Occupational Safety and Health (OSH) Program of

(COMPANY)
I. Complete Company Profile/ Project details

 Company Name: _ ______________________

 Date Established: _ _______________________________
 Complete Address:
 Phone and fax numbers ____________________________________
 Website URL/Email address _________________
__________________________________
 Name of Company Owner/Manager/President_____ _________
 Total Number of Employees; __Male Female _______
 Description of the business Pls specify
o Kindly check:
o Manufacturing:
______________________________
o Service:
______________________________
o Agri/fishing:
______________________________
o Wholesale/retail
______________________________
o Utilities ______________________________
o Banks and financial institution
_______________________
o Security Agency
o Maintenance
o Construction
o Others (Please specify)

 Product descriptions: (ex. Garments, shoes, electronics )______________________

 Description of services: General Construction_______________________________

Page | 1
Basic Components of Company OSH Program and Policy
(DO 198-18, Chapter IV, Section 12)

1.0 Company Commitment to Comply with OSH Requirements

2.0 General Safety and Health Programs
-Safety and health Hazard Identification, Risk Assessment and Control (HIRAC)
-Medical Surveillance for early detection and management of occupational and
work related diseases
-First-aid and emergency medical services
3.0 Promotion of Drug Free workplace, Mental health Services in the Workplace,
Healthy lifestyle
4.0 Prevention and Control of HIV-AIDS, Tuberculosis, Hepatitis B
5.0 Composition and Duties of health and safety Committee
6.0 OSH Personnel and Facilities
7.0 Safety and Health Promotion, Training and Education
-Orientation of all workers on OSH
-Conduct of Risk Assessment, evaluation and Control
-*Continuing training on OSH for OSH Personnel
-*Work permit System
8.0 Toolbox/Safety Meetings, job safety analysis
9.0 Accident/Incident/illness Investigation, Recording and Reporting
10.0 Personal Protective Equipment (PPE)
11.0 Safety signages
12.0 *Dust control and management and regulation on activities such as building of
temporary structures and lifting and operation of electrical, mechanical,
communications system and other requirements
13.0 Welfare Facilities
14.0 Emergency and disaster preparedness and response plan to include the organization
and creation of disaster control groups, business continuity plan, and updating the
hazard, risk and vulnerability assessment (as required)
15.0 Solid waste management system
16.0 Compliance with Reportorial Government Requirement (refer to Item 9.0)
17.0 Control and Management of Hazards (refer to Item 2-HIRAC)
18.0 *Prohibited Acts and Penalties for Violations
19.0 *Cost of Implementing Company OSH program

*(Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above)

Page | 2
1.0 Company Commitment to Comply with OSH Policy

____________(COMPANY)_________________ do hereby commit

Name of the Company)

to comply with the requirements of RA 11058 and DOLE Department Order 198-18 (its

Implementing Rules and Regulations) and the applicable provisions of the Occupational

Safety and Health Standards (OSHS).

We acknowledge the company’s obligation and responsibilities to provide appropriate funds

for implementing this OSH program including orientation and training of its employees on

OSH, provision and dissemination of IEC materials on safety and health, provision of Personal

Protective Equipment (PPE) when necessary and other OSH related requirements and

activities, to ensure the protection for our workers and employees against injuries, illnesses

and death through safe and healthy working conditions and environment.

We commit to conduct risk assessment as required to prevent workplace accidents as well

as comply with other provisions of this OSH program. That we are also fully aware of the

penalties and sanctions for OSH violations as provided for in RA 11058 and its Implementing

Rules and Regulations.

