Revised Form 1B-2023

Date of Revision: 07 March 2024

CHSP TEMPLATE

1.0 Statement of Commitment to Comply with OSH Requirements

I/WE INDUSTRIAL CONTROLS CORPORATION by accomplishing this Construction Safety and Health Program do hereby commit and bind ourselves to comply with the requirements
on the Guidelines Governing Occupational Safety and Health in the Construction Industry and the applicable provisions of the Occupational Safety and Health Standards (OSHS).

We (also) acknowledge our obligation and responsibility/ies to provide throughout the course of the project the appropriate Personal Protective Equipment (PPE) as added protection for
our workers and employees.

We also (hereby) commit to implement the necessary job safety and health instructions and training to all our workers for the entire (during the) duration of the project, as well as the
safety of the general public.

MANILA WATER COMPANY, INC. INDUSTRIAL CONTROLS CORPORATION

Signature Over Printed of Project Owner Signature Over Printed Name of Contractor

2.0 Company Safety and Health Policy

It is the general policy of INDUSTRIAL CONTROLS CORPORATION to perform work in the safest manner possible consistent with good construction practices. To fulfill the
requirements of this policy, an organized and effective Construction Safety and Health Program as described in this program and in consonance with DOLE OSH Standards must be
carried out on every project.
To achieve these objectives, we are committed to perform the following:
2.1 Identifying potential hazards that may arise from the programmed work activities;
2.2 Organizing the work activities so as to minimize the risk arising from them;
2.3 Developing and implementing project specific safety and health program;
2.4 Establishing and enforcing all necessary safe work procedures, rules & regulations;
2.5 Ensuring that all workers are given orientation/briefing or induction prior to deployment to the site;
2.6 Establishing a site safety and health committee to act as policy-making body of the project on all issues pertaining to safety and health;
2.7 Ensuring the conduct of daily toolbox meetings;
2.8 Establishing a system of follow-up of actions and periodic assessments to check program effectiveness.

3.0 Project Details

i. Specific name of project and Name of Owner: ii. Location of the project:
REHABILITATION OF FIRE DETECTION AND ALARM SYSTEM AT VARIOUS 1. BTP1, BTP2 – Complete Address
LOCATIONS, MANILA WATER COMPANY, INC.

iv. Name of General Constructor (constructor who has general supervision over other
iii. Classification of the project: constructors in the execution of this project and who directly receives instructions from the owner or
construction project manager, if any)

□ Gen. Building Const.

□ Gen. Engineering Const.
□ Specialty Trade Const. INDUSTRIAL CONTROLS CORPORATION
□ others, specify:
ELECTRICAL SYSTEM

v. Name of Construction Project Manager /Consultant, if any

(a person or entity who is hired by the project owner, to act in the owner’s behalf concerning supervision vi. Name of Project Manager/Contact Number (the overall technical personnel of the general
and monitoring of all matters related to the overall execution of this project. It shall be a separate entity constructor and or the subcontractor in charge of the actual execution of this project)

from the general constructor or any subcontractor of the construction project

LARVIN SANTIAGO PHILIP MARVIN JOVEN, P.E.E.

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viii. Name and Classification of Constructors (synonymous to builders who undertake or offer
vii. Name of Resident Engineer, if any (a duly licensed engineer who shall be
to undertake or purport to have the capacity to undertake or submit a bid to, or does himself or by or
tasked to be present at the construction site at all times, whenever work is being undertaken, and shall
through others, construct, alter, repair, add to, subtract from, improve, move, wreck or demolish any
have the responsibility of assuring the technical conformance of all designs, materials, processes, work
building, highway, road, railroad, excavation or other structure, project, development or improvement,
procedures rendered for the execution of this project, including safety and health of all persons within the
or to do any part thereof, including the erection of scaffolding or other structures or works in
construction site)
connection with this project. The term constructor includes subcontractor and specialty contractor.)

