DOLE/BWC/OHSD/OH-47 A

Republic of the Philippines

Department of Labor and
Employment Bureau of Working
Conditions

Occupational Health and Safety Division

ANNUAL MEDICAL REPORT FORM

For Period January 1, 2024 to December 31, 2024

1. Name of Establishment: CHANGTSAI CONSTRUCTION AND TRADING

2. Address: #54 BUNDAGUL, MABALACAT PAMPANGA
3. Name of Owner/Manager: RAMIL CRISOSTOMO
4. Nature of Business and Products/Service (Ex. Manufacturing, Textile)
CONSTRUCTION & SERVICE PROVIDER
5. Total Number of Employees: 40 Number of Shifts: 1 SHIFT
6. Number Distribution of Employees as to nature of workplace, sex and work shift

Office Production/Shop
1st Shift 2Nd Shift 3rd Shift

Male: 3 34 0 0
Female: 3 0 0 0
Total: 6 34 0 0

7. Preventive Occupational Health Services: (Check or Cross)

a. Occupational Health Services is

organized/provided by: ( ) the
establishment/undertaking
( ) government authority/institution
( ) other bodies/groups/institution (specify)

b. Occupational Health services as described under 8a above, is organized/provided as

a service: ( ) solely for the workers of the establishment/undertaking
( ) common to a number of establishments/undertakings

c. The employer engages the

services of: ( ) Occupational
health practitioner

Name:
Address:
( ) Occupational health physician
Name: FLODELIZA U. ELACIO-RAMOS, MD / CRISOSTOMO TORALBA, MD
Address: CANDELAIA, ZAMBALES / STA.CRUZ, ZAMBALES
( ) Occupational health nurse
Name: JESSA MAE Q. BACTOL. RN
Address: MASINLOC, ZAMBALES
d. The occupational health physician/practitioner/nurse/personnel conducts an inspection of the workplace:

( ) once every month ( ) once every three (3) months

( ) once every two (2) months ( ) once every six (6) months
( ) other details

8. Emergency Occupational Health Services:

a. The employer provides a treatment room/medical clinic in the workplace with medicines
and facilities: ( ) Yes ( ) No
( ) others, please specify

b. Schedule of attendance in the workplace:

Workshift

Occupational health physician: 4 hrs/day 1 st

Occupational health practitioner: 0 hrs/day 0
Occupational health nurse: 8 hrs/day 1 st
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c. Schedule of attendance of full-time first-
aider: ( ) 1st workshift
( ) 2nd
workshift ( )
3rd workshift

d. The following occupational health personnel of this establishment have undergone training in
occupational health and safety/first aid:
( ) occupational health
physician ( ) occupational
health nurse
( ) first-aider
( ) others, please specify

9. Occupational Health Services:

a. The occupational health personnel of this establishment conduct regular appraisal of the sanitation
system in the Workplace:
( ) Yes ( ) No
b. Number of workers who underwent the following medical examinations:

Physical Exams X-rays Urinalysis

1. Pre-placement 40 40 40
2. Periodic 0 __0 __ 0_
3. Return-to-work 0 0 0
4. Transfer 0 0 0
5. Special 0 0 0
6. Separation 0 0 0

Stool Exams Blood Test ECG

Others
1. Pre-placement 40 40 0
40
2. Periodic 0 0 0
0
3. Return-to-work 0 0 0
0
4. Transfer 0 0 0
0
5. Special 0 0 0
0
6. Separation 0 0 0
0

10. Report of Diseases

a. Number of cases diagnosed/treated for the following diseases ((/
of X):

Male Female Total Number of

Cases
Skin:
( ) allergy 0 0 0
( ) dermatoses
( ) infection as folliculitis/ 0 0 0
absecess/paronychia
( ) Others 0 0 0

Head
:
( ) migraine headache 0 0 0
( ) tension headache 2 0 2
( ) Others 0 0 0

Eyes
:
( ) Error of refraction 0 0 0
( ) Bacterial/Viral 0 0 0
conjunctivitis
( ) Cataract 0 0 0
( ) Others 1 0 1

Mouth & ENT:

( ) Gingivitis 0 0 0
( ) Herpes Labiales/nasalis 0 0 0
( ) Otitis Media/Externa 0 0 0
( ) Deafness 0 0 0
( ) Meniere’s 0 0 0
Syndrome/Vertigo
( ) Rhinitis/Colds 0 0 0
( ) Nasal Polyps 0 0 0
( ) Sinusitis 0 0 0
( ) Tonsillopharyngitis 0 0 0
 -3
( ) Laryngitis 0- 0 0
( ) Others 0 0 0
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-

Male Female Total Number of

Cases

Respiratory:
( ) Bronchitis 0 0 0
( ) Pronchial Asthma 0 0 0
( ) Pneumonia 0 0 0
( ) Tuberculosis 0 0 0
( ) Pneumoconiosos 0 0 0
( ) Others 0 0 0

Heart and Blood Vessel:

( ) Hypertension 0 0 0
( ) Hypotension 0 0 0
( ) Angina Pectoris 0 0 0
( ) Myocardial Infarction 0 0 0
( ) Vascular disturbances 0 0 0
in extremeties due to
continuous
vibration ( ) Others 0 0 0

Gastrointestinal:
( ) Gastroenteritis/Diarrhea 0 0 0
( ) Amoebiasis 0 0 0
( ) Gastritis/Hyperacidity 0 0 0
( ) Appendicitis 0 0 0
( ) Infectious Hepatitis 0 0 0
( ) Liver Cirrhosis 0 0 0
( ) Hepatic Absecess 0 0 0
( ) Cancer (Hepatic/Gastric) 0 0 0

