DPWH Clustered Project Construction Safety and Health Program Application
A. Company Profile / License / Registration of Main or General Contractors

Sub-contractors' Profile/License

B. Project Profile / Description
C. OSH Personnel assigned to the project

Other OSH Personnel (if more than 50 workers will be deployed in the project)
OH Nurse
OH Physician

Profile of person who prepared the CSH Program for the project

C.Client Feedback Survey

Pakilagyan ng tsek (✓) ang kahon na nagsasaad ng iyong tugon. (Please put a check mark (✓) in the appropriate box corresponding to your response.)
Mga Detalye
Lubos na nasiyahan
(Very Satisfied)
Ni nasiyahan o hindi nasiyahan
(Neither Satisfied nor Dissatisfied)
Hindi nasiyahan
Lubos na hindi nasiyahan
(Very Dissatisfied)
0. I am satisfied with the service that I availed.
     ((Ako ay kontento sa serbisyo na aking napakinabangan)
1. I spent an acceptable amount of time to complete my transaction
     (Gumugol ako ng katanggap-tanggap na tagal ng oras upang makumpleto ang aking transaksyon)
2. The office accurately informed and followed the transaction’s requirements and steps
     (Ang opisina ay may wastong kaalaman at sinunod ang mga kinakailangan at hakbang ng transaksyon )
3. My online transaction (including steps and payment) was simple and convenient
     (Ang aking online na transaksyon (kabilang ang mga hakbang at pagbabayad) ay simple at maginhawa)
(Access and Facilities)
4. I easily found information about my transaction from the office or its website
     (Madali kong nahanap ang impormasyon tungkol sa aking transaksyon mula sa opisina o sa website nito)
5. I paid an acceptable amount of fees for my transaction
     (Nagbayad ako ng katanggap-tanggap na halaga ng mga bayarin para sa aking transaksyon)
6. I am confident my online transaction was secure
     (Ako ay tiwala na ang aking online na transaksyon ay naging matiwasay)
7. The office's online support was available, or (if asked questions) online support was quick to respond
     (Available ang online na suporta ng opisina, o (kung magtatanong) mabilis na tumugon ang online na suporta)
8. I got what I needed from the government office.
     (Nakuha ko ang kailangan ko sa opisina ng gobyerno.)
Reklamo sa serbisyong natanggap mula sa DOLE
(Complaint on the service provided by DOLE):
Mungkahi/Rekomendasyon upang mas mapaganda pa namin ang pangkalahatang Serbisyong naibigay
(Suggestion/ Recommendation on how we could improve our overall service):
Company Profile/License/Registration of Main/General Contractor
Name of Company / General:
Company Address:
City / Municipality:
Telephone Number:
Contact Number:
Email Address:
Main Contractor Details
Name of Project Manager/Contact Person:
Main Contractor PCAB License No.:
PCAB License Date Validity:
Sub-contractors’ Profile/License
Project Profile / Description
Name of Owner:
Telephone Number:
Contact Number:
Email Address:
Project Classification:
Total Project Cost:
Estimated No. of Workers including subcontractors:
Date of Start / Execution of Project:
Duration of Project In calendar Days:
Brief Description of Actiities / Work Flow:
OSH Personnel
Safety Officers
No. Name of Safety Officer Date of Training
First Aiders
No. Name of First Aider Date of Training Validity of ID
Other OH personnel
Name Date of BOSH Training
OH Nurse
OH Physician
Heavy Equipments
No. Name of Heavy Equipment Name of Operator

Profile of person who prepared the CSH Program for the project
Full Name:
Educational Background:
Work Experience in OSH:
Other Qualifications:

Profile of person who prepared the CSH Program for the project
DPWH Letter of Approval File Uploaded:
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