[Signature] ______________________________

[Name] ________ ______

[President] / [Chief Executive Officer] / [Owner]
[Date] ;____ __________________

Page | 3
 2.0 General Safety and Health Programs
21. Conduct of Risk Assessment

Kindly accomplish. Pls use additional pages if needed. You may also wish to attach your
Company’s Risk Assessment Matrix as substitute

Risk Assessment Matrix

Priority: likelihood of
injury and illness to
Control
Task Hazard Identified Risk Description occur
Measures
(low, medium, high)

Working at Workers work at height, Risk in falling Provision of

heights uncomfortable & risk of resulting of serious scaffolding,
High
falling injury barrier and
Harness
Lifting of Lifting of Materials from Carrying etc. Give proper
Construction staging to construction High orientation in
Materials area lifting
Cutting of all kind of Eye injury, hand Wear proper
construction materials injury PPE, safety
googles,
Cutting of
safety
construction High
googles, and
Materials
proper
machine
orientation

Example of Simple Risk Assessment

Task Hazard Risk Priority Control
Delivering Drivers work alone May be unable to
Need for
product to call for help if high
helper
customers needed
Drivers have to Fatigue, short rest
Policy on
occasionally work long time between shifts medium
work break
hours
Drivers are often in very Increased chance Road safety
low
congested traffic of collision program
Longer working
medium Work breaks
hours
Drivers have to lift boxes Injury to back from Given proper
when delivering product lifting, reaching, high orientation on
carrying, etc. lifting

2.2 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:

Page | 4
 a. Routine : ( ) CBC ( ) Chest X-ray ( ) Urinalysis ( ) stool exam
b. Special: ( ) Blood Chemistry ( ) ECG ( ) others, please specify
c. Schedule of Annual medical examination: ( ) Q1 ( )Q2 ( )Q3 ( )Q4

d. Is random drug testing conducted? Yes_____ when_once s year) No ______

2.3 First-Aid, Health Care Medicines and Equipment Facilities

 How many treatment rooms/first aid rooms are existing in your company? __1___
 How many Clinics in the workplace? _n/a______
 What hospital (s) are you affiliated with? _n/a______

3.0 And 4.0 - Health Programs for the promotion, prevention and control

This refers to : Drug-free Workplace in compliance to RA 9165, Human Immunodeficiency

Syndrome (HIV/AIDS) in compliance to (RA 8504) RA 11166, Tuberculosis in compliance to
EO 187-03, Hepatitis B in compliance to DOLE Advisory No. 05 Series of 2010, Mental Health
in compliance to RA 11036.

Kindly accomplish the policy template in Annex A.

(*you may attach individual policy statements)

5.0 Composition and Duties of Safety and Health Committee

The SHC of the company is responsible to plan, develop and implement OSH policies and
programs, monitor and evaluate OSH programs and investigate all aspect of the work
pertaining to the safety and health of all the workers. SHC shall be composed of the following
in compliance with the law:

(a) For establishments with less than ten workers and low risk establishments with ten
(10) to fifty (50) workers. – A SO1 shall establish an OSH committee composed of the
following:

Chairperson : _______ ______________________

Name of Company owner or manager
Secretary : __________ ______________
Safety officer of the workplace
_________________________________________________________________________
Member : Name of at least one (1) worker, preferably a
union member, if organized

(b) For medium to high risk establishments with ten (10) to fifty (50) workers and low
to high risk establishments with fifty-one (51) workers and above. – The OSH committee of
the covered workplace shall be composed of the following:

Ex-officio : _____ ___________________

chairperson Name of Employer or his/her representative

Secretary : _____
Name of Safety officer of the workplace
Ex-officio :
members ___________________________
Name of Certified first-aider/s

________________N/A______________________________
Page | 5
 Name of OH nurse
________________N/A______________________________
Name of OH dentist, and OH physician, as applicable

_Rowaldo Serrano, Raimond C. Llaguno_________________

Members : Name of Safety officers representing the contractor or
subcontractor, as the case may be,

___________________________________________________
Name of workers’ representatives who shall come from the
union, if the workers are organized, or elected workers through a
simple vote of majority, if they an unorganized.

(c) Joint Coordinating Committee: For two (2) or more establishments housed under
one building or complex including malls.

