BASIC OCCUPATIONAL SAFETY AND HEALTH (BOSH) FOR SAFETY OFFICER 2

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RESPONSES TO OSH ISSUES AND CONCERNS –

4 OSH PROGRAM DEVELOPMENT

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OSH PROGRAM COMPONENTS – DO 198-18 SECTION 12

1.0 Company Commitment to Comply with OSH Requirements
2.0 General Safety and Health Programs
• Safety and Health Hazard Identification, Risk Assessment and Control (HIRAC)
• Medical Surveillance for early detection and management of occupational and work-related
diseases
• First aid and emergency medical services
3.0 Promotion of Drug Free Workplace, Mental Health Services in the Workplace, Healthy lifestyle
4.0 Prevention and Control of Human Immunodeficiency Virus and Acquired immune Deficiency
Syndrome (HIV-AIDS), Tuberculosis, Hepatitis B
5.0 Complete Company or Project Details
6.0 Composition and Duties of the Occupational Safety and Health (OSH) Committee
7.0 OSH Personnel and Facilities
8.0 Safety and Health Promotion, Training and Education
• Orientation of all workers on OSH
• Conduct of Risk Assessment, Evaluation and Control
• *Continuous training on OSH of OSH Personnel
• *Work Permit System
9.0 Conduct of Toolbox or Safety Meetings and Job Safety Analysis
10.0 Accident/Incident/Illness Investigation, Recording and Reporting
11.0 Provision and Use of Personal Protective Equipment (PPE)
12.0 Provision of Safety Signage
13.0 *Dust control and management and regulations on activities such as building of temporary
structures and lifting and operation of electrical, mechanical, communications system and other
equipment
14.0 Provision of Workers’ Welfare Facilities
15.0 Emergency and Disaster Preparedness and Response Plan to include the organization and
creation of disaster control groups, business continuity plan, and updating the hazard, risk and
vulnerability assessment, as required
16.0 Solid Waste Management System
17.0 Control and Management of Hazards (refer to Item 2.0 - HIRAC)
18.0 *Prohibited Acts and Penalties for Violations
19.0 *Cost of Implementing Company OSH program
*Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above.

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1.0 COMPANY COMMITMENT TO COMPLY WITH OSH REQUIREMENTS

COMMITMENT TO OCCUPATIONAL SAFETY AND HEALTH (OSH)

________________________________________________ (Name of the Company) do

hereby commit to comply with the requirements of Republic Act No. 11058 and DOLE Department
Order No. 198-18 (its Implementing Rules and Regulations) and the applicable provisions of the
Occupational Safety and Health Standards (OSHS).

We acknowledge the company’s obligation and responsibilities to provide appropriate funds

for implementing this OSH program including orientation and training of its employees on OSH,
provision and dissemination of IEC materials on safety and health, provision of Personal Protective
Equipment (PPE) when necessary and other OSH related requirements and activities, to ensure the
protection for our workers and employees against injuries, illnesses and death through safe and
healthy working conditions and environment.

We commit to conduct risk assessment as required to prevent workplace accidents as well as

comply with other provisions of this OSH program. That we are also fully aware of the penalties and
sanctions for OSH violations as provided for in RA 11058 and its Implementing Rules and Regulations.

_________________________________________
Name and Signature of Company Owner/President

____________________
Date Signed

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2.0 GENERAL SAFETY AND HEALTH PROGRAMS

2.1 Hazard Identification, Risk Assessment and Control (HIRAC)

Kindly accomplish. Please use additional pages if needed. You may also wish to attach your
Company’s Risk Assessment Matrix as substitute.

Risk Assessment Matrix

Priority: likelihood of injury
Hazard Control
Task Risk Description and illness to occur (low,
Identified Measures
medium, high)

Example of Simple Risk Assessment

Task Hazard Risk Priority Control

May be unable to call for
Drivers work alone high Need for helper
help if needed
Drivers have to
Fatigue, short rest time Policy on work
occasionally work medium
between shifts break
long hours
Delivering
product to Drivers are often in Increased chance of Road safety
low
customers very congested collision program
traffic Longer working hours medium Work breaks
Drivers have to lift Given proper
Injury to back from lifting,
boxes when high orientation on
reaching, carrying, etc.
delivering product lifting

2.2 Medical Surveillance

The company will require all employees to undergo a baseline or initial medical health
examination prior to assigning to a potentially hazardous activity. The examination will include
but not limited to the following:

a. Routine: ( ) CBC ( ) Chest X-ray ( ) Urinalysis ( ) stool exam

b. Special: ( ) Blood Chemistry ( ) ECG ( ) others, please specify
c. Schedule of Annual Medical Examination: ( ) Q1 ( ) Q2 ( ) Q3 ( ) Q4
d. Is random drug testing conducted? Yes _____ when _____ No _____