Name Classification
PHILIP MARVIN JOVEN, P.E.E.
1. INDUSTRIAL CONTROLS CORPORATION
ix. Estimated maximum number of workers x. Work Hours
7 workers 8:00 am to 5:00 pm.

xi. Estimated number of heavy equipment: xii. Projected dates of commencement and completion

□ Backhoe: _____ □ Dozer: _____

□ Loader: _____ □ Dump truck: _____ Start Date: MARCH 17, 2025
□ Crane: _____ □ Grader: ______ End Date: SEPTEMBER 12, 2025
□ others, specify: ____________________ Est. Days to Complete: 180 days
__________________________________

xiii. Name and Address of Emergency Health Provider (any person or organization who is certified or recognized by the Department of Health and who can provide the same or equivalent emergency
health services as an emergency hospital, including emergency treatment or workers on site, emergency transport and care during transport of injured workers to the nearest hospital, with adequate personnel,
supplies, and facilities for the complete immediate treatment of injuries or illnesses)

EAST AVENUE MEDICAL CENTER

xiv. Total Project Cost
P 15,888,320.00 for BTP1 and 2 only
xvi. Itemized cost on OSH (Use additional sheet if necessary)
P 378,948 divide this into 7 locations
4. Construction Safety & Health Committee

DOLE guidelines require that the rules of the Construction Safety and Health Program must be observed and enforced at the project site, each site shall, at the start of the construction
have a construction safety and health committee. With respect to this project, the committee will be organized in accordance with the requirements of Rule 1040 of the Occupational
Safety and Health (OSH) Standards of the Department of Labor and Employment (DOLE).
4.1 Composition of Construction Safety and Health Committee (CSHC)
Our CSHC at the REHABILITATION OF FIRE DETECTION AND ALARM SYSTEM AT VARIOUS LOCATIONS consists of:
4.1.1 Project Manager or his representative as the chairperson ex officio.
Name: PHILIP MARVIN JOVEN, P.E.E.
4.1.2 General Construction Safety and Health Officer/s (overall in charge of the implementation of the OSH program of this project hired by the General Constructor. Please attach a
certificate of training/s prescribed by DOLE. Numbers will be dependent on the number of workers and heavy equipment)
Name: ROMEO FESALBON
Name: REX EVANGELISTA
Name: JONATHAN ABRAHAN
4.1.3 Construction Safety and Health Officer/s from Subcontractors (any employee/worker trained and, in addition to their regular duties and responsibilities tasked by his employer
to implement occupational safety and health program in accordance with the provisions of the OSH Standard. Please attach a certificate of training/s prescribed by DOLE).
Name: ____________N/A_______________________________
Company Name: ______________________________________
4.1.4 Occupational Health Personnel (qualified first-aider, nurse, dentist, or physician, engaged by the employer to provide occupational health services in the
establishment/undertaking. Please attach a certificate of training/s prescribed by DOLE):
Name: WILRHIC OBORRO
Designation: FIRST AIDER
4.1.5 Workers’ representative (minimum of 3 union members if organized, not necessarily from one employer).
Name: ___________N/A_____________________________
Designation: _______________________________________
4.2 Duties of the CSH Committee shall include but are not limited to the following:
4.2.1 Plans, develops, and oversees the accident prevention programs for the construction project;
4.2.2 Directs the accident prevention efforts of the establishment in accordance with the safety programs and performance and government regulations in order to prevent accidents from
occurring in the worksite;
4.2.3 Conducts safety meetings at least once a month. The committee will hold a safety meeting every
st
__1 monday__of the month;

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4.2.4 Submits reports to the project manager on its meetings and activities one day after the meeting;
4.2.5 Reviews reports of inspection, accident investigation, and implementation of the program;
4.2.6 Provides necessary assistance to government inspecting authorities in the proper conduct of their activities specifically on the enforcement of the provision of DOLE’s OSHS;
4.2.7 Submits monthly the following safety and health reports to the DOLE Regional Office having jurisdiction over the project:
4.2.7.1 Summary of all safety and health committee meetings agreements;
4.2.7.2 Summary of all accident investigation reports using DOLE/BWC/ OHSD/IP-6 form;
4.2.7.3 Periodic hazards assessment with the corresponding remedial measures/actions for each hazard;
4.2.7.4 Annual Medical Report using the form DOLE/BWC/HSD/OH-47-A (if the duration of the project is more than one (1) year);
4.2.7.5 Initiates and supervises safety and health training for employees. Provide proof/s of training/orientation.

