GREAT WALL ENGINEERING # 249 P3 Cobangbang, Daet, Camarines Norte January 8, 2021 JOEL M. GONZALES Regional Director Department of Labor and Employment Regional Office No. V (Bicol Region) Dofia Aurora St., Old Albay, Legazpi City Sir Good day! We would ike to submit the Construction Safety and Health Program (CSHP) for the project, Completion of Evacuation Center at Bray. Pag-asa, Labo, Camarines Norte which was awarded to Great Walll Engineering. Project Classification/Category : Building Construction Estimated No. of Workers 28 Estimated Start and Duration of the Project January 15, 2021 / 60 calendar days Appointed Safety Officer :Dindo M. Solis Appointed First Aider :kim Gutierrez Project Owner/Address :Provincial Government of Cam. Norte In compliance with the Department Order No. 13 series of 1998 and Occupational Safety Health Standard (OSHS), amended. Please see attached documents listed below: Application Form Construction Safety Program of the Company DOLE Registration (Rule 1020) Photocopy of Certificate of Completion as Safety Officer and First Aider Certificate of Employment Breakdown of Safety and Health Budget DI Cerfificate / PCAB License For your evaluation and approval. Thank you. Respecttully, MMASWEL A- Proprietor E-mail address: greatwall 1205@gmail.com Contact nos. 0935-3114-211 ; 0921-4505-043 ; 099-418-4153‘CHECKLIST FOR EVALUATION OF CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP) _per requirements of D.O, No. 13 saries of 1998 ‘A. General Requirements Yas | No | — Remarks 8, Two @) copies of eter of intent. b, Name of authorized contact person with telephone number/s. ‘c._Two (2) coples ofthe Safety and Health Program. One copy must LC be original prin, B _CSHtProgram must contain the folowing: ‘Name of person who prepared the program. (please indeate if accreted by DOLE as OSH Practitioner) Project Description: 2, Specific name of project , Location of the profect . Project cassication 4. Project owner Name of man contractor {Estimated number of workers tobe deployed 9. Estimated start of execution of project Estimated duration I Scope of work to be undertaken 5. Company Safety Policy writen on a company Iatarhead CI Must be duy signed by the highest company offal or the highest: ‘ranking company representative who has over-all control of project execution, 4, Composition of Safety and Health Committee (Per project). Must spect the proposed structure and membership of the safety and ‘health committee (Spec the names) 5. Names of Site Safety and Health personnel (depending on the ‘number of workers tobe deployed onthe construction ste) 6. Specific duties and responsibilities of the Safety Officer [SPECIFIC PROVISIONS ON THE FOLLOWING (If applicable): 2. Ona fey nd heath protin an rtd L Information dlssemination '8, Accident and indent investigation and reporting 9. Protection ofthe general pube within the ity ofthe Veinty ofthe construction ste 10 Environmental Control 11, Guarding of hazardous machinery 12, Personal Protective Equipment B Handling of Hazardous substances 14. General materlals handing and storage procedures 15, Workers skis and certitcation (or etical occupation) I 16. Provisions for transportation facities for workers in case of T ‘emergency 17, Temporary Fre Protection Facies and equipment 18, Fist ald and heath care medlcnes, equipment and facies 19. Workers Welfare Facttes 20. Proposed Hous of Work and Rest BreaksYes | No | Remarks roe Testing and Inspection of construction heavy equipment (if zB ‘Construction waste dsposal congtruction heavy equipment wil be lized Inthe project per requirements of Sec. 10, 0.0. No. 13) }. Disaster and Emergency Preparedness contingency plan |. Standards Operating Procedure and Job Hazard Analysis for, the following activities and other hazardous work not outlined herein, 2, Ste Clearing b. Excavations Erection and dismanitng of scaffolds and other temporary wortng patforms 4. “Temporary electrical connecton/installations . Use of scaffolds and other temporary working platforms {Working at unprotected elevated worl platforms or surfaces 9. Use of power tools and equipment 1, Gas and electre welding and cutting operations | Working in confined spaces 44 Use of internal combustion engines Handling hazardous and/or toxic chemical substances 1k Use of hand tools "Use of mechanized Iftng apptances for movement of materials 1. Use of construction heavy equipment (©. Demin . Instalaton, use and dismanting of hoist and elevators 25, Penalties/Sanctions for violation ofthe provision/s of the SH Program TTT ATTACHMENTS 1 Photocopy of Registration Forms recelved and approved by the concerned DOLE Regional Office: * per DO 18-02 (require yeaty renewal) + per Rule 1020 ofthe OSHS (onetime Registration) Photocopy of Invation to Bi/Project Contract ‘Photocopy of Catiate of Completion on required Trlring of al designated OSH Personne! ~ Safety Omer - Basic Occupational Safety and Health Training for Construction Site Safety Officer ~ OH Nurse - Basie Occupational Safety and Heath Traning for (OH Nurse (any) - First Alder - Standard Fist Ald Training and vald PNR ID as Fist Alder “OH Physician - Basie Course on Occupational Medicine. (Wf any) ‘Ceticate of Inspection and Testing of Construction Heavy Equipment (CHE) conducted by 2 DOLE accredited inspection and test ‘organizaton. ‘organization acreited by DOLE; (if any) ‘Sklls Ceriicate of Construction Heavy Equipment operators Issued by TESOA (i ary) Contract with nearby hosptal/ancn le ofthe required infirmary hosptal. any)NO FEES REQUIRED FOR THE FILING, EVALUATION AND APPROVAL OF CSHP Revised Form.: CSHP-D013.98: Date of Revision: Junet, 2014 Page tof 3 REVISED APPLICATION FORM for Department of Labor and Employment EVALUATION! APPROVAL OF ‘ee, REGIONAL OFFICE NO. V (Bicol) CONSTRUCTION SAFETY & HEALTH PROGRAM (CSHP) Legal Basis: Section 5 of Department Order No. 13 s 1998 (Guidelines Governing Occupational Safety and Health In Construction Industry) Instructions: This form shall be duly accomplished and submitted by the MAIN/GENERAL CONTRACTOR in applying for an approval of a Construction Safety and Health Program intended for a specific construction project. Note: A CHECKLIST OF REQUIREMENTS shall be used in receiving the application. Only an application form with a complete requirements and attachments will be processed. Application found with incomplete requirements will be given 15 calendar days to comply. Failure to comply within the prescribed period, the application will be deemed disapproved. ‘A. Company Profile/License/Registration of Main/General Contractor Complete Name of the Company/ Complete Address: Main ]General Contractor 249 Brgy. Cobangbang, Daet, Camarines Norte SRE ATWALL ENGINEERING Tel. No: 09214505043 / 09954561514 Fax No. none Name of Project Manager/Contact Person: | Email greatwall1205@gmail.com EMMANUEL A. LO. Main Contractor PCAB License ‘Main Contractor Total employment 4 No__34573 Male_3 Female. 