Name: ______________________________ Date: ___________________

Position: ____________________________ Signature: ______________

ANTI OFFICE BULLYING

1. Did any of your employee experience office bullying? Yes or No?

2. Who is the in-charge officer for this kind of situations? For internal
employee and external employee?

3. How the company handle the situation?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________
ANTI SMOKING
1. Do you have a designated smoking area?

2. Have you experience having an employee violate the rules for smoking?

3. How the company handle the situation?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

OUTSIDE EMPLOYMENT
1. Are you allowing the outside employment?

2. Is there an instance that you had caught an employee for having extra job
or being in another company?

3. Is there a certain sanction or corrective action for it?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

DATA PRIVACY POLICY

1. Is there an instance that you’ve caught an employee for fraud a confidential
files or data of your company?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

LEAVE FOR VICTIMS OF VIOLENCE AGAINST FOR WOMEN AND THEIR

CHILDREN
1. Have you ever experienced having a female employee that is a victim of
violence?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

EDUCATIONAL ASSISTANCE
1. Is there a company program for educational assistance?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

FINANCIAL ASSISTANCE
1. Do you provide financial assistance such as advance payment and etc. to
be able help employee in their financial stability or in an emergency
cases/situation?

2. How much the minimum and maximum amount can company provide?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________
NIGHT SHIFT DIFFERENTIAL
1. Do you have employee working on a night shift?

2. Is night differential included?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

ANTI AGE DISCRIMINATION

1. Is there an age limitation or qualification in applying to your company?
Why?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

PERFORMANCE MANAGEMENT SYSTEM REWARDS

1. Do you give rewards or recognition to your employee?

2. Where do you base your rewards and recognition?

3. What type of rewards or recognition does your company give? Money,

certificate, etc.??
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

EMPLOYEE REFFERAL POLICY

1. Have you ever had the idea of having an employee referral into your
company to make the recruitment process faster?

2. How much would be the referral fee if there’s any?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

FIRST AID TREATMENT

1. Is there an incident or case of this company having an emergency
situation?

2. Is there an emergency kit or tool available when the incident occurs?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

EMERGENCY MEDICAL AND DENTAL SERVICES

1. If accident or emergency happens with in the company vicinity how
does your company handle this?

2. Does the company cover the expenses for hospitalization or dental

services?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

FITNESS PROGRAM
1. Do you conduct fitness or wellness programs?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

TEAM BUILDING
1. Do you conduct team building?

2. Who are included in your team building? Does external employee

include?

3. When do you conduct team building and how often?

4. Does the company cover the team building expenses or does your
employee pay for it?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

FIRE SAFETY POLICY

1. Is there a fire extinguisher available?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

SAFETY SEMINARS
1. Have you tried conducting seminar for safety like earthquake or fire
drill?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

PERFORMANCE COACHING AND MENTORING

1. How do you train your newly hired employee for them to be more
effective on their field of work?

2. For those newly promoted employees of your company, what are

trainings that they had just to do good in their new position?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

OPEN DOOR POLICY

1. Do you practice open door policy?

2. Does freedom of information apply to your company to build good

relationship between the company and its employee?

3. Can applicant choose what company/client they want to work?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

INTERNSHIP POLICY
1. Is there a program for your internship?

2. Is there a required course?

3. Is there an allowance given for OJTs or internships?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

TEMPORARY TRANSFER AND/OR RE-ASSIGNMENT OF WORK OF

POSITION
1. Does temporary transfer or reassign of work position possible in your
company? Did it happen before?
Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

ANTI NEPOTISM POLICY

1. Does nepotism apply to your company?

2. Are preferred of having nepotism or not?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________

ANTI BRIBERY AND CORRUPTION POLICY

1. Do you have experience being bribed or corrupted inside of the
company?

2. How the company handle the situation?

3. Is there a certain sanction or corrective action for it?

Name: ______________________________ Date: ___________________
Position: ____________________________ Signature: ______________