Type of OSH Training/Orientation OSH Personnel who conduct/supervises the training/orientation

40-Hour Construction Occupational Safety and Health Course ROMEO FESALBON

Mandatory OSH Orientation to all workers ROMEO FESALBON

Others ROMEO FESALBON

4.3 Duties of the Safety Officer

The principal function of the Safety Officer assigned to this project is to act as the employer’s (needs identification) principal assistant and consultant in the application of programs to
remove the hazard from the workplace and to correct unsafe work practices. For this purpose, the Safety Man has the following duties:
4.3.1 Serves as Secretary to the SHC, as such will perform the following:
4.3.1.1 prepare minutes of meetings.
4.3.1.2 report status of recommendations made;
4.3.1.3 notify members of the meetings; and
4.3.1.4 submit (needs identification) to the employer a report of the activities of the committee, including recommendations made.
4.3.2 Acts as an advisory capacity on all matters pertaining to health and safety for the guidance of the employer and the workers.
4.3.3 Conducts investigation of accident as member of the Health and Safety Committee and submits his separate report and analysis of accident to the employer (needs identification).
4.3.4 Coordinates all health and safety training programs for the workers/employees and employer (needs identification).
4.3.5 Conduct health and safety inspections as a member committee.
4.3.6 Maintains or helps in the maintenance of an efficient accident record system and coordinates actions taken by supervisors to eliminate accident causes.
4.3.7 Provide assistance to government agencies in the conduct of safety and health inspection, accident investigation, or any other related program.
4.3.8 For the purpose of effectiveness in the project site, the Safety Officer is to report directly to the employer (needs identification).
4.4 Dangerous Occurrence or Major Accident
In case of any dangerous occurrence or major accident resulting in death or permanent total disability, we will notify the DOLE Regional Office within twenty-four (24) hours of the
occurrence. After the conduct of the investigation by our concerned safety and health officer, we will report all permanent total disabilities to the DOLE Regional Office on or before the
th
20 of the month following the date of occurrence of an accident using the DOLE/BWC/HSD-IP-6 form.
5.0 Emergency Occupational Health Personnel and Facilities

Section 8 of D.O. No. 13 states that the construction project owner or his representative shall provide competent emergency health personnel within the worksite duly complemented by
adequate medical supplies, equipment, and facilities based on the total number of workers in the site.
5.1 Emergency Health Personnel and Facilities
Construction Stages Our number of workers during this Health Personnel & Facilities
stage Health Personnel Facilities

(Use additional sheet if necessary and attach all required training certificates in this section.)
6.0 Safety & Health Promotion & Education
The INDUSTRIAL CONTROLS CORPORATION is committed at ensuring that all workers or employees are given orientation/briefing or induction prior to deployment to the site. It is our
continuing effort to promote safety and health consciousness to all people involved in this project by providing them with the necessary safety and health training and education to
enhance their knowledge and skills to enable us to attain a safe and healthful project site.

6.1 Workers Safety and Health Orientation/Trainings

We require new workers to mandatorily attend our Safety & Health Orientation before they are deployed to this project site. The assigned Safety Officer, Mr./Ms. Romeo Fesalbon will
coordinate the conduct of this orientation.
We ensure that they receive instruction and training regarding the general safety and health measures we plan to implement for this project, specifically:
6.1.1 basic rights and duties of workers at the jobsite;
6.1.2 means of access and egress both during normal work and in emergency situation;
6.1.3 measures for good housekeeping;
6.1.4 location and proper use of welfare amenities and first –aid facilities;
6.1.5 proper care of PPEs and other protective clothing;
6.1.6 general measures for personal hygiene and health protection;
6.1.7 fire precautions to be taken;
6.1.8 action to be taken in case of any emergencies;
6.1.9 requirements of relevant health and safety rules and regulations.

Below are the list of workers who have undergone the DOLE-prescribed safety and health training and orientation:

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Name Title of training attended Remarks

ROMEO FESALBON LOSS CONTROL MANAGEMENT

HAZARD IDENTIFICATION, RISK ASSESSMENT AND

CONTROL

CONSTRUCTION OCCUPATIONAL SAFETY AND HEALTH

REX EVANGELISTA CONSTRUCTION OCCUPATIONAL SAFETY AND HEALTH

JONATHAN ABRAHAN CONSTRUCTION OCCUPATIONAL SAFETY AND HEALTH

(Use additional sheet if necessary)

6.2 Specialized Instruction and Trainings

DOLE OSH for construction activities requires specialized instruction and training be given to any person holding a critical occupation.