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2.3 First Aid and Emergency Medical Services

• How many treatment rooms/first aid rooms are existing in your company?
________________________________________________________________________
• How many clinics in the workplace?
________________________________________________________________________
• What hospital(s) are you affiliated with?
________________________________________________________________________

3.0 PROMOTION OF DRUG-FREE WORKPLACE, MENTAL HEALTH SERVICES IN THE

WORKPLACE, AND HEALTHY LIFESTYLE

Kindly accomplish the policy template in Annex A. (*you may attach individual policy statements)

3.1 Drug-free Workplace in compliance with Republic Act 9165 and Department Order 53-03

For further readings of this guideline, you can visit the link provided below:
http://bwc.dole.gov.ph/images/Issuances/DepartmentOrder/DO_53_03.pdf

3.2 Mental Health in compliance with Republic Act 11036 and Department Order 208-20

For further readings of this guideline, you can visit the link provided below:
https://www.dole.gov.ph/wp-content/uploads/2020/02/DO-208-20-Guidelines-for-the-
Implementation-of-Mental-Health-Workplace-Policies-and-Programs-for-the-Private-
Sector.pdf

3.3 Healthy Lifestyle

You may scan the QR code provided below to download the sample policy template:
https://www.ottawapublichealth.ca/en/professionals-and-
partners/resources/Documents/Workplace/sp_healthy_workplace_en.pdf

You may scan the QR code provided below to download the Drug-free Workplace and Mental
Health sample policy templates:

4.0 PREVENTION AND CONTROL OF HIV/AIDS, TUBERCULOSIS AND HEPATITIS B

Kindly accomplish the policy template in Annex A. (*you may attach individual policy statements)

4.1 Human Immunodeficiency Syndrome/Acquired Immune Deficiency Syndrome (HIV/AIDS) in

compliance to Republic Act 8504, Department Order 102-10 and Republic Act 11166

For further readings of this guideline, you can visit the links provided below:

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http://www.oshc.dole.gov.ph/images/Files/DO102-10_HIV-AIDS_Guidelines.pdf
http://bwc.dole.gov.ph/images/Issuances/DepartmentOrder/DO_102_10.pdf

4.2 Tuberculosis Policy in compliance to Executive Order 187-03 and Department Order 73-05

For further readings of this guideline, you can visit the link provided below:
http://bwc.dole.gov.ph/images/Issuances/DepartmentOrder/DO_73_05.pdf

4.3 Hepatitis B Policy in compliance to DOLE Advisory 05-10

For further readings of this guideline, you can visit the links provided below:
http://www.oshc.dole.gov.ph/images/Files/DOLE_Department_Advisory_No_%2005_S_201
0(1).pdf
http://bwc.dole.gov.ph/images/Issuances/DepartmentAdvisory/DOLE_Department_Advisor
y_No_05_S_2010.pdf

You may scan the QR code provided below to download the HIV/AIDS, Tuberculosis and Hepatitis
B sample policy templates:

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5.0 COMPLETE COMPANY OR PROJECT DETAILS

This shall be the first page of your OSH Program.

Occupational Safety and Health (OSH) Program of

(Company Name)

Complete Company Profile/ Project details

• Company Name: ________________________________________________________

• Date Established: ________________________________________________________
• Complete Address: ________________________________________________________
________________________________________________________
________________________________________________________

• Phone/Fax Numbers: ________________________________________________________

• Website: ________________________________________________________
• Email Address: ________________________________________________________

• Name of Company Owner/Manager/President:

________________________________________________________

• Total Number of Employees:

Male: _____________ Female: _____________ Total: ____________

• Description of the Business (please specify)

• Kindly check:
• Manufacturing: ________________________________________________________
• Service: ________________________________________________________
• Agri/fishing: ________________________________________________________
• Wholesale/retail: ______________________________________________________
• Utilities: ________________________________________________________
• Banks and Financial Institution: ___________________________________________
• Security Agency: _______________________________________________________
• Maintenance: ________________________________________________________
• Construction: ________________________________________________________
• Others (Please specify): _________________________________________________

• Product Descriptions (ex. garments, shoes, electronics):

___________________________________________________________________________
___________________________________________________________________________

• Description of Services:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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6.0 COMPOSITION AND DUTIES OF OSH COMMITTEE

The OSH Committee of the company is responsible to plan, develop and implement OSH policies and
programs, monitor and evaluate OSH programs and investigate all aspect of the work pertaining to
the safety and health of all the workers. HSC shall be composed of the following in compliance with
the law:

a. For establishments with less than ten workers and low risk establishments with ten (10) to
fifty (50) workers. – A Safety Officer 1 (SO1) shall establish an OSH committee composed of
the following:

