Republic of the Philippines

Department of Labor and Employment

National Capital Region

ANNUAL MEDICAL REPORT

For Period January 2021 to December 2021

1. Name of Establishment: BLACPrime Construction INC./ The Imperium at

Capitol commons
2. Address: Camino Verde Rd, Pasig, Metro Manila
3. Name of Owner/ Manager: Ortigas Land Corporation
4. Nature of Business & Product/ Service (Ex. Manufacturing – textile):
Fit-Out ONSTRUCTION
5. Total Number of Employee: 10 Number of Shift: 1
6. Number Distribution of Employee as to nature/workplace, sex & workship:
Office Product/Shop
1st Shift 2nd Shift 3rd Shift
Male : 9 _______ ________
Female: 1 _______ ________
Total: 10 _______ ________
7. Preventive Occupational Health Service: (Check or Cross)
a. Occupational health service is organized / provided by:
(X) the establishment / undertaking
( ) government authority / institution
( ) other bodies / group / institution (specify) ___________
b. Occupational health services as described under number 7a above, is organized /
provided as a service:
(X) Solely for the workers of the establishment / undertakings
( ) common to a number of establishment / undertakings
c. The employer engages the services of:
( ) Occupational health practitioner Name:
Address: NA
( ) Occupational health physician Name:
Address:
( ) Occupational health dentist Name:
Address:

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 ( ) Occupational health nurse Name:
Address:

d. The occupational health physician/practitioner/nurse/personnel conducts an inspection

of the work place:
( ) once every month
( ) once every two (2) months
( ) once every three (3) months
( ) once every six (6) months
(X) other details: Safety Officer conduct inspection

8. Emergency Occupational Health Services:

a. The employer provides a treatment room/medical clinic in the work place with
medicines and facilities
(X) Yes Site clinic with medicine supply ( ) No
( ) others, please specify: _____________________________
b. Schedule of attendance in the work place:
Work shift
Occupational health physician : On call_hrs. /day__________
Occupational health dentist : __________hrs. /day________
c. Schedule of attendance of full time first aider
(x) 1st shift
( ) 2nd shift
( ) 3rd shift
d. The following occupational health personal of this establishment have under gone
training in occupation health and safety/first aid:
( ) Occupational health physician
( ) Occupation health dentist
( ) Occupation health nurse
(x) First aider
( ) Others, please specify_____
9. Occupational Health Services
a. The occupational health personnel of this establishment regular appraisal of the
sanitation system in the workplace:
(x) Yes ( ) No
b. Number of workers who underwent the following medical examinations:
Physical Exam X-rays Urinalysis
1. Pre-placement 10 10 10
2. Periodic 0 0 0
3. Return-to –work 0 0 0
4. Transfer 0 0 0
5. Special 0 0 0

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 6. Separation 0 0 0

Stool Blood ECG Others

Exam Test
1. Pre-placement 10 10 0 0
2. Periodic 0 0 0 0
3. Return-to-work 0 0 0 0
4. Transfer 0 0 0 0
5. Special 0 0 0 0
6. Separation 0 0 0 0
10. Report of Diseases
a. Number of consultations/treatments for the following diseases:

Male Female Total No.

Of Cases
Skin:
( ) Allergy 0 0 0
( ) Dermatoses 0 0 0
( ) Infection as folliculitis
Abscess/paronychia 0 0 0
( ) Others
Head:
( ) Tension/headache 0 0 0
( ) Others 0 0 0
Eyes:
( ) Error of 0 0 0
Refraction
( ) Bacterial/Viral 0 0 0
Conjunctivitis
( ) Cataract 0 0 0
( ) Others 0 0 0
Mouth & ENT:
Male Female Total No.
Of Cases
( ) Gingivitis 0 0 0
( ) Herpes Labiales/ 0 0 0
nasalis
( ) Otitis Media 0 0 0
External
( ) Deafness 0 0 0
( ) Meniere’s 0 0 0
Syndrome/Vertigo

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 ( ) Rhinitis/Colds 0 0 0
( ) Nasal Polyps 0 0 0
( ) Sinusitis 0 0 0
0 0 0
( ) Tonsilio