( ) Others 0 0 0

Genito-Urinary:
( ) Urinary Tract Infection 0 0 0
( ) Stones 0 0 0
( ) Cancer 0 0 0
( ) Others 0 0 0

Reproductive:
( ) Dysmenorrhea 0 1 1
( ) Infection (Cervicitis) 0 0 0
(Vaginitis) 0 0 0
( ) Abortion (Spontaneous) 0 0 0
(Threatened) 0 0 0
( ) Hyperemesis Gravidarum 0 0 0
( ) Uterine Tumors 0 0 0
( ) Cervical Polyp/Cancer 0 0 0
( ) Ovarian Cyst/Tumors 0 0 0
( ) Sexually-Transmitted 0 0 0
Diseases
( ) Hernia (Inguinal) 0 0 0

(Femoral) 0 0 0
( ) Others 0 0 0

Neuromuscular/Skeletal/
Joints: ( ) 0 0 0
Peripheral Neuritis
( ) Torticollis 0 0 0
( ) Arthritis 0 0 0
( ) Others 0 0 0

Lymphatics and
Circulatory: ( ) 0 0 0
Anemia
( ) Leukemia 0 0 0
( ) Cerebrovascular Accidents 0 0 0
( ) Lymphadenitis 0 0 0
( ) Lymphoma 0 0 0

Infectious Diseases:
( ) Influenza 0 0 0
( ) Typhoid/Paratyphoid Fever 0 0 0
( ) Cholera 0 0 0
( ) Measles 0 0 0
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Male Female Total Number of

Cases

( ) Mumps 0 0 0
( ) Tetanus 0 0 0
( ) Malaria 0 0 0
( ) Schistosomiasis 0 0 0
( ) Herpes Zoster 0 0 0
( ) Chicken Fox 0 0 0
( ) German Measles 0 0 0
( ) Rabies 0 0 0
( ) Others 0 0 0

Diseases due to Physical

Environment: ( ) Diseases 0 0 0
due to abnormalities
in temperature and humidity
( ) Diseases due to 0 0 0
abnormalities
in air pressure
( ) Poisoning/Overdosage to 0 0 0
Chemicals
TOTAL NUMBER . . . . . . . . . . . 0 0 0

11. Report of Occupational Accidents/Injuries

Parts of Body Affected

Nature Male Female Total Number of Cases

Contussion, bruises, hematoma 0 0 0

Abrasions 0 0 0
0 Cuts, Lacerations, punctures 0 0 0
Concussion 0 0 0
Avulsion 0 0 0
Amputation, loss of body parts 0 0 0
Crushing injuries 0 0 0
Spinal injuries 0 0 0
Cranial injuries 0 0 0
Sprains 0 0 0
Dislocation/Fractures 0 0 0
Chemical Burns 0 0 0

12. Immunization Program (Indicate the number)

Tetanus Taxoid Injection 0 0 0

Tetanus Antitoxin Injection 0 0 0
Tetanus Globulin Injection 0 0 0
Anti-Cholera, Anti-Typhoid Triple Vaccine 0 0 0
Others (Please specify) 0 0 0

13. Keeping of Medical-Records of Workers (Please check) ( ) done ( ) not done

14. Health Education and Counselling by Health and Safety

Personnel: (Please check one or more)
( ) done individually as each worker comes to the clinic for
consultation.
( ) done in organized group discussions/seminars.
( ) done with the use of visual displays and/or promotional materials, leaflets, etc.

15. Other Health Programs

Use of Visual
Seminar Aid/ Counselling
Materials

Nutrition Program NONE NONE NONE

Maternal and Childcare NONE NONE NONE
Program Family Planning NONE NONE NONE
Program Mental Health NONE NONE NONE
Activities Personal Health NONE NONE NONE
Maintenance
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Physical Fitness Program: (Please check)

Sports Activities ( ) Yes ( ) No

Recreation Activities ( ) Yes ( ) No
Others (Please specify) ( ) Yes ( ) No

16.Hazards in the Workplace: (Please check and give details of the active substance)

Substances and/or Sources Number of Workers

Exposed
a. Chemicals Hazards:
( ) dust (Ex. Silica dust) Grinding Works 10
( ) liquids (Ex. Mercury) 0 0
( ) mist/fumes/vapors
(Ex. Mist from paint spraying) Welding & Painting 8
( ) gas (Ex. CO, H2S) 0 0
( ) others (please specify) 0 0

b. Physical
Hazards: ( ) 0 0
noise
( ) temperature/humidity Exposure Under sun 12
( ) pressure 0 0
( ) illumination 0 0
( ) 0 0
radiation/ultraviolet/microwave
( ) others (please specify) 0 0

c. Biological
Hazards: ( ) 0 0
Viral
( ) Bacterial 0 0
( ) Fungal 0 0
( ) Parasitic 0 0
( ) Others 0 0

d. Ergonomic Stress:
( ) Exhausting physical work 0 0
( ) Prolonged standing 0 0
( ) Low Back Pain Manual Lifting 6
( ) Unfavorable work posture 0 0
( ) Static/monotonous work 0 0
( ) Others, specify 0 0

Submitted by:

M. Joy Cuasay 12/31/2024

Admin Date

Noted by:

Ramil Crisostomo
Employer