Construction Safety Form PDF Details

When working on a construction site, it is important to have a safety form in place that outlines the safety hazards associated with the project and how workers can protect themselves. A safety form should be created before work begins and should be updated as the project progresses. A safety form can help ensure that everyone on the construction site is aware of potential hazards and takes appropriate precautions.

QuestionAnswer
Form NameConstruction Safety Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namescshp application form, sample of construction safety and health program approved by dole, construction safety and health program, dole cshp application form

Form Preview Example

NO FEES REQUIRED

FOR THE FILING , EVALUATION AND APPROVAL OF CSHP

 

Revised Form.: CSHP-DO13-98:

Date of Revision : June1, 2011

Page 1of 3

Department of Labor and Employment

REGIONAL OFFICE NO. ___

REVISED APPLICATION FORM for

EVALUATION/ APPROVAL OF CONSTRUCTION SAFETY & HEALTH PROGRAM (CSHP)

Legal Basis: Section 5 of Department Order No. 13 s 1998

(Guidelines Governing Occupational Safety and Health In Construction Industry)

Instructions: This form shall be duly accomplished and submitted by the MAIN/GENERAL CONTRACTOR in applying for an approval of a Construction Safety and Health Program intended for a specific construction project.

Note: A CHECKLIST OF REQUIREMENTS shall be used in receiving the application.

Only an application form with complete requirements and attachments will be processed. Application found with incomplete requirements will be given 15 calendar days to comply. Failure to comply within the prescribed period, the application will be deemed disapproved.

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

Complete Name of the Company/

 

 

Complete Address:

 

 

 

Main /General Contractor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel. No:

 

 

 

 

 

 

 

 

Fax No.

 

 

 

 

 

 

:

Email:

 

 

 

 

 

Name of Project Manager/Contact Person

 

 

 

 

 

 

 

 

 

 

 

Main Contractor PCAB License

 

 

Main Contractor Total employment _______

 

No.______________

 

 

___

Male _____ Female _____

 

 

Date of Validity:_______________________

 

 

 

 

 

 

DOLE

Registration of Main Contractor ( Pls. attach photo copy of Registration forms received and approved by

the concerned DOLE Regional Office)

 

 

 

 

 

 

 

 

 

 

 

 

Date Registered/Approved

DOLE-RO

a.

per DO 18-02 ( requires yearly renewal)

 

 

__________________

__________

b.

per Rule 1020, OSHS (one time registration)

 

__________________

___________

 

 

Sub-contractors’

Profile/License

 

 

 

 

 

 

 

 

 

No. of

PCAB

Validity

Date of

Name of Sub-contractors (If , any)

 

Scope of Work and

Workers

License

Date

DOLE

 

 

 

Project Cost

 

 

 

Registration

 

 

 

 

 

 

 

 

 

 

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Use separate sheet , if necessary)

Department of Labor and Employment

REGIONAL OFFICE NO. ___

REVISED APPLICATION FORM for

EVALUATION/ APPROVAL OF CONSTRUCTION SAFETY & HEALTH PROGRAM (CSHP)

B. Project Profile/Description

Name of the Project: (Please attach copy of Invitation to Bid/other documents indicating name and details of the project)

Complete Project Address/Location

Name of Project Owner

Tel. No: _____________

Fax No: _____________

Email : _____________

Project Classification:

 

Date of Estimated Start/Execution of

 

Estimated No. of Workers to

the project:

 

 

 

 

be deployed in the project:

________________________

 

 

Month

Day

Year

 

 

___________________

 

 

 

 

 

 

Duration of

the project

(Pls.

