Scribd
Upload
191 views6 pages

CSHP Application Form for Residential Projects

This document is an application for a Construction Safety and Health Program for a residential or minor construction project. It provides details of the project such as the name, address, duration, cost, number of workers. It also lists the contractor and project owner's contact information. The applicant commits to comply with occupational safety and health standards and guidelines, and to implement a Construction Safety and Health Program for the project. They also acknowledge their responsibility to provide appropriate safety equipment and training to workers.

Uploaded by

Leah Anne Pee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
191 views6 pages

CSHP Application Form for Residential Projects

This document is an application for a Construction Safety and Health Program for a residential or minor construction project. It provides details of the project such as the name, address, duration, cost, number of workers. It also lists the contractor and project owner's contact information. The applicant commits to comply with occupational safety and health standards and guidelines, and to implement a Construction Safety and Health Program for the project. They also acknowledge their responsibility to provide appropriate safety equipment and training to workers.

Uploaded by

Leah Anne Pee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Form Reference No: PM-NCR-03.

09-F-03
Regional Office: DOLE-NCR
Application No: ________

Application for
CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)
(Intended only for residential project/s (2 storey and below) or minor repair works with less than 10 workers.)
Project Name: ______________________________________________________________________
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 __________________________________ and


_________________________________
(Name of Contractor’s Authorized Official and/or Project Owner)
do hereby commit and bind ourself 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

(NOTE: NO FEES REQUIRED FOR APPLICATION, PROCESSING AND APPROVAL OF CSHP)

Form Reference No: PM-NCR-03.09-F-03 Application for CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP) (Intended only for residen
Project Name: ______________________________________________________________________ Project Complete Address/Location: _____
____________________________________________________________ Fax No.:_______________________ PCAB License No.______________ D
of OWNER / CONTRACTOR **********************************************************************
do hereby commit and bind ourself to comply with the applicable provisions of the Occupational Safety and Health S
_____________________________________ ___________________________________ PROJECT OWNER

You might also like