1 — Date of Validity: July 1, 2019 to June 30, 2020 DOLE Registration of Main Contractor ( Pls. attach photo copy of Registration forms received and approved by the concemed DOLE Regional Office) | Date Resistered/Approved LE-RO | a. per DO 18-02 ( requires yearly renewal) NA, b. per Rule 1020, OSHS (one time registration) December 21, 2015 RO no.5 Sub-contractors’ Profile/License No.of | PCAB | Validity | Date of Name of Sub-contractors (If, any) | Scope of Work and | Workers | License | Date DOLE Project Cost Registration TNA NIA NA NA [NA |N/A 23 [3 | [4 3.Department of Labor and Employment » REGIONAL OFFICE NO. V (Bicol) REVISED APPLICATION FORM for EVALUATION/ APPROVAL OF CONSTRUCTION SAFETY & HEALTH PROGRAM (CSHP) (Use separate sheet, ifnecessary) B, Project Profile/Description Project) Name of the Project: (Please attach copy of Invitation to Bid/other documents indicating name and details of the Completion of Evacuation Center Complete Project Address/Location Brgy. Pag-asa Labo, Camarines Norte Name of Project Owner Daet, Camarines Norte Tel. No: _(054) 440-2224 PROVINCIAL GOVERNMENT OF CAMARINES NORTE Fax No: Er | Project Classification: Date of Estimated StartExecution of Estimated No. of Workers to | the project: BUILDING CONSTRUCTION be deployed jin the project: January 15, 2021 Month — Day Year a Duration of the project (Pls. Total Project Cost_Php 992,976.64 (Workforce of the project to | state the number of calendar days: include workers of the sub- ccontractoris) 60 Removal of Obstruction Excavation RC Footing RC Column RC Beam Roof Tinning Roof Framing Painting Slab-on-fll (restoration) Health and Safety Mobilization and Demobilization AEH TOMMGOM> Brief Description of Activities/Work Flow (You may attach additional sheet, ifnecessary) ‘Completion of Evacuation Center which includes the following activities: Revised Form.: CSHP-DO 13-98 Date of Revision: Junet, 2017 Page 2of 3Department of labor and Employment REGIONAL OFFICE NO, V(S.coL} APPLICATION FORM for APPROVAL OF CONSTRUCTION SAFETY AND HEALTH PROGRAM ‘OSH Personnel assigned to the project ‘Name of Appointed Safety Officers: DINDO M. SOLIS. Date of his/her BOSH training: January 18-21, 2016 (Ps. attach photo copy of Cerificate of Completion on the Basic OSH Course for Construction Site Safety Officers issued by DOLE-BWC accredited Safety Training Organizations or recognized institutions) ‘Name of Appointed First-Aideris: KIM GUTIERREZ. Date of First Aid Training: _May 16-17, 2019. Validity of ID: Valid until May 17, 2024 (Pls. attach photo copy of Certificate of First-Aid Training and Valid First Aider ID from PNRC ‘Other OH personnel (if more than 50 workers will be deployed in the project) Name Date of BOSH Training ‘OH Nurse NA NA ‘OH Physician | NIA NA Dentist NA NA (lf Heavy Equipment will be used in the Project) List of Heavy Equipment to ba Used in the Project (Please attach additional sheet, if necessary) none Name of Heavy Equipment Operatoris (To attach photocopy of skills certification from TESDA) NIA Profile of the person who prepared the CSH Program for the abovementioned Project: Name and > DINDO M. SOLIS ‘Signature over printed name Educational Background: BS in Civil Engineering marines Norte State Coll ‘Work Experience in OSH: Safety Officer — Great Wall Engineering ‘Other Qualifications: | HEREBY CERTIFY ON MY HONOR TO THE TRUTHFULLNESS OF THE ABOVE-MENTIONED INFORMATION. THE COMPANY HEREBY COMMITS TO STRICTLY IMPLEMENT THE ATTACHED CONSTRUCTION SAFETY and HEALTH PROGRAM DESIGNED FOR THE ABOVE-MENTIONED PROJECT. ‘Submitted By: ‘Signature Over Printed Name (VEL A. LO Position: PROPRIETOR Date: January 8, 2021 Revised Form.: CSHP-DO 13-88 Date of Revision: Junet, 2017 Page 3 of 31|Page CSHP TEMPLATE (Comprehensive) 4.0 Statement of Commitment to Comply with OSH Requirements 1, Emmanuel A. Lo by accomplishing this Construction Safety and Health Program do hereby commit and bind ourselves to comply with the requirements of the Department Order No. 13, series of 1998 - Guidelines Governing Occupational Safety and Health in the Construction Industry and the applicable provisions of the Occupational Safety and Health Standards (OSHS). | (also) acknowledge our obligation and responsibilties to provide throughout the course of the project the appropriate Personal Protective Equipment (PPE) as added protection for our workers and employees. | also (hereby) commit to implement the necessary job safety and health instructions and training to all our workers for the entire (during the) duration of the project, as well as the safety of the general public Provincial Government of Camarines Norte Name of Project Owner Name of Contractor Signature over Printed Name Signature over Printed Name 2.0 Company Safety and Health Policy It is the general policy of Great Wall Engineering to perform work in the safest manner possible consistent with good construction practices. To fulfll the requirements of this policy, an organized and effective Construction Safety and Health Program as described in this program and in consonance with DOLE D.0. No. 13 and the OSH Standards must be carried out on every project To achieve these objectives, we are committed to perform the following: 2.1 Identifying potential hazards that may arise from the programmed work activities; 2.2 Organizing the work activities so as to minimize the risk arising from them; 2.3 Developing and implementing project specific safety and health program; 2.4 Establishing and enforcing all necessary safe work procedures, rules & regulations; 2.6 Ensuring that all workers are given orientation/briefing or indi prior to deployment to the site; 2.6 Establishing a site safety and health committee to act as policy making body of the project on all issues pertaining to safety and health; 2.7 Ensuring the conduct of daily toolbox meetings; 2.8 Establishing @ system of follow-up of actions and periodic assessment to check program effectiveness,3.0 Project Details T Spectic name of project and Name of Owner, T Location ofthe project Completion of Evacuation Center Provincial Government of Camarines Norte Brgy. Pag-asa, Labo, Camarines Norte Ti Clasiicaon of he project 'v. Name of General Constuctor (consrucor who as general supervision over other constructors inthe executton ofthis Bulding Construction (Completion) project and who rect receives instructions fom the owner or constuction project manager, any) (9Gen. Bung Const 1 Gen, Engineering Const 10 Specialy Tred Const EMMANUEL A. LO ‘cothers, spect: Name of Consbucton Project Manager Consultant any (a | vi Name of Pojecl Manager/Contact Number (fhe overall ‘person or entity whois hed bythe proect owner, actin the ‘owner's behalf conoeming supervision and montorng of all ‘matters rltedto the overal execution ofthis project. shall be a ‘soperate ently fom the general constructor or any subcontractor ofthe construction project technical personnel of the general constructor and or the ‘subcontractor in charge of the actual execution of this project) MARIO RUEL A. LO MARIO RUEL A. LO vi. Name of Resident Engineer, eny (a duly ioensed enginesr who shal be tasked fo be presenta the construction ste at ll tines, whenever works being undertaken ad shal have the responsi of assuring the technical conformance of al designs, ‘materials, processes, work procedures rendered forthe execution ofthis projec, incutng safety end heath of a persons within the construction site) “il Name and Cassicaon of Consinucors (6yronymous fo ‘ules who undertakes or ofr to undertake or purports fo have the capacity fo undertake or submits @bido, does himself or by or trough others, construc, tr, repat, ado, ‘ubtract fm, improve, move, wreck or demosh any bulking, ‘highway, road, ralroad, excavation or other structure, projec, development or improvement, orto do any par thereof, lnutg the erection of scafing roth stucure or works ‘in connection with this project. Te fem constructor nudes ‘subcontractor and special contactor.) EMMANUEL A. LO Name Cassfcation 1.NA 2 (Use addtional sheet fnecessary) ik Estimated maximum number of workers x Work Hours (including shi) ‘shit: from 8:00am to 5:00 pm 2¢shiftfom__NA fo NA ‘shift from _NiA___to__N/A__ bers:3|Page ‘Estimated number ofheavy equipment >, Projected dates of commencement and completion ‘DBackhoe_0 a Dozer, 0 ‘Sia Date: January 15, 2021 loader, a Dumptuck_0 End Date: March 15, 2024 corre 0 Grader 0 Est. Days to Complete: 60 days cothers, specity >ai_ Name and Adoress of Emergency Healh Provider (any person or organization who scatiied or recognized bythe Department ‘of Heath and who can provide the same or equivalent emergency heath services as an emergency hospital nduing emergency ‘treatment or workers on sit, emergency transport and care during transport of inured workers fo the nearest hospital, wih adequate Personne, supplies and fects forthe complete immediate treatment of njues or nesses) Labo Disrict Hospital, Labo, Camar Norte >iv, Total Project Cost | Php 992,876.64 Di, Total Coston OSH (breakdown) Use additonal shest if necessary) 4, Construction Safety & Health Committee Section 11 of D.O. No. 13 requires that rules of Construction Safety and Health Program must be observed and enforced at the project site, each site shall, at the start of the construction have a construction safety and health committee. With respect to this project, the committee will be organized in accordance with the requirements of Rule 1040 of the Occupational Safety and Health (OSH) Standards of the Department of Labor and Employment (DOLE). 4.1 Composition of Construction Safety and Health Committee (CSHC) (Our CSHC at the Completion of Evacuation Center consist of: 4.1.1 Project Manager or his representative as the chairperson ex officio Name: MARIO RUEL A. LO / MICHELLE MARIE M. UBANA 4.1.2 General Construction Safety and Health Officer/s (overall in charge in the implementation of the OSH program of this project hired by the General Constructor. Please attach certificate of training/s prescribed by DOLE. Numbers will be dependent on the numbers of workers and heavy equipment) Name: 1 Name: ‘JHON MICHAEL L_CUNANAN. Name:4lPag 4.1.3 Construction Safety and Health Officers from Subcontractors (any employee/worker trained and, in addition to their regular duties and responsibilities tasked by his employer to implement occupational safety and health program in accordance with the provisions of the OSH Standard. Please attach certificate of training/s prescribed by DOLE), Name: NA Company Name: Name: ‘Company Name: Name: ‘Company Name: Name: ‘Company Name: 4.1.4 Occupational Health Personnel (qualified first-aider, nurse, dentist, or physician, engaged by the employer to provide occupational health services in the establishmentlundertaking, Please attach certificate of training/s prescribed by DOLE): Name: KIM GUTIERREZ Designation: __ First Aider / Healthcare Provider Name: Designation: Name: Designation: 4.1.5 Workers’ representative (minimum of 3 union members if organized, not necessarily from one employer) Name: MATT IBIS. Designation: Name: Designation: 4.2 Duties of the CSH Committee shall include but are not limited to the following: 4.2.1 Plans, develops and oversees the accident