ONLINE APPLICATION OF CSHP

(Fill up online DPWH Application form; N/A if not applicable)

A. Company Profile/License/Registration of Main/General Contractor :

Engaged Subcontractors’ Profile:

B. Project Profile/Description :

Estimated number of workers to be deployed:

OSH Personnel assigned to the project:

Other OH personnel: (if more than 50 workers will be deployed in the project)

OH Nurse
OH Physician
Dentist

If Heavy Equipment will be used in the Project:

Profile of the person who prepared the CSHP:

Submitted By:

(Fill up CSHP online form; N/A if not applicable)

1.0 Statement of Commitment to Comply with OSH Requirements:

3.0 Project Details:

1st shift:
2nd shift:
3rd shift:
1st shift:
2nd shift:
3rd shift:

4.1 Composition of Construction Safety and Health Committee (CSHC)

4.2 Duties of the CSH Committee

Type of OSH Training/Orientation OSH Personnel who conducts/supervises the training/orientation Number of Attendees
Male Female
40-Hour Construction Occupational Safety and Health Course
Mandatory OSH Orientation to all workers
Others

5.0 Emergency Occupational Health Personnel and Facilities

Construction Stages Our number of workers during this stage Health Personnel & Facilities
Health Personnel Facilities

6.1 Workers Safety and Health Orientation/Trainings

List the workers who have undergone the DOLE-prescribed safety and health training and orientation below

Name Title of training attended Remarks

6.2 Specialized Instruction and Trainings

List below the inventory lists of workers who hold critical occupations and attended the specialized training

Name Title of training attended Remarks

7.1 Responsible for the Toolbox Meeting

Name of Supervisor Time of Toolbox Meeting
(indicate shift, e.g. 1st, 2nd, 3rd )		 Means of Documentation
(attach sample instrument)

8.1 Persons responsible for conducting the investigation

Following person/s will be assigned to conduct an accident/incident investigation:

All accidents All incidents/near miss Illnesses

9.0 Personal Protective Equipment (PPE)

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

11.1 Inspection and Maintenance of Safety Signages

14.1 Major Activities

14.2 Hazards Identified

a. Physical Hazards

b. Chemical Hazards

c. Biological Hazards

d. Ergonomic Hazards

14.3 Safe Work Practices

18.0 Working Hours & Break Time

The work schedule will be on (please check on the boxes that apply):

Check on the shift and indicate the work hours for the shift that applies.

Check on the shift and indicate the break for the shift that applies.

22.0 Penalties/Sanctions

Safety Violations 1st offense 2nd offense 3rd offense

Construction Safety and Health Program prepared by:

UPLOAD DOCUMENT
ACTION