Big Brother Monitoring Form

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Department of Labor and Employment

Bureau of Working Conditions


REGIONAL OFFICE NO. ___


KAPATIRAN WISE-TAV Program
Monitoring Form - 1
(BIG BROTHER)

Date





Name of Establishment :
Address :

Focal Person:
Designation :
Contact Numbers (Mobile & Landline) :
Nature of Business :
Number of Small Brothers :
Please attach List of Small Brothers
Number of Training Courses/Workshops Conducted:
Number of Participants per Course :
Number of Participating Small Brothers :
Please attach List of Training Courses conducted with corresponding number of participants.
Indicative Plan of Activities :
Please enumerate future activities relative to the Program (example, planned assistance visits) schedules
and target Small Brothers /Participants
Compliance Rates of Small Brothers with OSH Standards :

OSH Indicators
Compliance Rate
SB1 SB2 SB3 SB4
Registration of Establishment

Safety Officer

Health Personnel

DOLE Administrative Reports

- Work Accidents/Injuries report

- Annual Medical Report

- Minutes of Safety and Health Committee
Meetings



Number of Small Brothers who have become
Big Brothers this Quarter : ____________
Please attach list of Small Brothers.

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