Chairperson: ________________________________________________________
Name of Company Owner or Manager

Secretary: ________________________________________________________
Safety Officer of the workplace

Member: ________________________________________________________
Name of at least one (1) worker, preferably a union member, if
organized

b. For medium to high risk establishments with ten (10) to fifty (50) workers and low to high
risk establishments with fifty-one (51) workers and above. – The OSH Committee of the
covered workplace shall be composed of the following:

Ex-Officio Chairperson: ________________________________________________________

Name of Employer or his/her representative

Secretary: ________________________________________________________
Name of Safety Officer of the workplace

Ex-Officio Members: ________________________________________________________

Name of certified First-aiders

________________________________________________________
Name of Occupational Health (OH) Nurse

________________________________________________________
Name of OH Dentist, and OH Physician, as applicable

Members: ________________________________________________________
Name of Safety Officers representing the contractor or sub-
contractor, as the case may be

________________________________________________________
Name of workers’ representatives who shall come from the union, if
the workers are organized, or elected workers through a simple vote
of majority, if unorganized

c. Joint Coordinating Committee. For two (2) or more establishments housed under one building
or complex including malls.

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Chairperson: ________________________________________________________
Name of Building Owner or his/her representative such as the
Building Administrator

Secretary: ________________________________________________________
Name of Safety Officer appointed by the Chairperson

Members: ________________________________________________________
Name of two (2) Safety Officers from the building selected to the Joint
Health and Safety Committee

________________________________________________________
Name of two (2) workers’ representatives one from which must be
from a union if organized from any establishments under the building

(All members of the HSC shall perform their duties and responsibilities by the OSH law and its
implementing guidelines.)

Safety and Health Committee Minutes/Reports submitted to DOLE? Yes _____ No _____
(Please attach latest OSH committee minutes/report.)

7.0 OSH PERSONNEL AND FACILITIES

7.1 Safety Officer

Safety Officer(s), (attach certificate of training/s prescribed by DOLE). Please use additional
sheets as necessary.

Name of Safety Officer(s) Training(s) (kindly include number of hours)

7.2 Emergency Occupational Health Personnel and Facilities

List of competent emergency health personnel within the worksite duly complemented by
adequate medical supplies, equipment and facilities based on the total number of workers.
(Use additional sheet if necessary and attach all required training certificates in this section.)

Health Personnel & Facilities

Shift/Area/Unit/ Total number of Health Personnel (First- Facilities (Treatment
Department workers/area aider, Nurse, Physician, Room / Clinic /
Dentist) Hospital)

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8.0 SAFETY AND HEALTH PROMOTION, TRAINING AND EDUCATION

Please attach additional sheets as necessary.

8.1 Orientation of all workers on OSH

Name of OSH Training/Orientation Number of Employees in Attendance Date

8.2 Conduct of Risk Assessment, Evaluation and Control

Risk Assessment (may include Work Environment Measurement or WEM) Date

8.3 *Continuous training on OSH of OSH Personnel

Name of OSH Personnel Title of Advanced OSH Training Date

8.4 *Work Permit System

Example of Works with Permit Required

Hand and Power Tools Lockout/Tagout Permit Excavation Permit
Confined Space Machine Operation Demolition Works

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Hot Works Lifting Permit Crane Operation

Working at Heights Painting Works Heavy Equipment Operation
Scaffolding Permit Gondola Ladder Permit

*Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above.

9.0 CONDUCT OF TOOLBOX OR SAFETY MEETINGS AND JOB SAFETY ANALYSIS

Safety Meetings / Toolbox Meetings Topics Date

10.0 ACCIDENT/INCIDENT/ILLNESS INVESTIGATION, RECORDING AND REPORTING

Any dangerous occurrence, major accident resulting to death or permanent total disability, shall be
reported by the company to the DOLE Regional Office within twenty-four (24) hours from occurrence
using the prescribed form (Work Accident/Incident Notification).

After the conduct of investigation, the company shall prepare and submit work accident report using
the prescribed form (WAIR). Moreover, other work accidents resulting to disabling injuries such as
Permanent Partial Disability and Temporary Total Disability shall be reported to the DOLE Regional
Office within 30 days after the date of occurrence of accident using the DOLE prescribed form (WAIR).

All near misses shall be recorded and reported. A system for notification and reporting of work
accidents including near misses within the company shall be developed and reviewed by the OSH
Committee as necessary.

