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Republic of The Philippines Department of Public Works and Highways Office of The Secretary Manila

This document contains a roadworks safety assessment report for a project in the Philippines. It provides key details about the project such as its location, funding source, implementing office, contractor, and project progress to date. Safety documents that must be submitted with the report are also listed, including the traffic management plan, contractor's traffic operations program, and material test results for traffic control devices.

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Elias de Guzman
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56 views

Republic of The Philippines Department of Public Works and Highways Office of The Secretary Manila

This document contains a roadworks safety assessment report for a project in the Philippines. It provides key details about the project such as its location, funding source, implementing office, contractor, and project progress to date. Safety documents that must be submitted with the report are also listed, including the traffic management plan, contractor's traffic operations program, and material test results for traffic control devices.

Uploaded by

Elias de Guzman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS


OFFICE OF THE SECRETARY
MANILA

ROADWORKS SAFETY ASSESSMENT REPORT NO.


Date of Assessment:

Name of Project:

Location
Station Limits (if applicable)
Length, m (if applicable)
Width, m (if applicable)
Contractor
ABC
Original Contract Awarded Amount
Variance (+/-) ( - ) (-)
Revised Contract Amount N/A
Source of Fund Local (CI) Local (Regular) Local (Other agencies) Local (COE)
Funding Year
Implementing Office MM3DEO - NCR - DPWH
Head Office (Name & Designation) CASIANO P. DE GUZMAN - District Engineer
DPWH Project Engineer ELIAS G. DE GUZMAN, JR. - Project Engineer
Designation (PE 1, PE 2, PE 3) PE 1 Accreditation No. 3782
DPWH Project Inspector
Designation (PI 1, PI 2) Accreditation No.
DPWH Materials Engineer
Designation (ME 1, ME 2) Accreditation No.
Contractor's Materials Engineer
Designation (ME 1, ME 2) Accreditation No.
Date Started
Contract Duration Original Revised
Completion Date Original Revised
Scheduled % Actual % Slippage %
Project Accomplishment

Project ID

Please furnish the RSAT with a copy of the following documents:

1. Approved Roadworks Safety and 6. Latest Statement of Work


Traffic Management Plans Accomplished
7. Contractor's Traffic Operational
2. Site Instruction files
Program

3. Contract Documents 8. TMP Page 1 of 2


9. Material Test Results (for road signs,
4. Program of Work & Detailed
temporary marking other traffic control
Page 1 of 2
9. Material Test Results (for road signs,
4. Program of Work & Detailed
temporary marking other traffic control
Estimates
devices)
5. Project Inspection Report 10. Approved CSHP
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE SECRETARY
MANILA

DETAILED ACCOMPLISHMENT TO DATE


Items of Work Latest
Assessed
Approved Unit Unit Cost
(Item No. and Description) Item
Quantity

Accomplished by:

Name, Designation and Signature of


DPWH Personnel (PE/PI/ME)
WAYS

Actual Accomplishment %
Amount Percent %
To date
Weight

Page 2 of 2

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