Chairperson : _____N/A_________________________________________
Name of Building owner or his/her representative such as the
building administrator

Secretary : _____N/A__________________________________________
Name of Safety officer appointed by the Chairperson

Members : ______N/A____________________________________________

Name of 2 safety officers from the building selected to the Joint

OSH Committee
N/A
__________________________________________________
__________________________________________________
Name of two (2) workers’ representatives one from which must be
from a union if organized from any establishments under the
building

(All members of the HSC shall perform their duties and responsibilities by the OSH law
and its implementing guidelines.)

Safety and Health Committee Minutes/Reports submitted to DOLE (pls attach latest OSH
committee minutes/report)

Yes ____ No ______

6.0 OSH Personnel and Facilities

6.1 Safety Officer
Safety Officer(s): (attach certificate of training/s prescribed by DOLE)(please use
additional sheets as necessary)

Name of Safety Officer(s): Training(s) (kindly include number of hours)

Page | 6
 Rowaldo Serrano Construction Safety Orientation 8hrs/
Standard First Aid and Basic Life Support-
CPR w/ AED Training 32hrs

6.2 Emergency Occupational Health Personnel and Facilities

List of competent emergency health personnel within the worksite duly complemented by
adequate medical supplies, equipment and facilities based on the total number of workers.
(Use additional sheet if necessary and attach all required training certificates in this section.)
Emergency Health Personnel and Facilities

Total number of Health Personnel & Facilities

Shift/Area/unit/ workers/area Health Personnel (First- Facilities
Department aider, Nurse, Physician, (Treatment Room/
Dentist) Clinic/ Hospital)
Site Project 12 First-Aider Treatment Room

7.0 Safety and Health Promotion, training and education provided to workers

--Orientation of all workers on OSH

-Conduct of Risk Assessment, evaluation and Control

-*Continuing training on OSH for OSH Personnel

-*Work permit System
*(Applicable for medium to high risk establishments with 10 to 50
workers and low to high risk establishments with 51 workers and
above)

(please attach additional sheets as necessary)

Name of OSH Number of Employees in Date

Training/Orientation attendance
Safety Orientation 12 Nov. 11, 2025

Conduct of Risk Assessment (may include Date

WEM)

8.0 Conduct of Tool Box Meetings/ Safety Meetings if applicable

Page | 7
Conduct of Safety Meetings/Tool Box Date
Meetings
Tool Box Meetings Daily

9.0 Accident/Incident/Injury investigation recording and reporting

Any dangerous occurrence, major accident resulting to death or permanent total disability,
shall be reported by the company to the DOLE Regional Office within twenty four (24) hours
from occurrence using the prescribed form (Work Accident / Incident Notification).

After the conduct of investigation, the company shall prepare and submit work accident report
using the prescribed form (WAIR). Moreover, other work accidents resulting to disabling
injuries such as Permanent Partial Disability and Temporary Total Disability shall be reported
to the DOLE Regional Office within 30 days after the date of occurrence of accident using the
DOLE prescribed form (WAIR).

All near misses shall be recorded and reported. A system for notification and reporting of work
accidents including near misses within the company shall be developed and reviewed by the
OSH Committee as necessary.

(Kindly submit reports on the following: Work Accident /Injury Report (WAIR), Annual
Exposure Data Report (AEDR), Annual Medical Report (AMR)
Report Submitted Date

10.0 Provision and use of PPE

Issuance of PPE shall be supplemented by training on the application, use, handling, cleaning
and maintenance.

PPE provided Number of Workers given

Safety Shoes 12
Harness 12
Hard Hat 12
Safety Vest 12
Safety Goggles 12
Safety Gloves 12

11.0 Safety Signage

The safety signages include warning to workers and employees and the public about the
hazards within the workplace.

Type of Safety Signage: Kindly attach picture.

