CHECKLIST FOR EVALUATION OF CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)

per requirements of DOLE Department Order No. 13 Series of 1998

"Guidelines Governing Occupational Safety and Health in the Construction Industry"
NAME OF THE COMPANY/MAIN GENERAL CONTRACTOR:
HALREY CONSTRUCTION INC.
NAME OF THE PROJECT:
17BE0043 – WIDENING OF PERMANENT BRIDGES INCLUDING ROW – MORE THAN 2 LANES
CANSAN BR. 1 (BO1135LZ) ALONG DAANG MAHARLIKA (LZ) WIDENING OF BRIDGE, CABAGAN, ISABELA.
PROJECT LOCATION/ADDRESS:
CABAGAN, ISABELA
Put a on the appropriate column and N/A for those not applicable to the project. Yes No Remarks
Fill out the remarks column for your notation/s.
A. General Requirements
a. Two (2) copies of letter of intent.
b. Name of authorized contact person with telephone number/s.
c. Two (2) copies of the Safety and Health Program. One copy must
be original print.
B. CSHProgram must contain the following:
1. Name of person who prepared the program.
(Please indicate if accredited DOLE - OSH Practitioner
2. Project Description:
a. Specific name of project
b. Location of the project
c. Project classification (Gen. Building/Gen. Engineering/Specialty Trade)
d. Project owner
e. Name of main contractor
f. Estimated number of workers to be deployed including those of subcontractors
g. Estimated start of execution of project
h. Estimated duration
i. Scope of work to be undertaken
3. Company Safety Policy written on a company letterhead
Must be duly signed by the highest company official or the highest-ranking
company representative who has over-all control over project execution
4. Composition of Safety and Health Committee (Per project)
Must specify the proposed structure and membership of the safety and
health committee (Specify the names)
5. Name/s of Site Safety and Health Personnel (depending in the number
of workers to be deployed on the construction site)
6. Specific duties and responsibilities of the Safety Officer
Must specify the duties and responsibilities of the Safety Officer
Specific Provisions on the following (if applicable):
7. On-site safety and health promotion and continuing information dissemination

8. Accident and incident investigation and reporting

9. Protection of the general public within the vicinity of the construction site
10. Safety Signages
11. Environmental Control
12. Guarding of hazardous machinery
13. Personal Protective Equipment
14. Handling of Hazardous substances
15. General materials handling and storage procedures
16. Workers' skills and certification (for critical occupations)
17. Provision of transportation facilities for workers in case of emergency
18. Temporary Fire Protection Facilities and equipment
19. First aid and health care medicines, equipment and facilities
20. Workers Welfare Facilities
21. Proposed Hours of Work and Rest Breaks
22. Construction Waste Disposal
23. Testing and inspection of construction heavy equipment
(for construction heavy equipment utilized in the project per
requirements of Sec. 10, D.O. No. 13)
24. Disaster and Emergency Preparedness contingency plan
Put a on the appropriate column and N/A for those not applicable to the project. Yes No Remarks
Fill out the remarks column for your notation/s.
25. Standard Operating Procedure and Job Hazard Analysis for the
following activities and other hazardous work not outlined herein
a. Site Clearing
b. Excavations
c. Erection and dismantling of scaffolds and other temporary
working platforms
d. Temporary electrical connections/installations
e. Use of scaffolds and other temporary working platforms
f. Working at unprotected elevated working platforms or surfaces
g. Use of power tools and equipment
h. Gas and electric welding and cutting operations
i. Working in confined spaces
j. Use of internal combustion engines
k. Handling hazardous and/or toxic chemical substances
l. Use of hand tools
m. Use of mechanized lifting appliances for movement of materials
n. Use of construction heavy equipment
o. Demolition
p. Installation, use and dismantling of hoists and elevators
26. Penalties/Sanctions for violation of the provision/s of the CSHP
C. ATTACHMENTS
1. Photocopy of Registration Forms received and approved by the
concerned DOLE Regional Office:
- per Rule 1020 of the OSHS (one time Registration)
2. Photocopy of valid registration/license with DTI-PCAB
3. Photocopy of Notice of Award/Notice to Proceed
4. Photocopy of Certificate of Completion on required Training of all
designated OSH Personnel
- Safety Officer - Basic Occupational Safety and Health Training (BOSH)
for Construction Site Safety Officer/Construction Safety Training (CST)
Construction Occupational safety and Health (COSH) Training
- First Aider - Standard First Aid Training and valid ID
- OH Nurse - Basic Occupational Safety and Health Training for
Occupational Health Nurse (if applicable)
- OH Dentist - Basic Course on Occupational Dental Health. (if applicable)
- OH Physician - Basic Course on Occupational Medicine. (if applicable)
5. Certificate of Inspection and Testing of Construction Heavy Equipment
(CHE) conducted by a DOLE-Accredited Testing Organization (if any)
6. Skills Certificate of Construction Heavy Equipment Operators
issued by TESDA (if any)
7. Contract with nearby hospital/clinic in lieu of the required infirmary
hospital (if any)
PRE-EVALUATION SHEET
(To be filled-up by the dpwh - Frontliner/Pre-evaluator)
Received CSHP Application with complete documentary requirements
Returned CSHP Application and documents submitted specifying the reasons for returning the same
Incomplete documentary requirements, namely:

Invalid documents, namely:

Others (project almost completed/completed/bidding purposes, etc.

Briefly explain to client the reason/s for returning/not accepting the CSHP Application

COMMENTS/REMARKS:

Evaluated by: Reviewed by:

TERESA B. TELAN DEOFERIO P. VEHEMENTE, JR.
Engineer II Chief, Construction Section

Recommended for Approval and Endorsement to DOLE-RO No. 02:

EVELYN C. COSTALES, Ph.D.

District Engineer
Date: