Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. 3
City of San Fernando, Pampanga

REPORT SAFETY ORGANIZATION

Date Filed:______________
Regional Labor Office No. 03
File Number _______________

EDIZON AND CATH ENTERPRISE

Name of Establishment: _____________________________________________________________________

MARINA ST., SAN ANTONIO, CANDON CITY, ILOCOS SUR

Address: _________________________________________________________________________________

CONVINIENCE STORE
Nature of Business: ________________________________________________________________________

Persons Employed, including Management:

5
Male: _____ 3
Female: ____

A. Policy and Programs on Safety Committee:

B. Composition of Safety Committee: Type: _________

Name Position in Establishment

Chairman: CATHERINE LEAL

________________________________________ OWNER
_____________________________________

Members: PAUL JERICK FABIAN

________________________________________ SALES CLERK
_____________________________________

BRIAN PAUL ROSIMO

________________________________________ SALES CLERK
_____________________________________

________________________________________ _____________________________________

Secretary: KIMBERLY PURUGGANAN __________

______________________________ SALES CLERK
_____________________________________

C. Technical Information:

A. Brief description of process of operation and number and kind of equipment.

______________________________________________________________________________________________

CATHERINE REYES LEAL

_____________________________________
General Manager / Authorized Representative
PLEASE READ! This should be accomplished in 3 sets together w/ other admin reports and let it be stamped by DOLE
Pampanga at Room 303 Plaza Garcia Bldg. Dolores CSFP. Landmark is Esting’s Flower Shop Intersection hmg