Kindly submit reports of the following:

• Work Accident/Injury Report (WAIR)

Form needed: DOLE/BWC/OHSD-IP-6, scan the QR code to download:

• Annual Exposure Data Report (AEDR)

Form needed: DOLE/BWC/OHSD/IP-6b, scan the QR code to download:

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• Annual Medical Report (AMR)

Form needed: DOLE/BWC/OHSD/OH-47A, scan the QR code to download:

• OSH Committee Report (RSO)

Form needed: DOLE/BWC/OHSD/IP-5, scan the QR code to download:

Report Submitted Date

11. PROVISION AND USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

Issuance of PPE shall be supplemented by training on the application, use, handling, cleaning and
maintenance.

PPE Provided Number of Workers Given

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12. PROVISION OF SAFETY SIGNAGE

The safety signage include warning to workers and employees and the public about the hazards within
the workplace.

Examples of Safety Signage:

13.0 DUST CONTROL AND MANAGEMENT

Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above.

Kindly attach dust control procedures, plans on temporary structures, permits applicable for the
operation of electrical, mechanical, communications systems and other requirements.

14.0 PROVISION OF WORKERS’ WELFARE FACILITIES

Workers’ facilities provided:

PROVIDED? REMARKS
FACILITIES
YES NO
a. Adequate supply of drinking water
b. Adequate sanitary and washing facilities
c. Suitable living accommodation (if applicable)
d. Separate sanitary, washing and sleeping
facilities (if applicable)
e. Lactation station (in consonance with DOLE DO
143-15)
f. Ramps, railings, and the like
g. Other workers’ welfare facilities as prescribed
by OSHS and other related issuances

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15.0 EMERGENCY AND DISASTER PREPAREDNESS AND RESPONSE PLAN

15.1 Written Emergency and Disaster Program? Yes _____ No _____

15.2 Types and Number of Drills Conducted

Type of Drills (fire, earthquake) Date Responsible Person/Position

16.0 SOLID WASTE MANAGEMENT

Written Pollution Control Program? Yes _____ No _____

Name of Pollution Control Officer (PCO): ______ ____________________________________

17.0 CONTROL AND MANAGEMENT OF HAZARDS (REFER TO ACCOMPLISHED HIRAC)

18.0 PROHIBITED ACTS AND PENALTIES FOR VIOLATIONS

Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above.

Please attach existing company sanctions for violations on OSH.

Example of Company Violation Policies

Safety Violation 1st offense 2nd offense 3rd offense

1. Not using issued PPE warning 3 days suspension 5 days suspension
2. Littering and loitering warning 3 days suspension 5 days suspension
3. Smoking at prohibited area warning 3 days suspension 5 days suspension
4. Illegal dismantling of safety signage
warning 3 days suspension 5 days suspension
and paraphernalia
3 days
5. Not following safety rules 5 days suspension Dismissal
suspension

19.0 COST OF IMPLEMENTING COMPANY OSH PROGRAM

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Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above.

Php __________; Annual estimated amount for OSH program implementation to include but not
limited to the following: orientation/training of workers, safety officer, OH personnel, purchase and
maintenance of PPE, first aid medicine and other medical supplies, safety signage and devices, fire
safety equipment/tools, safety of equipment ( i.e. machine guards,) etc.

OSH Item Estimated Cost/year

PPEs
OSH Trainings
Safety Signage
Machine Guards and Related Equipment
Medical Examinations
Medical Supplies/Medicines
Others: Please Specify

To download this OSH Program template, you may visit the link provided below or scan the QR code:
http://bwc.dole.gov.ph/safety-and-health

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ANNEX A:

WORKPLACE POLICY AND PROGRAM ON PROMOTING WORKERS HEALTH AND ENSURING

PREVENTION AND CONTROL OF HEALTH-RELATED ISSUES AND ILLNESS

_____________________________________ Company is committed to promote and ensure

a healthy and safe working environment through its various health programs for its employees. We
shall conform to the all issuances and laws that guarantee workers health and safety at all times.

The company shall ensure that worker’s health is maintained through the following company
programs and activities:

a) Orientation and education of employees.

b) Access to reliable information on illness and hazards at work.
c) Referral to medical experts for diagnosis and management of illness or health-related
concerns.
d) Provide health-related programs such proper nutrition and exercise activities are made
available to the workers.

The above-mentioned programs shall comply with the Government’s issuances on promoting
healthy lifestyle, addressing mental health in the workplace and preventing and controlling substance
abuse.

In addition, company policies to protect workers’ rights arising from illness shall be
guaranteed. The company shall promote the following workers’ rights:

a) Confidentiality of information
b) Non-discrimination including non-termination
c) Work accommodation following a course of illness
d) Assistance to compensation

This policy is formulated for everybody’s information. The company is committed to ensuring
workers’ health and providing a healthy and safe workplace.

__________________________ ___________________________
Owner/Manager Employees’ Representative

_________________
Date

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