Page | 8
12.0*Dust control and management and regulation on activities such as building of
temporary structures and lifting and operation of electrical, mechanical,
communications system and other requirements *(Applicable for medium to high risk
establishments with 10 to 50 workers and low to high risk establishments with 51 workers and
above)

Kindly attach dust control procedures, plans on temporary structures, permits app;icable
for the operation of electrical, mechanical, communications systems and other
requirements

13.0 Workers Facilities Provided:

FACILITIES PROVIDED? REMARKS

YES NO
a. Adequate supply of drinking water
b. Adequate sanitary and washing
facilities
c. Suitable living accommodation (if
applicable)
d. Separate sanitary, washing and
sleeping facilities (if applicable)
e. Lactation station (in consonance
with DOLE D.O. 143-15)
f. Ramps, railings, and the like
g. Other workers’ welfare facilities as
prescribed by OSHS and other
related issuances

14.0 Emergency and Disaster Preparedness:

14.1 Written Emergency and Disaster Program Yes____ No_____

14.2 Types and number of Drills conducted

Type of Drills (fire, Date Responsible
earthquake) person/position
Nov. 5, 2025

15.0 Solid Waste Management System

Written Pollution Control Program: Yes:____ No: _____

Name of Pollution Control Officer:__________________________

16.0Compliance with Reportorial Government Requirements (refer to item 9.0)

17.0 Control and management of hazards.

Refer to accomplished HIRAC

Page | 9
18.0 *Prohibited Acts and Penalties/sanctions for violations on OSH
*(Applicable for medium to high risk establishments with 10 to 50 workers and low to high
risk establishments with 51 workers and above)

(Pls attach existing company sanctions for violations on OSH)

(Example of Company violation policies)

Safety Violation 1st offense 2nd offense 3rd offense
1. Not using issued PPE warning 3 day suspension 5 day
suspension
2. littering and loitering warning 3 day suspension 5 day
suspension
3. smoking at prohibited area warning 3 day suspension 5 day
suspension
4. illegal dismantling of safety warning 3 day suspension 5 day
signages and paraphernalia suspension
5. Not following safety rules 3 day 5 day suspension Dismissal
suspension

19.0 * Cost of implementing company OSH program

*(Applicable for medium to high risk establishments with 10 to 50 workers and low to high
risk establishments with 51 workers and above)

Php 86,000.00 ; Annual estimated amount for OSH program implementation to include but not
limited to the following: orientation/training of workers, safety officer, OH personnel, purchase
and maintenance of PPE, first aid medicine and other medical supplies, safety signages and
devices, fire safety equipment/tools, safety of equipment ( i.e machine guards,) etc.

OSH Item Estimated Cost/year

PPEs Php30,000.00

OSH trainings Php10,000.00

Safety Signages Php6,000.00

Machine Guards and related Php10,000.00

equipment

Medical examinations Php15,000.00

Medical supplies/medicines Php10,000.00

Others: Specify Php5,000.00

Page | 10
ANNEX A:

WORKPLACE POLICY AND PROGRAM ON PROMOTING WORKERS HEALTH AND

ENSURING PREVENTION AND CONTROL OF HEALTH-RELATED ISSUES AND
ILLNESS

___(COMPANY)____ company is committed to promote and ensure a healthy and

safe working environment through its various health programs for its employees. We shall
conform to the all issuances and laws that guarantee workers health and safety at all times.

The company shall ensure that worker’s health is maintained through the following
company programs and activities:
a) Orientation and education of employees
b) Access to reliable information on illness and hazards at work
c) Referral to medical experts for diagnosis and management of illness or health-
related concerns
d) Provide health-related programs such proper nutrition and exercise activities are
made available to the workers

The above-mentioned programs shall comply with the Government’s issuances on

promoting healthy lifestyle, addressing mental health in the workplace and preventing
and controlling substance abuse.

In addition, company policies to protect workers’ rights arising from illness shall be guaranteed.
The company shall promote the following workers’ rights:
a) Confidentiality of information
b) Non-discrimination including non-termination
c) Work accommodation following a course of illness
d) Assistance to compensation

This policy is formulated for everybody’s information. The company is committed to

ensuring workers’ health and providing a healthy and safe workplace.
_

Owner /Manager Employees’ Representative

DATE: ______________

Page | 11