction
over the project:

4.2.7.1 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;

4.2.7.3 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);

4.2.7.5 Initiates and supervises safety and health training for employees. Provide proof/s of
training/orientation.
Type of OSH Training/Orientation OSH Personnel who conducts/supervises the
training/orientation

40-Hour Construction Occupational Safety and

Alfredo Calub Jr.
Health Course

Mandatory OSH Orientation to all workers Alfredo Calub Jr.

Others Michael P. Jala

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4.3 Duties of the Safety Officer

The principal function of the Safety Officer 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 the 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 inspections as a 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 Officer is to report directly to the employer
(needs identification).

4.4 Dangerous Occurrence or Major Accident

In case of any dangerous occurrence or major accident resulting in death or permanent total disability, we
will notify the DOLE Regional Office within twenty-four (24) hours of the occurrence. After the conduct of the
investigation by our concerned safety and health officer, we will report all permanent total disabilities to the
DOLE Regional Office on or before the 20th of the month following the date of occurrence of an 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 facilities based on the total number of workers in the site.

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5.1 Emergency Health Personnel and Facilities

Our number of Health Personnel & Facilities

Construction Stages workers during this Health Personnel Facilities
stage
Delivery And Unloading Of First Aid
6 Oh Nurse
Materials Station
First Aid
Vertical Hauling 6 Oh Nurse
Station
First Aid
Lay Out 3 Oh Nurse
Station
First Aid
Dowel Installation 3 Oh Nurse
Station
First Aid
Eps Installation 8 Oh Nurse
Station
Mepfs Lay Out, Cutting, First Aid
4 Oh Nurse
Embedment And Restoration Station
First Aid
Mixing Of Concrete Materials 5 Oh Nurse
Station
First Aid
Coating Application 10 Oh Nurse
Station
First Aid
Sealant Application 5 Oh Nurse
Station
(Use additional sheet if necessary and attach all required training certificates in this section.)

6.0 Safety & Health Promotion & Education

The Macro Industrial Packaging Product Corp. is committed at ensuring that all workers or employees are
given orientation/briefing or induction prior to deployment to the site. It is our continuing effort to promote
safety and health consciousness to all people involved in this project by providing them with the necessary
safety and health training and education to enhance their knowledge and skills to enable us to attain a safe
and healthful project site.

6.1 Workers Safety and Health Orientation/Trainings

We require new workers to mandatorily attend our Safety & Health Orientation before they are deployed to
this project site. The assigned Safety Officer, Mr./Ms Alfredo Calub 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 training and
orientation

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Name Title of training attended Remarks

(Use additional sheet if necessary)

6.2 Specialized Instruction and Trainings

DOLE OSH for construction activities requires specialized instruction and training be given to any person
holding a critical occupation.

The inventory lists of our workers who hold critical occupations and attended the specialized training are
listed below. (Please attach training certificates)

Name Title of training attended Remarks

(Use additional sheet if necessary)

7.0 Toolbox Meeting

Toolbox meeting or gang meeting is 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.

7.1 Responsible for the Toolbox Meeting

The following supervisor or any designated person (e.g. foreman, leadman, gang boss, 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 of the necessary safety precautions that need to be undertaken.

Name of Supervisor Time of Toolbox Meeting (indicate Means of Documentation

shift, e.g. 1st, 2nd, 3rd ) (attach sample
instrument)

John Tan 7:00 a.m. Log Book

(Use additional sheet if necessary)

8.0 Accident/Incident/Illnesses Investigation & Reporting

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We consider accident/incident/illness 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, and the loss of job momentum affects our productivity. We involve our supervisors
in this program because they are more familiar with the people involved, they have a better understanding of
the operation, and they have a personal interest in the investigation since it’s their people who are involved.
For this reason, the Macro Industrial Packaging Product Corp. is committed to include this responsibility to
all supervisors and made them aware about it.

8.1 Persons responsible for conducting the investigation

In this project, the following person/s will be assigned to conduct an accident/incident investigation:

All accidents All incidents/near miss Illnesses

Alfredo Calub Jr. Alfredo Calub Jr. James Bryan Casal

Michael Jala

8.2 Conducting and documenting the accident/illnesses 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 in death or permanent total disability
using the form (DOLE/BWC/OHSD/IP – 6). Notification of major accidents to the DOLE Regional Office
concerned within 24 hours.

8.3.2 Summary of Work Accident/Illness Exposure Data Report will be submitted on or before the 20 th of the
month following the date of occurrence of the accident (for those projects with short duration or less than
one-year duration).

