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DOLE Construction Safety Program Application

This document is an application for a Construction Safety and Health Program for a residential construction project with less than 10 workers that will last a number of calendar days. It provides details about the project such as its name, address, estimated cost, number of workers, contractor information, and commitment by the contractor and project owner to comply with occupational safety and health standards by implementing a Construction Safety and Health Program and providing appropriate safety equipment and training for workers.

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948 views1 page

DOLE Construction Safety Program Application

This document is an application for a Construction Safety and Health Program for a residential construction project with less than 10 workers that will last a number of calendar days. It provides details about the project such as its name, address, estimated cost, number of workers, contractor information, and commitment by the contractor and project owner to comply with occupational safety and health standards by implementing a Construction Safety and Health Program and providing appropriate safety equipment and training for workers.

Uploaded by

buletzz
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • CSHP Application Form

Regional Office: DOLEO-RO8

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: ____________________

Submitted by: ____________________________________ ________________________________


Signature over Printed Name Position

**********************************************************************

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.

_____________________________________ ___________________________________
Name of Project Owner Name of Contractor
Signature Over Printed Name Signature Over Printed Name
(NOTE: NO FEES REQUIRED FOR APPLICATION, PROCESSING AND APPROVAL OF CSHP)

Application for CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP) (Intended only for residential project/s (2 store

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