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    Construction Safety and Health Program

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    thejohnnyvins

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    © All Rights Reserved
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    Construction Safety and Health Program

    Uploaded by

    thejohnnyvins
    4 views2 pages

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    Copyright:

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    Download as doc, pdf, or txt
    4 views2 pages

    Construction Safety and Health Program

    Uploaded by

    thejohnnyvins

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Form Reference No: PM-NCR-03.08-F-03.

    R02
    Regional Office: DOLE-NCR
    Application No: A-1440-03-12-RO69-0005

    Application for
    CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)

    Project Name: ____Proposed 2- Storey Residential Unit____


    Project Complete Address/Location: ___________________________________________________________
    _________________________________________________________________________________________
    Project Duration: _____________ Project Start: ________________ Completion Date: _________________
    (No. of Calendar days) (Date of estimated start) (Date of project completion)
    Estimated Project Cost: ______________________ Number of Workers: _______________________
    Name of Contractor (if any):___________________________________________________________________
    Contractor’s Address: ________________________________________________________________________
    ____________________________________________________________ Fax No.:_______________________
    PCAB License No.______________ Date of Validity: ____________ Email address: _______________________

    Name of Project Owner: __________________________________ Fax No.:_____________________


    Project Owner Address: ______________________________________________________________________
    ______________________________________________________ Email address: ____________________

    Accomplished by: ______________________________________________


    Signature over Printed Name of OWNER / CONTRACTOR

    **********************************************************************
    COMMITMENT TO COMPLY on OSH

    I/We _________________SPACE_________ and _____Engr


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

    do hereby commit and bind our self 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.

    _____________________________________
    ___________________________________
    PROJECT OWNER CONTRACTOR
    Signature Over Printed Name Signature
    Over Printed Name

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