The inventory lists of our workers who hold critical occupations and attended the specialized training are listed below. (Please attach training certificates)

Name Title of training attended Remarks

ROMEO FESALBON ADVANCE RISK MANAGEMENT TRAINING COURSE

(Use additional sheet if necessary)

7.0 Toolbox Meeting

Toolbox meeting or gang meeting is a daily meeting among workers and their respective supervisors for the purpose of instruction, discussion , and proper briefing on the planned work,
the assessment of past work, the possibility or actual occurrence of accidents at the site, tips and suggestions on how to prevent possible accidents and other related matters.
7.1 Responsible for the Toolbox Meeting
The following supervisor or any designated person (e.g. foreman, leadman, gang boss, etc.) is required to conduct daily toolbox or similar meetings prior to starting the tasks for the day
to discuss with the workers and anticipate safety and health problems related to every task and the potential solutions to those problems. The supervisor will remind the workers of the
necessary safety precautions that need to be undertaken.
Name of Supervisor Time of Toolbox Meeting ( Regular working hours ) Means of Documentation (attach sample
instrument)

Romeo Fesalbon 8:00 am – 5:00 pm Toolbox & attendance

(Use additional sheet if necessary)

8.0 Accident/Incident/Illnesses Investigation & Reporting

We consider accident/incident/illness investigation and reporting as our responsibility. Absenteeism can greatly affect our work schedule. Looking for replacement can be costly for the
company, the hiring effort, training of new workers, and the loss of job momentum affects our productivity. We involve our supervisors in this program because they are more familiar with
the people involved, they have a better understanding of the operation, and they have a personal interest in the investigation since it’s their people who are involved. For this reason, the
Industrial Control Corporation (ICC) is committed to include this responsibility to all supervisors and made them aware about it.
8.1 Persons responsible for conducting the investigation
In this project, the following person/s will be assigned to conduct an accident/incident investigation:
All accidents All incidents/near miss Illnesses

ROMEO FESALBON ROMEO FESALBON ROMEO FESALBON

REX EVANGELISTA REX EVANGELISTA REX EVANGELISTA

JONATHAN ABRAHAN JONATHAN ABRAHAN JONATHAN ABRAHAN

8.2 Conducting and documenting the accident/illnesses investigation

In conducting the accident/illness investigation, we gather facts, analyze them and make the necessary recommendation. (Please attach sample forms that will be used to document your
investigation)

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8.3 Compliance with Government Requirements

We will submit the following reports to the DOLE Regional Office concerned:
8.3.1 In case of any dangerous occurrence or major accidents resulting in death or permanent total disability using the form (DOLE/BWC/OHSD/IP – 6). Notification of major accidents to
the DOLE Regional Office concerned within 24 hours.
th
8.3.2 Summary of Work Accident/Illness Exposure Data Report will be submitted on or before the 20 of the month following the date of occurrence of the accident (for those projects
with short duration or less than one-year duration).

8.3.3 Annual Work Accident/Illness Report using the form DOLE/BWC/OHSD/IP – 6B for those construction projects with more than one year duration.
9.0 Personal Protective Equipment (PPE)

Every employer shall, at his own expense, furnish his workers with protective equipment for eyes, face, hands, feet, lifeline, safety belt/harness, protective shields, and barriers whenever
necessary by reason of the hazardous work process or environment, chemical or radiological or other mechanical irritants or hazards capable of causing injury or impairment in the
function or any part of the body through absorption, inhalation or physical agent.
Provision of PPE shall be in accordance with Rule 1080 of the OSHS (must include Rule 1070 for noise). The equivalent cost for the provision of PPE (life span, depreciation,
replacement, etc.) shall be an integral part of the project cost.

