DOLE-RO5 | Construction Safety and Health Program

A. Project Details

Name of Project

Street Address

Region

Province

City/Municipality

Barangay

Brief Description of Project (e.g. Number of Storeys....)

Project Duration (in calendar days)

Project Date Start (Estimated date of project start)

Completion Date (Date of project completion)

Project Specific Construction Activites

Total Project Cost

No. of Male Workers

No. of Female Workers

Direct Administration / To be implemented by project owner

Rule 1020 Number

Rule 1020 Date Registered

Issued By:

Rule 1020 Certificate Copy

DO 174 Number

DO 174 Date Registered / Approved

Issued By:

DO 174 Registration

Name of Project Owner

Contact Number

Owner Email Address

Owner Address (House #, Street)

Region

Province

City/Municipality

Barangay

B.OSH and CSHP

Name of Safety Officer (If there is any)

Date of Training

Copy of Certificate of Training

Name of First Aider (If there is any)

Date of Training

Date of Validity

Copy of Certificate of Training

Signed Construction Safety and Health Program (Simplified) File Click here for a copy of the CSHP Template

Letter of Intent File

C.Client Feedback Survey

Type of Client Served

General Public

Business/Private Company

Government Agency/Official/Employee

Pesta(Date)

Kasarian (Gender)

Email Adddress

Pangalan(Name)

Edad(Age)

Contact Number

Cizitens Charter Questions

CC1 Do you know about the Citizen’s Charter (document of an agency’s services and reqs.)?

Yes, aware before my transaction with this office
(Oo, alam ko bago ang aking transaksyon sa opisinang ito)

Yes, but aware only when I saw the CC of this office
(Oo, pero alam ko lang nung nakita ko yung CC nitong opisina)

No, not aware of the CC (Skip questions CC2 and CC3)
(Hindi, hindi ko alam ang CC (Laktawan ang mga tanong CC2 at CC3) )

CC2 If Yes to the previous question, did you see this office’s Citizen’s Charter? (Kung Oo sa nakaraang tanong, nakita mo ba ang Citizen’s Charter sa opisinang ito?)

Yes, the CC was easy to find
(Oo, madaling mahanap ang CC)

Yes, but the CC was hard to find
(Oo, ngunit ang CC ay mahirap hanapin)

No, I did not see this office’s CC (Skip question CC3)
(Hindi, hindi ko nakita ang CC ng opisinang ito (Laktawan ang tanong CC3)

CC3 If Yes to the previous question, did you use the Citizen’s Charter as a guide for the service/s you availed?

Yes, I was able to use the CC
(Oo, nagamit ko ang CC)

No, I was not able to use the CC because
(Hindi, hindi ko nagamit ang CC dahil)

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 (Particulars)	Lubos na nasiyahan (Very Satisfied) 😀 5	Nasiyahan (Satisfied) 🙂 4	Ni nasiyahan o hindi nasiyahan (Neither Satisfied nor Dissatisfied) 🤔 3	Hindi nasiyahan (Dissatisfied) 😕 2	Lubos na hindi nasiyahan (Very Dissatisfied) 😠 1
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) (Responsiveness)
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 ) (Reliability)
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) (Communication)
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) (Costs)	NOT APPLICABLE
6. I am confident my online transaction was secure (Ako ay tiwala na ang aking online na transaksyon ay naging matiwasay) (Integrity)
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) (Assurance)
8. I got what I needed from the government office. (Nakuha ko ang kailangan ko sa opisina ng gobyerno.) (Outcome)
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):

I hereby certify that all the information provided by me in this application are true and correct to the best of my knowledge. I understand that all the information I provided will form part of the public record, which may be used for any legal processes of the government. Thus, any misrepresentation of facts may subject my application to denial and myself to possible administrative and/or criminal action.

Company Profile/License/Registration of Main/General Contractor

Project Type:
Project Name:
Project Address:
Region:
Province:
City / Municipality:
Barangay:

Project Duration:
Project Date Start:
Completion Date:
Estimated Project Cost:
Number of Male Workers:
Number of Female Workers:
Project Specific Construction Activites:

Owner Details

Name of Owner
Owner Address:
Region:
Province:
City / Municipality:
Barangay:
Email Address:
Contact Number:
Email Address:

OSH Personnel and Attachments

Name of Safety Officer
Date of Training:
Safety Officer Certificate File:

First Aider Name
Date of Training:
Date Valid:
First Aider Certificate File:

CSHP File Uploaded:

COMMITMENT TO COMPLY on OSH

I/We TEST 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.