( ) Pharyngitis 0 0 0
0 0 0
( ) Laryngitis
0 0 0
( ) Others
Respiratory:
( ) Bronchitis 0 0 0
( ) Bronchial/Asthma
( ) Pneumonia 0 0 0
( ) Tuberculosis
( ) Pneumoconiosis 0 0 0
( ) Others 0 0 0
Heart and Blood Vessel:
() Hypertension 0 0 0
( ) Hypotension 0 0 0
( ) Angina Pectoris 0 0 0
( ) Myocardial Infraction 0 0 0
( ) Vascular disturbances 0 0 0
in extremities due to
Continuous vibration
( ) Others
Gastrointestinal:
( ) Casroenteritis/ Diarrhea 0 0 0
( ) Amoebiasis 0 0 0
() Gastritis/ Hyperacidity 0 0 0
( ) Appendicitis 0 0 0
( ) Infectious Hepatitis 0 0 0
( ) Liver Cirrhosis 0 0 0
( ) Hepatic Abscess 0 0 0
( ) Cancer (Hepatic/ Gastric) 0 0 0
( ) Ulcer 0 0 0
( ) Others 0 0 0

Genito Urinary:
( ) Urinary Tract infection 0 0 0
( ) Stones 0 0 0
( ) Cancer 0 0 0
( ) Others 0 0 0
Reproductive:
( ) Dysmenorrhea 0 0 0
0 0 0

4
 ( ) Insfection
(Cervicitive)
(Vaginitis)
( ) Abortion 0 0 0
(Spontaneus)
(Threatened)
( ) Hyperremesis 0 0 0
Gravidarum
( ) Uterine Tumors 0 0 0
( ) Cervical Polyp/ 0 0 0
Cancer
( ) Ovarian cyst/Tumors 0 0 0
( ) Sexually transmitted 0 0 0
diseases

Male Female Total No.

Of Cases
( ) Hernia (Inguinal) 0 0 0
(Femoral)
( ) Others 0 0 0
Neuromuscular /Skeletal joints
( ) Peripheral Neuritis 0 0 0
( ) Torticollis 0 0 0
( ) Arthritis 0 0 0
( ) Others (muscle pain)
Lymphatic and circulatory
( ) Anemia 0 0 0
( ) Leukemia 0 0 0
( ) Cerebrovascular 0 0 0
( ) Lymphadenitis 0 0 0
( ) Lymphoma 0 0 0
Infectious Diseases
( ) Influenza 0 0 0
( ) Typhoid/Paratyphoid 0 0 0
fever
( ) Cholera 0 0 0
( ) Measles 0 0 0
( ) Mumps 0 0 0
( ) Tetanus 0 0 0
( ) Malaria 0 0 0
( ) Schitosomiasis 0 0 0
( ) Herpes Zoster 0 0 0
( ) Chicken pox 0 0 0
0 0 0

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 ( ) German measles
( ) Rabies 0 0 0
( ) Others 0 0 0

12. Immunization Program (Indicate number immunized)

Nature Male Female Total No.
Of Cases

Tetanus Toxoid Injection 0 0 0

Tetanus Antioxin Injection 0 0 0
Tetanus Globulin Injection 0 0 0
Hepatitis B Vaccine 0 0 0
Rabies Vaccine 0 0 0
Others (Please Specify) 0 0 0
13. Keeping of Medical Records of Workers (Please Check)
(x) Done ( ) Not Done
14. Health Education and Counseling by Health and Safety Personnel: (Please Check one or
more)
(x) Done individual as each worker comes to the clinic for consultation.
(x) Done in organized group discussions/seminars.
(x) Done with the use of visual displays and/or promotional materials, leaflets, etc.
15. Other Health Programs (Please Check)
Kinds of Program Seminar Use of Visual Counseling
Id/Materials
Nutrition Program () () (/)
Material and Child () () ()
Care Program
Family Planning Program () () ()
Mental Health Activities () () ()
Personal Health Maintenance ( ) () ()

Physical Fitness Program: (Please Check)

Sport Activities (x) Yes ( ) No
No Others (Daily Exercise) (x) Yes ( ) No

16. Hazard in the workplace: (Please check and give details of the substance)
Substance and/or Number of workers

Sources Exposed

a. Chemical Hazard:

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 (X) Dust (Ex. Silica dust) Skimcoat 10
( ) Liquid (Ex. Mercury)
( ) Mist/fumes/vapors (Ex. mist from paint spraying)
( ) Gas (Ex. CO, H2S)
( ) Others (please specify) (Ex. solvents)
Physical Hazards
() Noise
( ) Temperature/humidity
( ) Pressure
( ) Illumination
( ) Radiation/ultraviolet/microwave
( ) Vibration
( ) Others (Please specify)
b. Biological hazard:
( ) Viral
( ) Bacterial
( ) Fungal
( ) Parasitic
( ) Others, specify
c. Ergonomic Stress:
(x) Exhausting physical work 10
(x) Prolonged standing 10

(x) Low back pain 10

(x) Unfavorable work posture 10
( ) Static/monotonous work
( ) Others, specify

Submitted by:

Engr. Alaine G. Sobredo – Safety Engineer January 28, 2022

Medical Personnel/Title Date

Noted by:

Mark S. Jasarino
Project in Charge