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    Peza - SMR Format

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    joncdeleon
    The summary provides an overview of the company's personnel, accommodation, and workplace area conditions and preventative measures taken. It addresses the health of employees, accommodation cleanliness and social distancing, and disinfection of the workplace and use of protective equipment. The company representative signs that the information is true and correct, and that they are compliant with government COVID-19 prevention rules.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Peza - SMR Format

    Uploaded by

    joncdeleon
    19 views1 page
    The summary provides an overview of the company's personnel, accommodation, and workplace area conditions and preventative measures taken. It addresses the health of employees, accommodation cleanliness and social distancing, and disinfection of the workplace and use of protective equipment. The company representative signs that the information is true and correct, and that they are compliant with government COVID-19 prevention rules.

    Original Description:

    PEZA LOCATOR SMR FORMAT

    Original Title

    PEZA - SMR FORMAT

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    The summary provides an overview of the company's personnel, accommodation, and workplace area conditions and preventative measures taken. It addresses the health of employees, accommodation cleanliness and social distancing, and disinfection of the workplace and use of protective equipment. The company representative signs that the information is true and correct, and that they are compliant with government COVID-19 prevention rules.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views1 page

    Peza - SMR Format

    Uploaded by

    joncdeleon
    The summary provides an overview of the company's personnel, accommodation, and workplace area conditions and preventative measures taken. It addresses the health of employees, accommodation cleanliness and social distancing, and disinfection of the workplace and use of protective equipment. The company representative signs that the information is true and correct, and that they are compliant with government COVID-19 prevention rules.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    PHILIPPINE ECONOMIC ZONE AUTHORITY

    CAVITE ECONOMIC ZONE

    LOCATOR’S SELF MONITORING REPORT (SMR) FOR COVID19 PREVENTIVE MEASURES


    Company Name: _________________________ Date: ________________________
    E-mail Address: _________________________ Contact Number: ________________________
    Total No. of Employees: Male: _____ Female: _____ No. of Employees ________________________
    (Normal Operation prior to COVID19) “Work from Home”
    (WFH):
    Total No. of Employees: (Skeletal) Male: _____ Female: _____

     PERSONNEL

     All employees are in good condition (without any COVID-19 symptoms: fever or cough or colds or and/or diarrhea)
    With suspected COVID19 symptoms (Number):  Colds (____)  Cough (____) Fever (____) Diarrhea (____)
    - With [ Contact exposure (when?) : _________________ Travel History (When?): _________________ ]
    - Measure:  Sent back at home  Brought to Hospital (Physician’s Diagnosis: ___________________________)
    - Indicate Employee’s: Name: ____________________________ Age:_______ Address:________________________
     ACCOMMODATION Where?:  Outside (Type & Location): ____________________ Inside Company Premises
     All areas for accommodation are in good condition  Equipped with Hand Disinfectants (Specify):___________
     Provided with basic sleeping Paraphernalia (Pillows Blankets  Foam/Beddings)
     Meets the Social Distancing Requirement (At least 1m distance per Personnel)  Equipped with Thermal Scanner
    Number of employees housed at accommodation: _______ *Will exceed Capacity:  YES  NO
    - *If YES, how did you accommodate excess employee?: __________________________________________________
     Meets Sanitation requirements: ( Adequate Sanitary Facilities (CRs, lavatories)  With adequate dining area
    - Disinfected the Accommodation Area:
     YES (Frequency/day: (Once Twice  Thrice  Others (Specify) _________)
     NO (We will conduct area disinfection on: _______________)
     WORKPLACE AREA:

     Meets the Social Distancing Requirement (At least 1m distance per Personnel)  Equipped with thermal scanner

     Equipped with Human disinfectants [Specify kind (e.g. alcohol, Hand sanitizer, etc.)]: _____________________

    - All employees are equipped with:  Masks Gloves  Goggles  Others (Specify): __________________________

    - Disinfected the Workplace Area:

     YES (Frequency/day: (Once Twice  Thrice  Others (Specify) _________)


     NO (We will conduct area disinfection on: _______________)

     Kind of Disinfectants (Specify): _____________________________

    We hereby certify that the above information are true and correct. We further certify that we are implementing all
    necessary measures for the prevention of spread of COVID19 compliant with government rules.

    Company Representative/Informant’s Name Attested by:

    ______________________________________________ ____________________________________________
    Printed Name over Signature Company Head/President/General Manager

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