Total Project Cost:__________________

(Workforce of the project to

state the number of calendar days

 

include workers of the sub-

 

 

 

 

 

contractor/s)

_________________________

 

 

 

 

 

Brief Description of Activities/Work Flow

(You may attach additional sheet, if necessary)

 

 

Revised Form.: CSHP-DO 13-98

 

Date of Revision: June1, 2011

Page 2of 3

Department of labor and Employment

REGIONAL OFFICE NO. ________

APPLICATION FORM for APPROVAL OF

CONSTRUCTION SAFETY AND HEALTH PROGRAM

OSH Personnel assigned to the project

Name of Appointed Safety Officer/s:

____________________________________

Date of his/her BOSH training: _________________

(Pls. attach photo copy of Certificate of Completion on the Basic OSH Course for Construction Site Safety Officers issued by DOLE-BWC accredited Safety Training Organizations or recognized institutions)

Name of Appointed First-Aider/s:

______________________________________

Date of First –Aid Training: _______________

Validity of ID: __________________

(Pls. attach photo copy of Certificate of First-Aid Training and Valid First Aider ID from PNRC

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

Name

Date of BOSH Training

OH Nurse

OH Physician

Dentist

(If Heavy Equipment will be used in the Project)

List of Heavy Equipment to be Used in the Project (Please attach additional sheet, if necessary)

Name of Heavy Equipment Operator/s (To attach photo copy of skills certification from TESDA)

Profile of the person who prepared the CSH Program for the abovementioned Project:

Name and Signature

___________________________

Signature over printed name

Educational Background:

Work Experience in OSH:

Other Qualifications:

I HEREBY CERTIFY ON MY HONOR TO THE TRUTHFULLNESS OF THE ABOVEMENTIONED INFORMATION. THE COMPANY HEREBY COMMIT TO STRICTLY IMPLEMENT THE ATTACHED CONSTRUCTION SAFETY and HEALTH PROGRAM DESIGNED FOR THE ABOVEMENTIONED PROJECT.

Submitted By:

Signature Over Printed Name ______________________________________

 

Position:

______________________________________________________

 

Date:

______________________________________________________

 

 

 

Revised Form.: CSHP-DO 13-98

 

Date of Revision: June1, 2011

Page 3 of 3

How to Edit Construction Safety Form Online for Free

You'll be able to fill out construction safety and health program sample easily by using our online PDF editor. To make our tool better and less complicated to utilize, we continuously implement new features, with our users' feedback in mind. Starting is effortless! All that you should do is adhere to the following basic steps directly below:

Step 1: First of all, access the pdf tool by clicking the "Get Form Button" in the top section of this page.

Step 2: This tool lets you modify most PDF files in many different ways. Enhance it with any text, adjust existing content, and put in a signature - all when you need it!

It will be simple to complete the form following our helpful guide! Here is what you have to do:

1. When submitting the construction safety and health program sample, make sure to include all of the needed fields within its corresponding area. This will help expedite the process, enabling your information to be handled efficiently and correctly.

dole cshp online application conclusion process detailed (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Name of Project ManagerContact, Tel No Fax No Email, Main Contractor PCAB License No, Main Contractor Total employment, a per DO requires yearly renewal, Subcontractors ProfileLicense No of, Name of Subcontractors If any, Scope of Work and, Workers, PCAB License, Validity, Date, Date of DOLE, Registration, and Project Cost with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Part number 2 of filling out dole cshp online application

People who work with this form often make some errors while completing PCAB License in this section. Ensure that you revise what you type in right here.

3. In this specific step, have a look at Use separate sheet if necessary. Each of these have to be completed with greatest focus on detail.

The way to complete dole cshp online application stage 3

4. Now complete the next form section! In this case you will have all these Department of Labor and Employment, REGIONAL OFFICE NO, REVISED APPLICATION FORM for, B Project ProfileDescription, Name of the Project Please attach, Tel No Fax No Email, Project Classification Total, Estimated No of Workers to be, and Date of Estimated StartExecution blank fields to do.

How to complete dole cshp online application stage 4

5. Last of all, the following last part is what you'll have to complete before submitting the document. The blanks in this instance are the next: Project Classification Total, Estimated No of Workers to be, Date of Estimated StartExecution, and Brief Description of.

Simple tips to fill out dole cshp online application step 5

Step 3: Right after you've looked once more at the details in the blanks, click on "Done" to complete your form. Acquire your construction safety and health program sample when you join for a 7-day free trial. Readily get access to the pdf document inside your FormsPal cabinet, with any modifications and adjustments being all kept! FormsPal offers protected document completion devoid of data recording or distributing. Feel safe knowing that your details are safe here!