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Edit CSHP Application Form

This document is an application for a Construction Safety and Health Program for a proposed construction project. It provides details of the project such as the address, duration of 180 days starting in February and completing in August, estimated cost of PHP 2,341,377.39, and number of workers at 12. The contractor is listed as Harold E. Manabat and the project owner is Marilou Maruyama. Both the contractor and project owner commit to complying with occupational safety and health standards and providing appropriate personal protective equipment and training to workers.

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17 views

Edit CSHP Application Form

This document is an application for a Construction Safety and Health Program for a proposed construction project. It provides details of the project such as the address, duration of 180 days starting in February and completing in August, estimated cost of PHP 2,341,377.39, and number of workers at 12. The contractor is listed as Harold E. Manabat and the project owner is Marilou Maruyama. Both the contractor and project owner commit to complying with occupational safety and health standards and providing appropriate personal protective equipment and training to workers.

Uploaded by

jazzygameseu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Application for

CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)


(Intended only for residential project/s (2 storey and below) or minor repair works with 15 workers or less or with
project cost of less than Php3,000,000.00.)

Project Name: __Proposed Two Storey 4-units Apartment__________________________________


Project Complete Address/Location: __Lot 9-H-6 Mangga Village, San Agustin, City of San Fernando, Pamp.__
_________________________________________________________________________________________
Project Duration: _180 days_____ Project Start: _February_______ Completion Date: _August___________
(No. of Calendar days) (Date of estimated start) (Date of project completion)
Estimated Project Cost: _PHP 2,341,377.39______ Number of Workers: ___12__________________
Name of Contractor (if any):__Harold E. Manabat_________________________________________________
Contractor’s Address: ___Betis, Guagua, Pampanga ______________________________________________
____________________________________________________________ Fax No.:_______________________
PCAB License No.______________ Date of Validity: ____________ Email address: ar.harold.manabat@gmail.com

Name of Project Owner: ___Marilou Maruyama_______________ Fax No.:_____________________


Project Owner Address: _402 Eloisa St., Mangga Village, San Agustin, City of San Fernando, Pampanga_______
______________________________________________________ Email address: ____________________

Accomplished by: ___ Marilou Maruyama_______


Signature over Printed Name
of
OWNER / CONTRACTOR
**********************************************************************
COMMITMENT TO COMPLY on OSH

I/We __ __Harold E. Manabat_ ____ and ____ __Marilou Maruyama__________


(Name of Contractor’s Authorized Official and/or Project Owner)

do hereby commit and bind ourself 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) and job
safety and health instructions and training to all our workers during the duration of the
project.
___________Marilou Maruyama___________ __ _Harold E. Manabat
_________
PROJECT OWNER CONTRACTOR
Signature Over Printed Name Signature Over Printed Name

(NOTE: NO FEES REQUIRED FOR APPLICATION, PROCESSING AND APPROVAL OF CSHP)

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