Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

_________________ Field Office
Koronadal City, Philippines
______________________________________________________________________________
VERIFICATION INSPECTION REPORT
In support for Contractor/Subcontractor (DO-174-17) Application

Business Name
Business Address
Nature of Business Contact No. Fax No.
Name of Head of Office Contact Person Position
Date Application Received Date of Inspection

Facilities, Equipment, Tools and Work Premises Findings

Facilities, Equipment, Tools and Work Premises Photos (Please use another page if required)
Photo Title: Photo Title:

Recommendations

Prepared by: Noted:

___________________ _________________ ____________________ _________________

Name and Position Date Field Office Head Date

102 Acepal Building, Mabini Extension, Koronadal City 9506Phones/Telefax: (083)228-2190,(083)520-0125)

Email:dole12.ro@gmail.comWebsite: www.ro12.dole.gov.ph