ONLINE APPLICATION OF COMPREHENSIVE CSHP

BACK

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

Contract ID No.:

Project Name:

Location:

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

Select Checkbox

DPWH project

Other Public/private construction project:

Residential project engaging the services of a construction firm:

Complete Name of the Company/Main/General Contractor/Project Owner:

Complete Address of the Company:

Tel. NO.:

Fax NO.:

Name of Project Manager/Owner/Contact Person:

Tel. NO.:

Email:

Contractor’s PCAB/JV License No:

Date of Validity:

Number of Workers:

Male:

Female:

Total Employment:

Engaged Subcontractors’ Profile:

Name of Sub-contractors
(if any):

Scope of Work and Project Cost:

No. of Workers:

PCAB License:

Date of Validity:

Date of DOLE Registration:

B. Project Profile/Description :

Name of the Project: (Please attach copy of Notice of Award or Notice to Proceed or other documents indicating name and details of the project)

Complete Project Address/Location:

Name of Project Owner:

Tel No.:

Email:

Project Classification:

Total Project Cost:

Estimated No. of Workers to be deployed in the project:

Workforce of the project to include workers of the subcontractor/s:

Date of Estimated Start/Execution of the project:

Duration of the project (Pls. state the number of calendar days)

Brief Description of Activities/Work Flow:

OSH Personnel assigned to the project:

Designated Safety Officers:

Name:

Designation:

Date of Training:

Designated First Aider:

Name:

Date of Training:

ID Validity:

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

OH Nurse

Name:

Date of BOSH Training:

OH Physician

Dentist

If Heavy Equipment will be used in the Project:

List of heavy equipment to be used in the Project:

Name of Heavy Equipment Operator/s:

Profile of the person who prepared the CSHP:

Name:

eSignature: (if applicable)

Educational Background:

Work Experience in OSH:

Other Qualifications:

Submitted By:

Name:

Position:

eSignature: (if applicable)

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

Project Name:

UPLOAD DOCUMENT

ACTION

ONLINE APPLICATION OF COMPREHENSIVE CSHP

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

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

Select Checkbox

Engaged Subcontractors’ Profile:

B. Project Profile/Description :

OSH Personnel assigned to the project:

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

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)

Upload or drag Letter of Intent files here

Upload or drag CSHP files here

Upload or drag Registration under OSHS Rule 1020 files here

Upload or drag Valid PCAB License files here

Upload or drag Project Contract files here

Upload or drag Valid Certificate of Inspection files here

Upload or drag Certificate of Completion files here

Upload or drag Valid NC files here