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

1 Hard Hat 7 ₱ 300 ₱ 2100

2 Electrical Gloves 21 pairs ₱ 35 / per pair ₱ 735

3 Safety Shoes 7 ₱ 1200 / pair ₱ 8400

4 Safety Glasses / Goggles 7 ₱ 245 ₱ 1,715

5 Reflectorize vest / High Visibility Long Sleeve Shirt 7 ₱ 200 ₱ 1,400

6 Harness 7 ₱ 500 ₱ 3,500

(Use additional sheet if necessary)

9.1 Cleaning and Proper Maintenance of PPEs

It is important that all PPE be kept clean and properly maintained. Cleaning is particularly important for eye and face protection where dirty or fogged lenses could impair vision. Our
workers or employees inspect, clean, and maintain their PPE according to the manufacturers’ instructions before and after each use. Our supervisors are responsible for ensuring that
users properly maintain their PPEs in good condition.
We enforce our rule that PPEs must not be shared between workers or employees until it has been properly cleaned and sanitized. PPEs are distributed for individual use whenever
possible.
If workers or employees provide their own PPEs, we make sure that it is adequate for the workplace hazards, and that it is maintained in a clean and stored in conducive condition.
We never allow the use of defective or damaged PPEs. We immediately discard and replace them to avoid any unintentional use.
We also consider the importance of ensuring that any contaminated PPE which cannot be decontaminated is disposed of in a manner that protects workers or employees from exposure
to hazards.
10.0 Protection of the General Public

We comply with Rule 1412.09 of the DOLE OSH standard in providing a safely covered walkway over the sidewalk for use by pedestrians in a building construction work less than 2.3
meters (7ft.) from a sidewalk or public road.
We comply with Rule 1412.10 of the OSH Standard, Protection from Falling Materials. We observe the following:
10.1 We will take the steps to protect workers from falling materials, such as the provisions of safety helmets and safety shoes.
10.2 We will ensure that tools, objects, and materials including waste materials will not be thrown or tipped from a height, but will be properly lowered by crane, hoist , or chutes. If such is
not practicable, the area where the material is thrown will be fenced and no person will be allowed in the fenced area.

The person responsible for this program:

Name: Romeo Fesalbon

Designation: SAFETY OFFICER
11.0 Safety Signages

Our Safety Signages provide warning to workers and employees and the public about the hazards around the project site. These will be posted in prominent positions at a strategic

location visible as far as possible in a language understandable to most of the workers and employees as well as the public.

11.1 The specific safety signages we intend to set up for this project include but are not limited to:
11.1.1 Mandatory requirement on the usage of PPE prior to entry to the project site (attach sample picture of this signage that you plan to use for this project);
11.1.2 Areas where there are potential risks of falling objects (if applicable, attach a sample picture of this signage that you plan to use for this project);
11.1.3 Areas where there are potential risks of falling (if applicable, attach a sample picture of this signage that you plan to use for this project);
11.1.4 Areas where explosives and flammable substances are used or stored (if applicable, attach a sample picture of this signage that you plan to use for this project);

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11.1.5 Areas where there are tripping or slipping hazards (if applicable, attach a sample picture of this signage that you plan to use for this project);
11.1.6 Approaches to working areas where danger from toxic or irritant airborne contaminants/substance may exist which should indicate the name of the contaminant/substance
involved and the type of respiratory equipment to be worn (if applicable, attach a sample picture of this signage that you plan to use for this project);
11.1.7 All places where contact with or proximity to electrical/facility equipment can cause danger (if applicable, attach a sample picture of this signage that you plan to use for this
project);
11.1.8 All places where workers may come in contact with dangerous moving parts of the machineries or equipment (if applicable, attach a sample picture of this signage that you plan to
use for this project);
11.1.9 Location of the fire alarms and fire-fighting equipment (attach sample picture of this signage that you plan to use for this project);
11.1.10 Instructions on the usage of specific construction equipment (if applicable, attach a sample picture of this signage that you plan to use for this project);
11.1.11 Periodic updating of man-hours lost.
11.2 Inspection and Maintenance of Safety Signages
We will regularly inspect and maintain in good condition all safety signages that we will be providing for this project. The person in charge in inspecting is/are, he/she is/are our SAFETY
OFFICER. Inspection will be carried out _______every two weeks_______.
Our Safety officer will remove and replace any signages that are damaged, illegible, or no longer apply to the current hazard.
12.0 Construction Workers Skills Certification

The company will ensure that all workers assigned in the critical occupations and those who will be assigned in the operation of construction heavy equipment (CHE) will undergo
mandatory skills testing for certification by TESDA (Attach TESDA certificates of those workers certified by TESDA.)