8.3.3 Annual Work Accident/Illness Report using the form DOLE/BWC/OHSD/IP – 6B for those construction
projects with more than one year duration.
9.0 Personal Protective Equipment (PPE)

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.

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Item No. Type of PPE Quantity needed Unit Price Total cost

Safety Shoes 50 Php 1200.00 Php 60,000

Safety Vest 50 Php 250.00 Php 12,500

Hard Hat 50 Php 300.00 Php 15,000

Safety Goggles 50 Php 180.00 Php 9,000

Safety Gloves 50 Php 100.00 Php 5,000

Full Body Harness 5 Php 2,700.00 Php 13,500

(Use additional sheet if necessary)

9.1 Cleaning and Proper Maintenance of PPEs

It is 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 after 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. PPEs are distributed for individual use whenever possible.

If workers or employees provide their own PPEs, we make sure that it is adequate for the workplace hazards,
and that it is maintained in a clean and stored in 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 safely covered walkway over the
sidewalk for use by pedestrians in a building construction work less than 2.3 meters (7ft.) from a sidewalk or
public road.

We comply with Rule 1412.10 of the OSH Standard, Protection from Falling Materials. We observe the
following:

10.1 We will take the steps to protect workers 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 will be 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.

The person responsible for this program:

Name: _Alfredo Calub Jr.___________

Designation: Safety Officer_______________

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11.0 Safety Signages

Our Safety Signages provide warning to workers and employees and the public about the hazards around
the project site. These will be posted in prominent positions at a strategic location visible as far as possible
in a 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 are 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 applicable, attach a sample 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 a sample picture of this signage
that you plan to use for this project);

11.1.4 Areas where explosives and flammable substances are used or stored (if applicable, attach a sample
picture of this signage that you plan to use for this project);

11.1.5 Areas where there are tripping or slipping hazards (if applicable, attach a sample picture of this 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 (if applicable, attach a sample picture 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
applicable, attach a sample picture of this signage that you plan to use for this project);

11.1.8 All places where workers may come in contact with dangerous moving parts of the machineries or
equipment (if applicable, attach a sample picture of this signage that you plan to use for this project);

11.1.9 Location of the fire alarms and fire-fighting equipment (attach sample picture of this signage that you
plan to use for this project);

11.1.10 Instructions on the usage of specific construction equipment (if applicable, attach a sample picture
of this signage that you plan to use for this project);

11.1.11 Periodic updating of man-hours lost.

11.2 Inspection and Maintenance of Safety Signages

We will regularly inspect and maintain in good condition all safety signages that we will be providing for this
project. The person in charge in inspecting is/are Alfredo Calub Jr. / Michael Jala, he/she is/are our Safety
Officer. Inspection will be carried out on a Weekly Basis.

Our Safety Officers will remove and replace any signages that are damaged, illegible, or no longer apply to
the current hazard.

12.0 Construction Workers Skills Certification

The company will ensure that all workers assigned in the critical occupations 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 certificates of those workers certified by TESDA.)

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13.0 Testing & Inspection of Construction Heavy Equipment

All construction heavy equipment will be tested and inspected in accordance with the requirements of OSHS.
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 include but not limited to the following: (please check on the box all that applies)

□ Demolition □ Excavation
□ Earthmoving □ Piling
□ Scaffold □ Formwork
□ Structural Steel □ Crane Operation
□ Concreting □ Rebar works
□ Welding □ Electrical
□ HVAC □ Plumbing
□ Painting □ interior Decoration
□ Others (please specify)

Interior Wall Partition

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 on the box all that applies)
□ machineries □ power and hand tools
□ electrical □ ladders and scaffolds
□ noise □ ventilation
□ exposure to heat □ tripping
□ fall hazards □ collapse
□ others (please specify)

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14.2.2 Chemical Hazards

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)

□ solvents □ paint products

□ acids □ cleaning products
□ acetylene □ propane
□ gasoline □ explosive chemical
□ welding fumes □ others (please specify)

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 include but are not limited to the following: (please check on
the box all that applies)

□ blood or other body fluids □ fungi

□ bacteria and viruses □ plants
□ insect bites □ animal and bird droppings
□ others (please specify)

14.2.4 Ergonomic Hazards

Ergonomic hazards occur when the type of work, body position, and working conditions put a 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 include but are not limited to the following: (please
check on the box all that applies)

□ poor lighting □ frequent lifting

□ poor posture □ repetitive motion
□ exertion of force □ awkward movement c
□ others (please specify)

(Enumerate control measures to address those hazards identified, Use an additional sheet if necessary)

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14.3 Safe Work Practices

Safe work practices are procedures adopted for carrying out specific tasks that ensure 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.