prevention programs for the construction Project; 4.2.2 Directs the accident prevention efforts of the establishment in accordance with the safety Programs and performance and government regulations in order to prevent accidents from ‘occurring in the worksite; 4.2.3 Conducts safety meetings at least once a month. The committee will hold a safety meeting every __1" Monday of the month; 4.2.4 Submits reports to the project manager (Is this pm of the owner or pm of the gen con?) on its meetings and activities one day after the meeting; 4.2.5 Reviews reports of inspection, accident investigation and implementation of program;8|Pag 4.2.6 Provides necessary assistance to government inspecting authorities in the proper conduct of their activities specifically on the enforcement of the provision of DOLE's OSHS; 4.2.7 Submits the monthly the following safety and health reports to the DOLE Regional Office having jurisdiction over the project: 4.2.7.1 Summary of all safety and health committee meetings agreements; 4.2.7.2 Summary of all accident investigation reports using DOLE/BWC/ OHSD/IP-6 form; 4.2.7.3 Periodic hazards assessment with the corresponding remedial measures/actions for each hazard; 4.2.7.4 Annual Medical Report using the form DOLE/BWC/HSD/OH-47-A (if the duration of the project is more than one (1) year); 4.2.7.5 Initiates and supervises safety and health training for employees. (Check on the boxes oF list down the training to be provided for workers and employees), 12 49-Hour Construction Occupational Safety and Health Course Jay Workers Safety & Health Orientation f others, specify: 4.3 Duties of the Safety Man/Officer ‘The principal function of the Safety Man assigned to this project is to act as the employer's (needs identification) principal assistant and consultant in the application of programs to Temove the hazard from the workplace and to correct unsafe work practices. For this purpose, the Safety Man has the following duties: 4.3.1 Serves as Secretary to the SHC, as such will perform the following: 4.3.1.1 prepare minutes of meetings; 4.3.1.2 report status of recommendations made; 4.3.1.3 notify members of the meetings; and 4.3.1.4vsubmit (needs identification) to the employer a report of the activities of the committee, including recommendations made. 4.3.2 Acts as an advisory capacity on all matters pertaining to health and safety for guidance of the employer and the workers. 4.3.3 Conducts investigation of accident as member of the Health and Safety Committee and ‘submits his separate report and analysis of accident to the employer (needs identification) 4.3.4 Coordinates all health and safety training programs for the workers/employees and employer (needs identification) 4.3.5 Conduct health and safety inspection as member committee. 4.36 Maintains or helps in the maintenance of an efficient accident record system and coordinates actions taken by supervisors to eliminate accident causes. 43.7 Provide assistance to government agencies in the conduct of safety and health inspection, accident investigation or any other related program.6IP 4.3.8 For the purpose of effectiveness in the project site, the Safety Man is to report directly to the employer (needs identification), 4.4 Dangerous Occurrence or Major Accident In case of any dangerous occurrence or major accident resulting to death or permanent total disability, we will notify the DOLE Regional Office within twenty four (24) hours from occurrence. After the conduct of investigation by our concerned safety and health officer, we will report alll permanent total disabilities to the DOLE Regional Office on or before the 20" of the month following the date of occurrence of accident using the DOLE/BWC/HSD-IP-6 form. ‘5.0 Emergency Occupational Health Personnel and Facilities, Section 8 of D.O. No. 13 states that the construction project owner or his representative shall provide competent emergency health personnel within the worksite duly complemented by ‘adequate medical supplies, equipment and facilities based on the total number of workers in the site, 6.1 Emergency Health Personnel and Facilities, ‘Our number of Health Personnel & Facies Construction Stages workers during Health 5 this stage, Personnel poms, ‘A Removal of Obstruction 'B. Excavation (C. RC Footing 'D. RC Column ERC Beam’ Roof Tinning ‘G. Roof Framing H. Slab-on-Fill Restoration) I. Health and Safety ‘J. Mobilization and Demablization Ja |2|rlo|a|e|@|o]a}a} (Use additional sheet if necessary and attach all required training certificates in this section.) 6.0 Safety & Health Promotion & Education ‘The GREAT WALL ENGINEERING is committed at ensuring that all workers or employees are given orientation/briefing or induction prior to deployment to the site. Itis our continuing effort to promote safety and health consciousness to all people involved in this project by providing them with the necessary safety and health training and education to enhance their knowledge and skills to enable us to attain a safe and healthful project site. 6.1 Workers Safety and Health Orientation/Trainings We require new workers to attend our Safety & Health Orientation before they are deployed to this project site in consonance to Section 12 of the D.O. 13. The assigned Safety Officer, Ms. Jhon Michael L. Cunanan will coordinate the conduct of this orientation We ensure that they receive instruction and training regarding the general safety and health measures we pian to implement for this project, specifically 6.1.1 basic rights and duties of workers at the jobsite; 6.1.2 means of access and egress both during normal work and in emergency situation; 6.1.3 measures for good housekeeping;7|Pag 6.1.4 location and proper use of welfare amenities and first ~aid facilities; 6.1.6 proper care of PPEs and other protective clothing; 6.1.6 general measures for personal hygiene and health protection; 6.1.7 fire precautions to be taken; 6.1.8 action to be taken in case of any emergencies; 6.1.9 requirements of relevant health and safety rules and regulations. Below are the list