1.

0 Statement of Commitment to Comply with OSH Requirements

I Danilo M. Toledanes by accomplishing this Construction Safety and Health Program do hereby commit
and bind ourselves to comply with the requirements of the Department Order No. 13, series of 1998 –
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 responsibilities 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.

MATHIAS L. MALENAB DANILO M. TOLEDANES

DISTRICT ENGINEER DJCM CONSTRUCTION CORPORATION
DPWH INED II PRESIDENT/GENERAL MANAGER

2.0 Company Safety and Health Policy

It is the general policy of DJCM CONSTRUCTION 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
D.O. No. 13 and the 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 assessment to check program effectiveness.
3.0 Project Details
i. Specific name of project and Name of Owner: ii. Location of the project:

CONSTRUCTION/REHABILITATION OF FLOOD PAGUDPUD, ILOCOS NORTE

MITIGATION FACILITIES WITHIN

iii. Classification of the project: iv. Name of General Constructor (constructor who has general
supervision over other 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.

N/A
□ Specialty Trade Const.

□ others, specify: ____________________

__________________________________

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

Danilo M. Toledanes Danilo M. Toledanes

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

Name Classification

1.

CEASAR JACINTO 2.

3.

(Use additional sheet if necessary)

ix. Estimated maximum number of workers x. Work Hours (including shift)

25 workers 1st shift: from 8:00 AM to 5:00 PM

2nd shift: from________to_________

3rd shift: from________to_________

Others: __________________________

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

□ Backhoe: ___1__ □ Dozer: _____ Start Date: OCTOBER 04, 2018

□ Loader: ____ □ Dumptruck: __1___ End Date: FEBRUARY 01, 2019

□ Roller: _____ □ Grader: _____ Est. Days to Complete: _ _120 DAYS___

□ others, specify: Concrete Vibrator, Bar Cutter, One Bagger

Mixer, Welding machine

xiii. Name and Address of Emergency Health Provider (any person or organization who is certified or recognized by the Department
4. Construction Safety & Health Committee

Section 11 of D.O. No. 13 requires that rules of 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 CONSTRUCTION OF CLASSROOM 2 STOREY (2 UNITS SCIENCE LAB) PASALENG NATIONAL HIGH
SCHOOL, PAGUDPUD, ILOCOS NORTE. consists of:

4.1.1 Project Manager or his representative as the chairperson ex officio

Name: DANILO M. TOLEDANES

4.1.2 General Construction Safety and Health Officer/s (overall in charge in the implementation of the OSH program
of this project hired by the General Constructor. Please attach certificate of training/s prescribed by DOLE. Numbers
will be dependent on the numbers of workers and heavy equipment)

Name: RIEMA ROMERO

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 certificate of training/s prescribed by DOLE).

Name: ______________N/A_________________

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 certificate of training/s
prescribed by DOLE):

Name: ____KRSTAN PAOLO ROMERO_________

Designation: _First Aider__

4.1.5 Workers’ representative (minimum of 3 union members if organized, not necessarily from one employer)

Name: LEO DELA CRUZ Name: RICTHIE MACABANTE

Designation: _FOREMAN_ Designation: _MASON _

Name: __EDDIE BOY AGCAOLI

Designation: _SKILLED _

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 ____15th
day____ of the month;

4.2.4 Submits reports to the project manager (is this pm of the owner or pm of the gen con?) on its meetings and
activities one day after the meeting;

4.2.5 Reviews reports of inspection, accident investigation and implementation of 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 the 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. (Check on the boxes or list down the
training to be provided for workers and employees).

 40-Hour Construction Occupational Safety and Health Course

□ 1-Day Workers Safety & Health Orientation
□ others, specify:
_______________________________________________________
_______________________________________________________

4.3 Duties of the Safety Man/Officer

The principal function of the Safety Man 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 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 inspection as 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 Man 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 to death or permanent total disability, we will notify
the DOLE Regional Office within twenty four (24) hours from occurrence. After the conduct of investigation by our
concerned safety and health officer, we will report all permanent total disabilities to the DOLE Regional Office on or
before the 20th of the month following the date of occurrence of 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

Our number Health Personnel & Facilities
Construction Stages of workers Health Facilities
during this Personnel
stage
RIEMA
FACILITIES FOE ENGINEERS 2 ROMERO/KRSTAN First Aid Kit &
PAOLO ROMERO PPE
RIEMA
EATHWORKS 3 ROMERO/KRSTAN First Aid Kit &
PAOLO ROMERO PPE
RIEMA
PLAIN AND REINFORCE CONCRETE 5 ROMERO/KRSTAN First Aid Kit &
PAOLO ROMERO PPE
RIEMA
FINISHING WORKS 5 ROMERO/KRSTAN First Aid Kit &
PAOLO ROMERO PPE
RIEMA
ELECTRICAL WORKS 1 ROMERO/KRSTAN First Aid Kit &
PAOLO ROMERO PPE
 (Use additional sheet if necessary and attach all required training certificates in this section

6.0 Safety & Health Promotion & Education

The DJCM CONSTRUCTION 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 attend our Safety & Health Orientation before they are deployed to this project site in consonance to Section 12
of the D.O. 13. The assigned Safety Officer, Mrs. RIEMA ROMERO 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 trainings and orientation

Name Title of training attended Remarks

KRSTAN PAOLO ROMERO BLS for Healthcare Provider Course / Occupation Cert. of Completion
First Aid & CPR/AED training.

RIEMA ROMERO Construction Occupational Safety and Health Cert. of Completion

6.2 Specialized Instruction and Trainings

Section 12.6 of the D.O. No. 13 requires specialized instruction and training be given to any person holding critical occupation.