All 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
chronological order each step in a process.

(Enumerate below the safe work practices that you intend to perform relative to the hazards you previously
identified above.)

15.0 First-Aid, Health Care Medicines, and Equipment Facilities

The company will provide first-aid kits and health care medicines and facilities for workers on 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 on the site to ensure humane 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 on the site the company will
implement the provision of toilets and other facilities in accordance with the requirements of the Sanitation
Code.

17.0 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 be limited to the following:

17.1 Complete medical and work history;

17.2 Physical examination (Pre-employment, During employment, and Separation);

17.3 Other special examination (Pulmonary function test, blood panel, ECG >40 years of age, audiogram);

17.4 Random drug testing.

18.0 Working Hours & Break Time

The work schedule will be on ( please check on the boxes that apply):
□ Mon. □Tue. □Wed. □Thur. □Fri. □Sat. □Sun

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Check on the shift and indicate the work hours for the shift that applies.
□ 1st Shift from 7:00 (am/pm) to 6:00 (am/pm)
□ 2nd Shift from ________(am/pm) to __________ (am/pm)
□ 3rd Shift from ________(am/pm) to __________ (am/pm)
Check on the shift and indicate the break for the shift that applies.
□ 1st Shift from ________(am/pm) to __________ (am/pm)
□ 2nd Shift from ________(am/pm) to __________ (am/pm)
□ 3rd 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 the disposal of wastes will be implemented in the
site:

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 Oil spills and spoiled grease should be wrapped in the black garbage bag and will be properly disposed
of.
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 a copy of the company emergency preparedness plan.

21.0 Pandemic Control Plan

In the event that another pandemic will occur, the company including subcontractors shall provide a
separate additional program to contain provisions on the following:

21.1 Reduction on the transmission of the agent causing the pandemic;

21.2 Minimizing the contact rate;
21.3 Reduction of the risk of infection
21.4 Assistance to the affected employees
21.5 Reporting to the concerned government on the employees affected

22.0 Penalties/Sanctions

For every offense 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 the CSH program: (Please attach company policy on penalties, if there are any).

Safety Violation 1st offense 2nd offense 3rd offense

1. No helmet, no safety shoes, no warning 3 day 5 day
safety belt/harness suspension suspension
2. no ID, Uniform, working attire, warning 3 day 5 day
goggles, glove & apron suspension suspension
3. eating at prohibited area warning 3 day 5 day
suspension suspension

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Revised Form 1B-2023
Date of Revision: 07 March 2024

4. littering and loitering warning 3 day 5 day

suspension suspension
5. smoking at prohibited area warning 3 day 5 day
suspension suspension
6. urinating at prohibited area warning 3 day 5 day
suspension suspension
7. illegal dismantling of safety signages warning 3 day 5 day
and paraphernalia suspension suspension
8. illegal gambling 3 day 5 day Dismissal
suspension suspension
9. overnight stay w/o permission 3 day 5 day Dismissal
suspension suspension
10. fighting & provoking others 5 day Dismissal
suspension
11. working under the influence of Dismissal
drugs and liquor
12. possession of illegal drugs, deadly Dismissal
weapon & gambling paraphernalia
13. pilferage and robbery Dismissal
14. illegal entry/exit Dismissal
15. refusal to surrender ID & giving Dismissal
false representation

23.0 Attachments

Attached are the following:

23.1 DOLE Company registration under Rule 1020 of the OSHS
23.2 Company registration under DOLE D.O. 174- 17, if any
23.3 DTI – PCAB License/ JV License and agreement for joint venture projects
23.4 Notice of Award/contract or any documentary proofs showing that the company/contractor is the
chosen/winning bidder
23.5 Certificates of training completed by the designated safety and health personnel
(FA/OHNAP/PCOM), whatever is applicable
23.6 CHE certificate of testing and inspection (if heavy equipment will be used)
23.7 Skills certification of workers (critical occupations)
23.8 OSH reportorial requirements (if applicable)
23.9 Other supporting documents to support what is indicated in the Construction Safety and Health Program

Construction Safety and Health Program prepared by:

JEROME C. NORCIO Date: __________________
Signature over printed name

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