13.0 Testing & Inspection of Construction Heavy Equipment

All construction heavy equipment will be tested and inspected in accordance with the requirements of OSHS. The company will ensure that all heavy equipment will be operated by
qualified and certified operators. (Attach Certificate of Testing and Inspection of CHE used issued by DOLE Accredited Testing Organizations for CHE and TESDA certificate of CHE
operator/s).
14.0 Control Measures on Construction Activities
To ensure safe and healthy working conditions throughout the duration of the project the following control measure activities will be enforced and disseminated to all the workers in the
site:
14.1 Major Activities
Major activities for this project include but not limited to the following: (please check on the box all that applies)
□ Demolition □ Excavation
□ Earthmoving □ Piling

 □ Scaffold □ Formwork
□ Structural Steel □ Crane Operation
□ Concreting □ Rebar works
□ Welding 
□ Electrical
□ HVAC □ Plumbing
□ Painting □ interior Decoration
□ Others (please specify)

14.2 Hazards Identified

Based on the list of activities for this project, we found the following potential hazards that we may possibly encounter in the course of project implementation:
14.2.1 Physical Hazards
Physical hazards are the most common in most workplaces. The physical hazards that we identified for this project include but are not limited to the following: (please check on the box
all that applies)
□ machineries □ power and hand tools

 □ electrical 

□ ladders and scaffolds
□ noise □ ventilation
□ exposure to heat □ tripping

 □ fall hazards □ collapse

□ others (please specify)

14.2.2 Chemical Hazards

Chemical hazards are present workers handle chemical preparations in any form (solid, liquid or gas). Some are safer than others, however, some workers are more sensitive to
chemicals, even the common solutions causing illness, skin irritation or breathing problems.
The chemical hazards that we identified for this project include but are not limited to the following: (please check on the box all that applies)
□ solvents □ paint products
□ acids □ cleaning products
□ acetylene □ propane
□ gasoline □ explosive chemical
□ welding fumes □ others (please specify)

14.2.3 Biological Hazards

Biological hazards come from working with infectious people, plants, and other living materials. The biological hazards that we have identified for this project include but are not limited to
the following: (please check on the box all that applies)
□ blood or other body fluids □ fungi
□ bacteria and viruses □ plants
□ insect bites □ animal and bird droppings

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□ others (please specify)

14.2.4 Ergonomic Hazards

Ergonomic hazards occur when the type of work, body position, and working conditions put a strain on the body. They are the hardest to spot since one does not immediately notice the
strain on your body or the harm these hazards pose. Short-term exposure may result in "sore muscles" on the days following exposure, but long-term exposure can result in serious
musculoskeletal injuries.
The ergonomic hazards that we identified for this project include but are not limited to the following: (please check on the box all that applies)
□ poor lighting □ frequent lifting
□ poor posture □ repetitive motion
□ exertion of force □ awkward movement
□ others (please specify)

(Enumerate control measures to address those hazards identified, Use an additional sheet if necessary)
14.3 Safe Work Practices

Safe work practices are procedures adopted for carrying out specific tasks that ensure workers' exposure to hazardous situations, substances, and physical agents is controlled in a safe
manner. Safe work practices are generally written methods outlining how to perform a task with minimum risk to people, equipment, materials, environment, and processes. It should be
developed as a result of completing a Hazard Assessment and should closely reflect the activities in this project.
All safe work practices should be kept in a location central to the work being performed and readily available to the workforce. Some safe work practices will require specific job
procedures, which clearly set out in chronological order each step in a process.
(Enumerate below the safe work practices that you intend to perform relative to the hazards you previously identified above.)
15.0 First-Aid, Health Care Medicines, and Equipment Facilities

The company will provide first-aid kits and health care medicines and facilities for workers on the site in accordance with the requirements of Rule 1960 of the OSHS.
16.0 Workers' Welfare Facilities

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

To assure that the company provides adequate welfare facilities for the workers on the site the company will implement the provision of toilets and other facilities in accordance with the
requirements of the Sanitation Code.

17.0 Medical Surveillance

The company will require all employees to undergo a baseline or initial medical health examination prior to assigning to a potentially hazardous activity. The examination will include but
not be limited to the following:

17.1 Complete medical and work history;

17.2 Physical examination (Pre-employment, During employment, and Separation);
17.3 Other special examination (Pulmonary function test, blood panel, ECG >40 years of age, audiogram);
17.4 Random drug testing.