of workers who have undergone the DOLE prescribed safety and health trainings and orientation, Name Title of training attended Remarks (Gse additonal sheet ifnecessary) 6.2 Specialized Instruction and Trainings Section 12.6 of the D.O. No. 13 requires specialized instruction and training be given to any person holding critical occupation. The inventory lists of our workers who hold critical occupation and attended the specialized trainings are listed below. (Please attach training certificates) Name Title of training attended Remarks (Use additional sheet if necessary) 7.0 Toolbox Meeting D.O. No. 13 define toolbox meeting or gang meeting as a daily meeting among workers and their respective supervisors for the purpose of instruction, discussion and proper briefing on the planned work, the assessment of past work, the possibility or actual occurrence of accidents at the site, tips and suggestions on how to prevent possible accidents and other related matters. 7.1 Responsible for the Toolbox Mesting ‘The following supervisor or any designated person (e.g. foreman, leadman, gangboss, etc.) is required to conduct dally toolbox or similar meetings prior to starting the tasks for the day to discuss with the workers and anticipate safety and health problems related to every task and thepotential solutions to those problems. The supervisor will remind the workers on the necessary safety precautions that need to be undertaken. ; Means of Documentation Name of Supervisor prin of Lobos decking Urdicate) (attach sample shift, eg. 1%, 2%, 3") Pegi (Use adifonal sheet necessan) 8.0 Accident/incidentilinesses Investigation & Reporting We consider accident/incidenvilinesses investigation and reporting as our responsibilty. Absenteeism can greatly affect our work schedule. Looking for replacement can be costly for the company, the hiring effort, training of new workers, the loss of job momentum affect our productivity. We involve our supervisors in this program because they are more familiar with the people involved, they have better understanding of the operation, and they have personal interest in the investigation since it's their people who are involved. For this reason, the GREAT WALL ENGINEERING is committed to include this responsibilty to all supervisors and made them aware about it 8.1 Persons responsible for conducting investigation In this project the following person/s will be assigned to conduct accident/incident investigation: All accidents All incidents/near miss Tlinesses Ware Ruel. To Wari RUBIA 16 Wari RUBIA, 6 EmmanuelA Lo EmmanuelA, Le Emmanuel A. Le TWichelle Marie M Ubana ‘Wichel Marie M. Ubana ‘Wichel Marie M. Ubara Dindo Mi. Sole indo M Soe indo M, Sole Kin Gutierrez Kin Gutierrez Kim Gutierrez 8.2 Conducting and documenting the accidentillinesses investigation In conducting the accidentillness investigation, we gather facts, analyze them and make the necessary recommendation. (Please attach sample forms that wil be used to document your investigation) 8.3 Compliance with Government Requirements: ‘We will submit the following reports to the DOLE Regional Office concerned: 8.3.1 In case of any dangerous occurrence or major accidents resulting to death or permanent total disability using the form (DOLE/BWC/OHSDIIP — 6). Notification of major accidents to DOLE Regional Office concerned within 24 hours. 8.3.2 Summary of Work Accident/lliness Exposure Data Report will be submitted on or before the 20” of the month following the date of occurrence of accident (for those projects with short duration or less than one year duration). 8.3.3 Annual Work Accidentiliness Report using the form DOLE/BWC/OHSD/P - 6B for those construction projects with more than one year duration9.0 Personal Protective Equipment (PPE) Section 6 of D.O. No. 13 requires that every employer shall, at his own expense, furnish his workers with protective equipment for eyes, face, hands, feet, lifeline, safety belttharness, protective shields and barriers whenever necessary by reason of the hazardous work process or environment, chemical or radiological or other mechanical irtants or hazards capable of causing injury or impairment in the function or any part of the body through absorption, inhalation or Physical agent. Provision of PPE shall be in accordance with Rule 1080 of the OSHS (must include Rule 1070 for noise). ‘The equivalent cost for the provision of PPE (life span, depreciation, replacement, etc.) shall be an integral part of the project cost. Ttem | Type of PPE ‘Quantity Unit Total No. needed Price cost 7 Hardhat 3 200.00 T6000 z Gloves 3 7000 SOO 3 Satay Shoes/Boots z F000 3,800.00 7 Rofectoriaed Vest 3 T5000 7200.00 5 Welding Mask 2 350.00 700.00 (Use additional shoot i necessary) 9.1 Cleaning and Proper Maintenance of PPEs {tis important that ell PPE be kept clean and properly maintained. Cleaning is particularly important for eye and face protection where dirty or fogged lenses could impair vision. Our workers or employees inspect, clean, and maintain their PPE according to the manufacturers’ instructions before and after each use. Our supervisors are responsible for ensuring that users properly maintain their PES in good condion. We enforce our rule that PPEs must not be shared between workers or employees unti it has been property cleaned and sanitized. PPE are distributed for individual use whenever possible. lf workers or employees provide their own PPEs, we make sure that it is adequate for the work place hazards, and that itis maintained in a clean and stored in a conducive condition. ‘We never allow the use of defective or damaged PPEs. We immediately discard and replace them to ‘avoid any unintentional use. We also consider the importance of ensuring that any contaminated PPE which cannot be decontaminated is disposed of in a manner that protects workers or employees from exposure to hazards 10.0 Protection of the General Public We comply with Rule 1412.09 of the DOLE OSH standard in providing a safe covered walkway over the sidewalk for use by pedestrians in a building construction