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CSHP TEMPLATE FOR SMALL CONSTRUCTION PROJECTS

RESIDENTIAL PROJECT/S (2 STOREY AND BELOW) OR MINOR REPAIR WORKS

1.0 Company Safety and Health Policy

It is the general policy of GNF GASOLINE STATION___ to perform work in
the safest manner possible consistent with good construction practices.

To achieve these objectives, we are committed to the following:

 Identification of potential hazards that may arise from the

programmed/scheduled work activities;
 Organizing the work activities so as to minimize the risk arising from them;
 Ensuring that all workers are given orientation/briefing or induction prior to
deployment to the site;
 Establishing a site safety committee to act as policy making body of the project
on all issues pertaining to safety and health;
 Ensure the conduct of daily toolbox meetings;

2.0 Project Details

Project description:

a. specific name of project: _CONSTRUCTION OF GASOLINE STATION__

b. Address/location: SANTOS, QUEZON,ISABELA

c. classification of the project: (2 storey residential or minor repair works 15 workers

and less) CANOPY AND EXCAVATION WORKS

d. project owner: JULIUS NALUS JAYME

e. name of main contractor and list of sub-contractors (if any) and PCAB License,

______________________________________________________________

f. estimated number of workers in the site: 5___________________________

g. estimated start date of (execution of the project) construction___07-01/2022____

h. duration of the project (no. of calendar days) and; _30_____________

i. specific scope of work to be undertaken:___BUILDING AND EXCAVATION

3.0 Composition of Construction Safety and Health Committee (CSHC).

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I/We _____JULIUS N. JAYME______ am/are committed to organize a CSH Committee

at the project site to act as a policy making body of the project on all issues pertaining to safety
and health.

3.1 Composition of Construction Safety and Health Committee (SHC)

Our CSHC at the CONSTRUCTION OF GASOLINE STATION
consist of:
o Chairman – ______JULIUS JAYME_______________________

 Members : ___LALAINE BEVERLY ALSIYANG_______

_____VALERIE WASIGAN______________
__________________________
__________________________

 Secretary – ___ZENY BOCAD_____________________________

3.2 Functions of CSH Committee shall include but are not limited to the following:

 Plans, develops and oversees the accident prevention programs for the
construction project;

 Gather feedback, discuss, review safety policies, procedures and

recommend improvements;

 Conducts safety/toolbox meetings.

 Communicate safety and health concerns and information to management

and staff personnel;

 Reviews reports of accident investigation and implementation of program;

 Solicit, evaluate and confirm implementation of safety and health

suggestions from employees.

4.0 Composition of Health & Safety Personnel (if there is any)

 5.1 Complete Name of Safety Officer/s: __LALAINE BEVERLY ALSIYANG____

(please attached the certificate of COSH training)

 5.2 Complete Name of First-Aider/s: ___VALERIE W. WASIGAN___________

(please attached the certificate of First-Aid training)
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5.0 Duties and Responsibilities

a. Owner
 Responsible in operation, safety and health of the entire project.
 Delegate personnel for the implementation of safety
 Chairman of the safety and health committee. Arranges schedule and place of
meeting and notifies members.

b. Project Coordinator
 Ensures that all workers under his supervision understand safety responsibility.
 Ensures that proper use of PPE
 Acts without delay in addressing all hazards and unsafe conditions or actions
within the scope of their area of responsibility.
 Holds toolbox safety meeting with the workers.

c. Worker
 Consistently observes work conditions, operation, equipment and tools for the
purpose of accident prevention.
 Complies with all the regulations as well as safe work practices and safety rules.
 Uses all necessary personal protective safety equipment and other safe working
practices.
 Corrects any unsafe practices within the scope of work operations and reports
any unsafe conditions.
 Attend all committee/toolbox meetings.

6.0 Conduct of Toolbox Meeting

To hold a daily safety toolbox meeting every morning before the start of work to attain
the following objectives:
 To discuss matters pertaining to the job;
 To provide briefing on the planned work;
 To predict potential hazards or actual occurrence of accidents at the site;
 To provide tips and suggestions on how to prevent possible accidents, and;
 To discuss other pertinent matters (e.g. accident prevention)

7.0 Personal Protective Equipment

The company will provide the following basic PPEs and enforce the use of the
adequate and approved type of personal protective clothing and equipment suited to the risk
inherent in the work and operations performed:

 Safety shoes - will be used for general works and to be worn at all times on the
site.
 Safety helmet – all workers must wear an approved safety helmet while on the
construction site.
 Safety gloves - to be worn wherever possible for hand protection
 Safety goggles/Face shield – protection against flying objects from doing work
such as chipping, grinding, cutting, drilling works and alike.
 Safety belt/harness – to be used whenever working at height.
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 Others (specify depending on the nature of work and hazard identified)

8.0 First-Aid, Health Care Medicines and Equipment Facilities

The owner/employer will provide the following basic first-aid kit and health care
medicines and facilities for workers in the site:
___FIRST AID KIT_____________________________________________
_____FACEMASK_________________________________________________
_____ALCOHOL_________________________________________________

9.0 Workers Welfare Facilities

The following welfare facilities will be provided in the site to ensure humane working
conditions:
a. Adequate supply of safe drinking water
b. Adequate sanitary, washing and sleeping facilities separate for men and
women workers
c. Adequate facilities for changing and for the storage and drying of work clothes.
d. Adequate accommodation for taking meals.

10.0 Working Hour & Break Time (Indicate the maximum number of work hours per day).
_______8 HOURS_______________________________________________
_______8 AM TO 5 PM_________________________________________

11.0 Construction Waste Disposal

The main constructor including subcontractors will be responsible for minimizing
waste generated during the implementation of the project. The following procedures for
disposal of wastes will be implemented in the site:

1. Ensure that the construction wastes are segregated from that of domestic
waste.
2. All domestic wastes are to be collected on a daily basis.
3. Construction debris (broken hollow blocks, spoiled concrete, loose
concrete, etc) should be taken out on the staging area.
4. Oil spills and spoiled greases should be wrapping in the black garbage bag
and will be properly disposed.
5. Application of good housekeeping.

12.0 Safety Work Practices - (indicate safety work practices based on the scope of work to be undertaken.
Use additional sheet if necessary)

12.1 Welding and Cutting –USE SAFETY GOGGLES,GLOVES AND CUTTING OUTFIT

12.2 Hand and Power Tools –USE PPE

12.3 Safe Handling of Materials – USE PPE’s

12.4 Electrical Works and Installation –USE PPE

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13.0 Enumerate/describe other safety procedures in accomplishing the project.

____ENSURE A HEALTHY WORKING PROCEDURES BY DAILY EVALUATION AND
REMINDERS OF SAFETY PROCEDURES________________

14.0 Penalties/Sanctions – as a matter of policy and to ensure that the safety and health rules
specified herein are complied with, the owner recommended the following sanctions/penalties for any
violations of CSH program(Please attach company policy on penalties, if there are any). :
 First offense – ______warning – (written)______
 Second offense -- penalty – (one (1) day salary deduction)
 Third offense – penalty – (three (3) days salary deduction)
 Fourth offense – dismissal

_JULIUS JAYME__________________ ___________________

Name of Project Owner Date
Signature over Printed Name

JAN PATRIC JAYME

________________________
Name of Person who will supervise the project Date
Signature over Printed Name