DPWHROXIII QAHD | DIGITAL MANAGEMENT SYSTEM

(Fill up online DPWH Application form; N/A if not applicable)

Contract ID No.:

Project Name:

Location:

A. Company Profile/License/Registration of Main/General Contractor :

Complete Name of the Company/Main/General Contractor/Project Owner:

Complete Address of the Company:

Tel. NO.:

Fax NO.:

Name of Project Manager/Owner/Contact Person:

Tel. NO.:

Mobile. NO.:

Email:

Contractor’s PCAB/JV License No:

Date of Validity:

Number of Workers:

Male:

Female:

Total Employment:

Engaged Subcontractors’ Profile:

Name of Sub-contractors
(if any):

Scope of Work and Project Cost:

No. of Workers:

PCAB License:

Date of Validity:

Date of DOLE Registration:

B. Project Profile/Description :

Name of the Project: (Please attach copy of Notice of Award or Notice to Proceed or other documents indicating name and details of the project)

Complete Project Address/Location:

Project Classification:

Total Project Cost:

Date of Estimated Start/Execution of the project:

Duration of the project (Pls. state the number of calendar days)

Estimated number of workers to be deployed:

Phase/Stage:

Construction Activity

Estimated No. of Workers:

Brief Description of Activities/Work Flow:

OSH Personnel assigned to the project:

Designated Safety Officers:

Name:

Designation:

Date of Training:

Designated First Aider:

Name:

Date of Training:

ID Validity:

Other OH personnel: (if more than 50 workers will be deployed in the project)

OH Nurse

Name:

Date of BOSH Training:

OH Physician

Dentist

If Heavy Equipment will be used in the Project:

List of heavy equipment to be used in the Project:

Name of Heavy Equipment Operator/s:

Profile of the person who prepared the CSHP:

Name:

eSignature: (if applicable)

Educational Background:

Work Experience in OSH:

Other Qualifications:

Submitted By:

Name:

Position:

eSignature: (if applicable)

(Fill up CSHP online form; N/A if not applicable)

1.0 Statement of Commitment to Comply with OSH Requirements:

Project Owner:

Name of Project Manager/Owner/Contact Person:

3.0 Project Details:

i. Specific name of project and name of owner:

ii. Project Owner:

ii. Location of the project:

iii. Classification of the project

General Building Construction

General Engineering Construction

Specialty Trade Construction

Others(Please Specify):

iv. Name of the general constructor:

v. Name of project manager/contact number/email:

vi. Name of resident engineer, if any

vii. Name and Classification of Constructors :

Name of contractor/subcontractor

Classification

ix. Number of workers

1st shift:

Male:

Female:

2nd shift:

3rd shift:

x. Work hours, including shift

1st shift:

From:

To:

2nd shift:

3rd shift:

xi. Estimated number of heavy equipment:

Backhoe:

Dozer:

Loader:

Dump truck:

Crane:

Grader:

Others(Please Specify):

xii. Projected dates of commencement and completion

Start Date:

End Date:

Days to Complete:

xiii. Name and address of emergency health provider

xiv. Total project cost

xvi. Itemized cost on OSH

4.1 Composition of Construction Safety and Health Committee (CSHC)

a. Project Manager or his representative as the chairperson

b. General Construction Safety and Health Officer/s

Safety Officer:

c. Construction Safety and Health Officer/s from Subcontractors

Safety Officer

Company

d. Occupational Health Personnel

First Aider:

Company:

First Aider:

Company:

First Aider:

Company:

AHAS

Dentist:

Company:

Dentist:

Company:

Dentist:

Company:

Nurse:

Company:

Nurse:

Company:

Nurse:

Company:

Physician:

Company:

Physician:

Company:

Physician:

Company:

e. Workers’ representative

Name

Designation

Company

4.2 Duties of the CSH Committee

Specific Day of Safety Meeting Every Month:

ONLINE APPLICATION OF COMPREHENSIVE CSHP

(Fill up online DPWH Application form; N/A if not applicable)

A. Company Profile/License/Registration of Main/General Contractor :

Engaged Subcontractors’ Profile:

B. Project Profile/Description :

Estimated number of workers to be deployed:

OSH Personnel assigned to the project:

Other OH personnel: (if more than 50 workers will be deployed in the project)

If Heavy Equipment will be used in the Project:

Profile of the person who prepared the CSHP:

Submitted By:

(Fill up CSHP online form; N/A if not applicable)

1.0 Statement of Commitment to Comply with OSH Requirements:

3.0 Project Details:

4.1 Composition of Construction Safety and Health Committee (CSHC)

4.2 Duties of the CSH Committee

Upload or drag Letter of Intent files here

Upload or drag Registration under OSHS Rule 1020 files here

Upload or drag Valid PCAB License files here

Upload or drag Project Contract files here

Upload or drag Valid Certificate of Inspection files here

Upload or drag Certificate of Completion files here

Upload or drag Valid NC files here