work less than 2.3 meter (7ft) from a side ‘walk or public road. ‘We comply with Rule 1412.10 of the OSH Standard, Protection from Falling Materials. We observe the following: 10.1 We wil take the steps to protect worker from falling materials, such as the provisions of safety helmets and safety shoes,10|Page 10.2 We will ensure that tools, objects and materials including waste materials) wil not be thrown or ‘ipped from a height, but will be property lowered by crane, hoist or chutes. if such is not Pracicaba, the area where the materal is thrown wil be fenced and no person wil be alowed in 1¢ fenced area, ‘The person responsible for this program: Name: DINDO M. SOLIS. Designation: Safety Officer 11.0 Safety Signages Our Safety Signages provides warming to workers and employees and the public about the hazards around the project site. These will be posted in prominent positions at strategic location visible as far as possible in a language understandable to most of the workers and employees as well as the public, 11.1 The specific safety signages we intend to set-up for this project include but not limited to: 11.1.1 Mandatory requirement on the usage of PPE prior to entry to the project site (attach sample ‘picture of this signage that you plen to use for this project); 11.1.2 Areas where there are potential risks of falling objects (if applicable, attach sample picture of this signage that you plan to use for this project); 11.1.3 Areas where there are potential risks of falling (if applicable, attach sample picture of this ‘signage that you plan to use for this project); 11.1.4 Areas where explosives and flammable substances are used or stored (if applicable, attach ‘Sample picture ofthis signage thet you plan to use for this project); 11.1.5 Areas where there are tripping or slipping hazards (if applicable, attach sample picture of this signage that you plan to use for this project) 11.1.8 Approaches to working areas where danger from toxic “or irritant airborne contaminants/substance may exist which should indicate the name of the contaminanYsubstance Involved and the type of respiratory equipment to be wom (if applicable, attach sample picture of this signage that you plan to use for this project); 14.1.7 All places where contact with or proximity to electrical/acility equipment can cause danger (if epplicable, attach sample picture of this signage that you plan to use for this project); 11.1.8 All places where workers may come in contact with dangerous moving parts of the machineries or equipment (if applicable, attach sample picture ofthis signage that you plan to use for this project); 11.1.9 Location of the fire alarms and fire-fighting equipment (attach sample picture of this signage that you plan to use for this project); 11.1.10 Instructions on the usage of specific construction equipment (if applicable, attach sample ‘picture of this signage that you plan to use for this project); 1.1.11 Periodic updating of man-hours lost. 14.2 Inspection and Maintenance of Safety Signages We will regularly inspect and maintain in good condition all safety signages that we will be providing for this project. The person in charge in inspecting is/are __Kim Gutierrez , he/she \s/are our __First Aider__. Inspection will be carried out on a weekly basis.[Page Our foreman will remove and replaced any signages that are damaged, ilegible, or no longer apply with the current hazard. 12.0 Construction Workers Skills Certification ‘The company will ensure that all workers assi Section 15 of D.O. No. 13 and those who will be ‘equipment (CHE) will undergo manda! Ccorticates of those workers certified by igned in the critical occupations as defined in assigned in the operation of construction heavy tory cone testing for certification by TESDA (Attach TESDA 13.0 Testing & inspection of Construction Heavy Equipment All construction heavy equipment requirements of Section 10 of D.O. Ne will be tested and inspected in accordance with the 10. 13. The company will ensure that all heavy equipment will ‘be operated by qualified and certified operators. (Attach Cartifate of Testing and Inspection of CHE used issued by DOLE Accredited Testing Organizations for CHE end TESDA certificate of CHE operator/s) 14.0 Control Measures on Construction Activities To ensure safe and healthy working conditions throt control measure activities will be enforced and 14.1 Major Activities uughout the duration of the project the following minated to all the workers in the site: Major activities for this project includes but not limited to the following: (please check on the box all that applies) 2 Demolition 1 Earthmoving pScatfold Structural Stee! =Concreting Welding 5 HYAC fainting 10 Others (please specity) Excavation 0 Piling ‘Formwork 1 Crane Operation aRebarworks crElectrical 1 Plumbing © interior Decoration 14.2 Hazards Identified ‘Based on the list of activities for this project, we found the following potential hazards that we may Possibly encounter in the course of project implementation: 14.2.4 Physical Hazards Physical hazards are the most common in most workplaces. The physical hazards that we \dentified for this project include but are not limited to the following: (please check on the box all that applies) @machineries erelectrical onoise 1 exposure to heat fall hazards G others (please specify) = power and hand tools otadders and scaffolds 13 ventilation 1 tripping ncollapse12 Pe 14.2.2 Chemical Hazards Chemical hazards are present workers handle chemical preparations in any form (solid, liquid or gas). Some are safer than others, however, some workers are more sensitive to chemicals, ‘even the common solutions causing iliness, skin iritation or breathing problems. The chemical hazards that we identified for this project include but are not limited to the following: (please check on the box all that applies) cosolvents ‘Paint products acids 3 cleaning products Bacetylene 15 propane ‘ gasaine 13 explosive chemical siding fumes others (please specify) 14.2.3 Biological Hazards Biological hazards