18.0 Working Hours & Break Time

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

□ Mon. □Tue. □Wed. 

□Thur. □Fri. 
□Sat. □Sun  
Check on the shift and indicate the work hours for the shift that applies.
st
□ 1 Shift from 8:00 am to 5:00 pm
nd
□ 2 Shift from N/A (am/pm) to N/A (am/pm)
rd
□ 3 Shift from N/A (am/pm) to N/A (am/pm)

Check on the shift and indicate the break for the shift that applies.
st
□ 1 Shift from N/A (am/pm) to N/A (am/pm)
nd
□ 2 Shift from N/A (am/pm) to N/A (am/pm)
rd
□ 3 Shift from N/A (am/pm) to N/A (am/pm)

19.0 Construction Waste Disposal

The company including subcontractors will be responsible for minimizing waste generated during the implementation of the project. The following procedures for the disposal of wastes
will be implemented in the site:
19.1 Ensure that the construction wastes are segregated from that of domestic waste.

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19.2 All domestic wastes are to be collected on a daily basis.

19.3 Construction debris (broken hollow blocks, spoiled concrete, loose concrete, etc) should be taken out on the staging area.
19.4 Oil spills and spoiled grease should be wrapped in the black garbage bag and will be properly disposed of.
19.5 Application of good housekeeping.

20.0 Emergency Preparedness

The objectives of this are to ensure that the company has developed and communicated plans that will allow for the effective management of emergencies. Attach a copy of the
company emergency preparedness plan.
21.0 Pandemic Control Plan

In the event that another pandemic will occur, the company including subcontractors shall provide a separate additional program to contain provisions on the following:

21.1 Reduction on the transmission of the agent causing the pandemic;

21.2 Minimizing the contact rate;
21.3 Reduction of the risk of infection
21.4 Assistance to the affected employees
21.5 Reporting to the concerned government on the employees affected
22.0 Penalties/Sanctions

For every offense and violation of any safety rules, regulations, and general practices promulgated by the project and/or the company, the company recommended the following penalties
and sanctions for violation of the CSH program: (Please attach company policy on penalties, if there are any).

st nd rd
Safety Violation 1 offense 2 offense 3 offense
21. No helmet, no safety shoes, no safety belt/harness warning 3-day suspension 5-day suspension
2. no ID, Uniform, working attire, goggles, glove & apron warning 3-day suspension 5-day suspension
3. eating at prohibited area warning 3-day suspension 5-day suspension
4. littering and loitering warning 3-day suspension 5-day suspension
5. smoking at prohibited area warning 3-day suspension 5-day suspension
6. urinating at prohibited area warning 3-day suspension 5-day suspension
7. illegal dismantling of safety signages and paraphernalia warning 3-day suspension 5-day suspension
8. illegal gambling 3-day suspension 5-day suspension Dismissal
9. overnight stay w/o permission 3-day suspension 5-day suspension dismissal
10. fighting & provoking others 5-day suspension Dismissal

11. working under the influence of drugs and liquor Dismissal

12. possession of illegal drugs, deadly weapon & gambling Dismissal
paraphernalia
13. pilferage and robbery Dismissal
14. illegal entry/exit Dismissal
15. refusal to surrender ID & giving false representation Dismissal
23.0 Attachments

Attached are the following:

23.1 DOLE Company registration under Rule 1020 of the OSHS

23.2 Company registration under DOLE D.O. 174- 17, if any

23.3 DTI – PCAB License/ JV License and agreement for joint venture projects

23.4 Notice of Award/contract or any documentary proofs showing that the company/contractor is the

chosen/winning bidder

23.5 Certificates of training completed by the designated safety and health personnel

(FA/OHNAP/PCOM), whatever is applicable

23.6 CHE certificate of testing and inspection (if heavy equipment will be used)

23.7 Skills certification of workers (critical occupations)

23.8 OSH reportorial requirements (if applicable)

23.9 Other supporting documents to support what is indicated in the Construction Safety and Health Program

Construction Safety and Health Program prepared by:

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Revised Form 1B-2023
Date of Revision: 07 March 2024

_____________________________________________________ Date: __________________

Signature over printed name

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