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

Name Title of training attended Remarks

REX G. LARA JR. DRIVING (DRIVE PASSENGER BUS/DRIVE STRAIGHT NC III

TRUCK)

RONNIE M.TOLEDANES HEAVY EQUIPMENT OPERATION ( HYDRAULIC NC II

EXCAVATOR)

7.0 Toolbox Meeting

D.O. No. 13 define toolbox meeting or gang meeting as 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, gangboss, 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 on the necessary safety precautions
that need to be undertaken.

Name of Supervisor Time of Toolbox Meeting (indicate shift, e.g. 1 st, Means of Documentation (attach (Us
e
2nd, 3rd ) sample instrument)

LEO DELA CRUZ 07:00-08:00 AM Logbook

RIEMA ROMERO 07:00-08:00 AM Logbook

additional sheet if necessary)

8.0 Accident/Incident/Illnesses Investigation & Reporting

 We consider accident/incident/illnesses 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, the loss of job momentum
affect our productivity. We involve our supervisors in this program because they are more familiar with the people involved, they have
better understanding of the operation, and they have personal interest in the investigation since it’s their people who are involved. For
this reason, the DJCM CONSTRUCTION CORPORATION is committed to include this responsibility to all supervisors and made them
aware about it.

8.1 Persons responsible for conducting investigation

In this project the following person/s will be assigned to conduct accident/incident investigation:

All accidents All incidents/near miss Illnesses

RIEMA ROMERO RIEMA ROMERO RIEMA ROMERO

KRSTAN PAOLO ROMERO KRSTAN PAOLO ROMERO KRSTAN PAOLO ROMERO

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)

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 to death or permanent total disability using the form
(DOLE/BWC/OHSD/IP – 6). Notification of major accidents to DOLE Regional Office concerned within 24 hours.

8.3.2 Summary of Work Accident/Illness Exposure Data Report will be submitted on or before the 20 th of the month following the
date of occurrence of 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)

Section 6 of D.O. No. 13 requires that 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 Type of PPE Quantity needed Unit Total

No. Price cost

1 Hard Hat 30 500 15,000.00

2 Safety Shoes 30 500 15,000.00

3 Gloves 30 400 12,000.00

4 Long Sleeves 30 150.00 4,500.00

5 Ear Plug 30 70.00 2,100.00

TOTAL 150 1,620.00 48,600.00

(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. PPE are
distributed for individual use whenever possible.

If workers or employees provide their own PPEs, we make sure that it is adequate for the work place hazards, and that it is maintained in a
clean and stored in a 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 safe covered walkway over the sidewalk for use by pedestrians in a
building construction work less than 2.3 meter (7ft.) from a side walk 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 worker 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: Danilo M. Toledanes

Designation: Authorized Managing Officer

11.0 Safety Signage’s

Our Safety Signage’s provides warning to workers and employees and the public about the hazards around the project site. These will
be posted in prominent positions at 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 signage’s we intend to set-up for this project include but 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 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 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 sample picture of this
signage that you plan to use for this project);

11.1.5 Areas where there are tripping or slipping hazards (if applicable, attach 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 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
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 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 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 Signage’s

We will regularly inspect and maintain in good condition all safety signage’s that we will be providing for this project.
The person in charge in inspecting is/are RIEMA ROMERO he is our Safety officer. Inspection will be carried out on
a Daily.

Our Company will remove and replaced any signage’s that are damaged, illegible, or no longer apply with the current
hazard.
12.0 Construction Workers Skills Certification

The company will ensure that all workers assigned in the critical occupations as defined in Section 15 of D.O. No. 13
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 Section 10 of
D.O. No. 13. 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 includes 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)

Please see attached

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)

Please see attached

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)

Please see attached

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 includes but 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
□ others (please specify)

Please see attached

14.2.4 Ergonomic Hazards

Ergonomic hazards occur when the type of work, body position and working conditions put 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 includes but 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)

Please see attached

(Enumerate control measures to address those hazards identified, Use additional sheet if necessary)

14.3 Safe Work Practices

Safe work practices are procedures adopted for carrying out specific tasks that ensures 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 a 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 kit and health care medicines and facilities for workers in 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 in the site to ensure human 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 in 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 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 Hour & 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.
□ 1st Shift from 08:00 (am/pm) to 05:00 (am/pm)
nd
□ 2 Shift from ________(am/pm) to __________ (am/pm)
□ 3rd Shift from ________(am/pm) to __________ (am/pm)

Check on the shift and indicate the break for the shift that applies.
□ 1st Shift from __12:00_(am/pm) to __1:00___ (am/pm)
□ 2nd Shift from ________(am/pm) to __________ (am/pm)
□ 3rd Shift from ________(am/pm) to __________ (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 disposal of wastes will be implemented in the site:

19.1 Ensure that the construction wastes are segregated from that of domestic waste.

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 greases should be wrapping in the black garbage bag and will be properly disposed.

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 copy of company emergency preparedness plan.
21.0 Penalties/Sanctions

For every offenses 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 CSH program:
(Please attach company policy on penalties, if there are any).

Safety Violation 1st offense 2nd offense 3rd offense

1. No helmet, no safety shoes, no safety Warning 3 day suspension 5 day
belt/harness suspension
2. no ID, Uniform, working attire, goggles, Warning 3 day suspension 5 day
glove & apron 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 Warning 3 day suspension 5 day
and paraphernalia 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 Dismissal

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

22.0 Attachments

Attached are the following:

22.1 Certificate of DOLE Company registration under Rule 1020 of the OSHS
22.2 DTI – PCAB License
22.3 Notice of Award/contract
22.4 Certificates of trainings completed of appointed safety and health personnel
22.5 CHE certificate of testing and inspection (if heavy equipment will be used)
22.6 Skills certification of workers (critical occupations)
22.7 OSH Reportorial requirements
22.8 Others ________________________________________