come from working with infectious people, plants, and other living materials. The biological hazards that we have identified for this project includes but not limited to the following: (please check on the box all that applies) 2 blood or other body fluids fungi a bacteria and viruses © plants pAtisect bites © animal and bird droppings A others (please speci) 14.2.4 Ergonomic Hazards Ergonomic hazards occur when the type of work, body position and working conditions put strain on the body. They are the hardest to spot since one does not immediately notice the strain on your body or the harm these hazards pose. Short-term exposure may result in "sore muscles" on the days following exposure, but long term exposure can result in serious musculoskeletal injuries. The ergonomic hazards that we identified for this project includes but not limited to the following: (please check on the box all thet epplies) © poor lighting frequent lifting Boor posture ertepetitive motion ‘rexertion of force © awkward movement 0 others (please specify)13|Page (Enumerate contro! measures to address those hazards identified, Use additional sheet i necessary) 14.3 Safe Work Practices Safe work practices are procedures adopted for carrying out specific tasks that ensures workers’ exposure to hazardous situations, substances, and physical agents is controlled in a safe manner. Safe work practices are generally written methods outlining how to perform a task with minimum risk to people, equipment, materials, environment, and processes. It should be developed as a result of completing a Hazard Assessment and should closely Teflect the activities in this project. Al safe work practices should be kept in a location central to the work being performed and readily available to the workforce. Some safe work practices will require specific job Procedures, which clearly set out in a chronological order each step in a process. (Enumerate below the safe work practices that you Intend fo perform reletive to the hazards you previously identified above.) 18.0 Firet-Ald, Health Care Medicines and Equipment Facilities ‘The company will provide first-aid kit and health care medicines and facilities for workers in the Site in accordance with the requirements of Rule 1960 of the OSHS. 18.0 Workers Welfare Facilities ‘The following welfare faclities will be provided in the site to ensure human working conditions: 16.1 Adequate supply of safe drinking water 16.2 Adequate sanitary, washing and sleeping facilities separate for men and women workers 16.3 Adequate facilities for changing and for the storage and drying of work clothes. 16.4 Adequate accommodation for taking meals. To assure that the company provides adequate welfare facilities for the workers in the site the ‘company will implement the provision of toilets and other facilities in accordance with the requirements of the Sanitation Code. 17.0 Medical Surveillance 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: 17.4 Complete medical and work history; 17.2 Physical examination (Pre-employment, During employment and Separation); 17.3 Other special examination (Pulmonary function test, blood panel, ECG >40 years of age, audiogram);14|Page 17.4 Random drug testing. 18.0 Working Hour & Break Time ‘The work schedule will be on ( please check on the boxes that apply): oAfon, oTie. pied. Thur. Fri, Sat. oSun Check on the shift and indicate the work hours for the shift that applies. 1" Shift from 2:2? (amipm) to_£.00 (amipm) co 2" Shift from —(am/pm) to__(am/pm) 23 Shift from (amipm) to (amvpm) Check on the shift and indicate the break for the shift that applies. 40 1" Shift from 1:00 _ (am/pm) 9 2" Shift from (am/pm) co 3" Shift from___(am/pm) to (am/pm) 18.0 Construction Waste Disposal ‘The company including subcontractors will be responsible for minimizing waste generated during the implementation of the project. The following procedures for disposal of wastes will be implemented in the site: 19.1 Ensure that the construction wastes are segregated from that of domestic waste. 19.2 All domestic wastes are to be collected on a daily basis. 19.3 Construction debris (broken hollow blocks, spoiled concrete, loose concrete, etc) should be taken out on the staging area. 19.4 Oil spills and spoiled greases should be wrapping in the black garbage bag and will be properly disposed. 19.5 Application of good housekeeping. 20.0 Emergency Preparedness ‘The objectives of this are to ensure that the company has developed and communicated plans that will allow for the effective management of emergencies. Attach copy of company emergency preparedness plan 21.0 Penalties/Sanctions For every offenses and violation of any safety rules, regulations and general practices Promulgated by the project and/or the company, the company recommended the following Penalties and sanctions for violation of CSH program: (Please attach company policy on penalties, If there are any).18|Page ‘Safety Violation 1 offense 2™ offense 3 offense 1. No helmet, no safety shoes, no | waming 3 day [5 day safety belhamess ‘suspension suspension 2° no 1D, Uniform, working attire, | warming 3 day | 5 day goggles, glove & apron suspension ___| suspension 3. eating at prohibited area warning 3 day [5 day suspension | suspension 4. littering and loitering warning 3 day |5 day suspension | suspension 5. smoking at prohibited area warning: 3 day | 5 day suspension | suspension 6. urinating at prohibited area warning 3 day [5 day ‘suspension Suspension 7. illegal dismantling of safety | warning 3 day [5 day signages and paraphernalia suspension ___| suspension & illegal gambling 3 day | 5 day | Dismissal suspension __| suspension ‘9. overnight stay w/o permission 3 day [5 day | dismissal suspension | suspension 10. fighting & provoking others 5 day | Dismissal ‘suspension 11. working under the influence of | Dismissal drugs and liquor 12. possession of illegal drugs, deadly | Dismissal weapon & gambiing paraphernalia 13. pilferage and robbery Dismissal 14. illegal entry/exit Dismissal 15. refusal to surrender ID & giving | Dismissal false representation 2.0 Attachments ‘Attached are the following: 22.1 Certificate of DOLE Company registration under Rule 1020 of the OSHS 22.2 DTI-PCAB License 22.3. Notice of Award/contract 22.4 Certificates of trainings completed of appointed safety and health personnel 22.5 CHE certificate of testing and inspection (if heavy equipment will be used) 22.6 Skills certification of workers (critical occupations) 22.7 OSH Reportorial requirements 22.8 OthersHOTICE Gt AWARL MAMANUEL A. 1 that the COMPLETION OF EVACUATION CENTER Brgy. > reby awarded ti sh0r ail valent to Nine Hundied Ninety-Two Thousand igh Soventy-Six and 64/ 100 pesos ‘only (P 992,876.64). Camarines Norte You Ore therefore required, wathin fer {10} days f ter into cont in the Inst nthe receipt ot # {with us, and subrst the iction ta Bidens utily she siyers to enter int fe @ sufficient groun socuity Very truly yo: ————— EDGARDO A. TALLADO Gower < EMMANUELA. LO Greet Wail Engineering Qate: be RSs 2 = 1c / AMO Great Wall Engineeringie Philippines F Regional Office No, § sazpi Citw This FIN YO.__95 993739 CERTIFICATE OF REGISTRATION GREAT WALL ENGINEERING 249 Purok 3, Brgy. Cobangbang, ed to Daet, Camarines Norte Name & Adare in compliance with Rule 1020 of the Ocewpational Safety and H Standards and by virtue nf tie power i vested in the Department of L aber and Employment under Articie 162 of the } ubor Code of the Philippines s__i8_“dayof December. ___zors. ‘tone AAS, NATHANIEL Vv. (Acanere Regional Di ona! Dieta, “Scam Gereteste shal be poset InsRse wgtas ema ‘A. LO Proprietor / AMO. Great Wall Engineeringprey 6.ayfa20F sino} pu’ Aagsnpuy WOIN4ysUOy vy Guibas, 43H PLL Ayafng jorronodnx 70 3508 InOH-OP ay payejduuo2 Bf 59 jae y 10d STTOS “IW OCNIC 0} Papszware st UO) fo apy ; 3900-SLOZZ0-0£0T “ON HORE aay F100 ANJWAOTIN GNV yasvl iO ANaWuwd3d nyaane/MaiNa> HuIWaH ONW ALISVS: TWNOLVal INO} SNAHOM IO 20 WS 4.58% #8 8Philippine Red Cross Camarines Norte Chapter Provincial Hospital Compound Bagasbas Rd, Duet, Camarines Norte Telephone No, (054) 885.2023 E-mail Add: camarines.norte@redcross. ong. ph C6-0519-024 ] CERTIFICATE OF COMPLETION ‘This is to certity that KIM GUTIERREZ has satisfactorily completed the OCCUPATIONAL FIRST ALD TRAINING with CPR conducted on May 16-17, 2019 at Dect Doctors Hospital, Ine, Dact, Camannes Notte. This training was conducted under the supervision of Mr, Christian Lester G, Trinidad and Mr. Julius P. Azatfla, ‘This certification is being issued for REFERENCE purposes only and shall be vallel wp to May 17,2021, Dre OL ores FERDINAND aoa Q. FERRER Chapter Administrator Always First, Always Ready, Ab Great Wall EngineeringGREAT WALL ENGINEERING # 249 P3 Cobangbang, Daet, Camarines Norte (CERTIFICATE OF EMPLOYMENT/ENGAGEMENT This is to certify that Mr. Dindo M. Sols and Ms. Kim Gutierrez, will be assigned as safely officer/first aider respectively for the project: Completion of Evacuation Center, located Gt Bray. Pag-asa, Labo, Camarines Norte for the duration of sixty days (60) days which will start on January 15, 2021. This cerffication is being issued os requirement for the approval of Construction Safety and Health Program. Given this 8th day of January, 2021 at Daet, Camarines Norte. Authorized Managing Officer Acknowledgement: Sa DINDO M. SOLIS Signature over Printed Name of Safety Officer KIMIGUTERREZ Signature over PI Name of First Aider E-mail address: greatwall 1205@amailcom Contact nos. 0935-3114-211 ; 0921-4505-043 ; 099-418-4153DO. No. $65. 2005 ‘Name: Completion of Evacuation Center Location: Brgy. Pag-asa, Labo, Camarines Norte Item No. Quantity 1.00 Description: Safety and Health Budget Unit Lumpsum TO) TTC AMOUR Ee Feonal Protective Bguipnest Sarety Shoes/Boots z Pes o.oo 3,500.00 Tard Hat = pes 200.007 7,600.00 Satery Gloves % es 70.00 360.00 Reflecorized Vest, s Pes. 730.00 7,200.00 PPE for Specialized Ses [Ful Body amess ifeines [Welding Mask z Bes 33000 FOO “Tapron Ete. (Washable Face Mask) z 7 F000 Oo. Sub-Total A 3,060.00 rE mi TE | AMOUNT a Fenn! Protesve Equipment Firs Aider T 16 35000] 50000 Safety Offi r 0 350.00] 21,000.00 [Sub-Tomra 36,600.00 rOTAL DIRECT COST(ATB) PHP 34,660.00 Submitted by: IMANUBEA. LO GREAT WALL ENGINEERINGRepublic ofthe Philippines on Gy cur Deparment of Trade and Industry . ‘CONSTRUCTION INDUSTRY AUTHORITY OF THE PHILIPPINES PHILIPPINE CONTRACTORS ACCREDITATION BOARD Makati Ci, Mea Manila CONTRACTOR'S LICENSE FORM NO. 20-00001 +*20-00001* This certifies that CONTRACTOR'S PARTICULARS GREAT WALL ENG REGION 5 (Bicol | Region hhaving complied with all the requirements for | vay Pes arms UssreaReneut Nieonsure pursuant to Republic Act No. 4586 | July 01, 2020 to June 30, 2021 (as amended) and its implementing rules and | "¥ °% ne regulations, is hereby authorized to engage | Pncea Cusuncaon ane Caos in the construction contracting business in | General Engineering 8 the Philippines, subject to herein limitations | cine Gaxsteanns Genera Building of license validity period, classification and category as prescribed under License Particulars in the box to the right and to the terms and conditions annotated at the back oreo. ates eet te isteme rae eae ieee pea eer pete Retest est terete acne See fai | "eta rata Reopcie a Ra | Ree. bctray,Peemant Rabueys Apert ores) Madi A to June 24, 2022 censor Given at Metro Mania Pippines, on rennet o_o 2avr2000 es =o & == = poston nen ton = | E 00 20 iat Pant ‘Smale | Board Member aces! a . = ey ae trond oa eae cate erber DE. Matienzo eetome Exetutive Disetor ‘Board Seeretary NUBEA LO "roptictor 7AMO a OGUMENTARY STAMP TAX PAID et neering (mp 30.0 Great Wall Engineeringthat GRE** WALL ENGINEERING S amended by compliance with -ertificate of Business Name Registration ang iesue the 23 Abet- AMON M/LOPEZ \, Seerdiér Ce-ifleate No. 05371684 This certificate is "ct 2 ice = to engage in ani TRN B92z26.To reduce risk of injury, * Hard hat * Safety glasses * Safety shoes MUST be worn on this site. Construction area. Authorized personnel only. EL A. LO Proprietor / AMO Great Wall Engineering SAFETY SIGNAGES