DOLE-RO5 | Construction Safety and Health Program

A. Project Details

Project Specification / Category

Name of Project

Street Address

Region

Province

City/Municipality

Barangay

Project Duration (in calendar days)

Project Date Start (Estimated date of project start)

Completion Date (Date of project completion)

Total Project Cost

No. of 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

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 Workers:

Contractors

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 and TEST do hereby commit and bind ourselves to comply with the applicable provisions of the Occupational Safety and Health Standards (OSHS) and Department Order No.13 series of 1998 – Guidelines Governing Occupational Safety and Health in the Construction Industry. I/We hereby commit to implement a suitable Construction Safety and Health Program designed for the abovementioned project. I/We also acknowledge my/our responsibilities to provide the appropriate Personal Protective Equipment (PPE), safety officer, first- aider, and job safety and health instructions and training to all our workers during the duration of the project, as the case maybe.

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. I also do understand that incomplete applications would be subject for denial.