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Environment Health and Safety EHS-MDCBP-FOO8
(EHS) Revision Code: 0 Page 1 of 1

FORM : Equipment Operator Cetificate Monitoring Effectivity : August 3, 2015
Environment Health and Safety EHS-MDCBP-F000
FORM : Table of Contents Effectivity : August 3, 2015
No. Documents I.D Number Description Revision Number

1 EHS-MDCBP-F001 EHS Attendance Sheet
2 EHS-MDCBP-F002 Safety Orientation Acknowledgement
3 EHS-MDCBP-F003 Personnel Information Sheet
4 EHS-MDCBP-F004 Skilled Workers Certificate Monitoring
5 EHS-MDCBP-F005 Heavy Equipment Operator Certificate Monitoring
6 EHS-MDCBP-F006 Heavy Equipment Certificate Monitoring
7 EHS-MDCBP-F007 MSDS Monitoring
8 EHS-MDCBP-F008 Monthly Fire Extinguisher Monitoring
9 EHS-MDCBP-F009 Minutes of Meeting
10 EHS-MDCBP-F010 Excavation Permit
11 EHS-MDCBP-F011 Confined Space Entry Permit
31 EHS-MDCBP-F011A Confined Space Entry Attendance
12 EHS-MDCBP-F012 LOTO Permit
13 EHS-MDCBP-F013 Power Tools Inspection Checklist
14 EHS-MDCBP-F014 Working Near Energized Power Lines
15 EHS-MDCBP-F015 Hot Work Permit
16 EHS-MDCBP-F016 Scaffolding Inspection
17 EHS-MDCBP-F017 Gondola Checklist Inspection
18 EHS-MDCBP-F018 Critical Lifting Permit
19 EHS-MDCBP-F019 Sling Inspection Checklist
20 EHS-MDCBP-F020 Safety Observation Report
21 EHS-MDCBP-F021 Safety Corrective Action Report
22 EHS-MDCBP-F022 EHS Violation Notice Monitoring
23 EHS-MDCBP-F023 EHS Inspection Checklist
24 EHS-MDCBP-F024 EHS Audit Report
25 EHS-MDCBP-F025 Post Drill Evaluation
26 EHS-MDCBP-F026 Accident Investigation Report
27 EHS-MDCBP-F027 Self Monitoring Report
28 EHS-MDCBP-F028 Project EHS Performance Monitoring
29 EHS-MDCBP-F029 Regulatory Compliance Checklist
30 EHS-MDCBP-F030 Demolition Permit
31 EHS-MDCBP-F031 EHS Committee Inspection Report
32 EHS-MDCBP-F032 EHS Risk Register
33 EHS-MDCBP-F033 EHS Residual Risk Register
34 EHS-MDCBP-F034 Objectives, Targets and Program Form
35 EHS-MDCBP-F035 Use of Powder Actuated Tools
EHS-MDCBP-F001
Environment Health and Safety (EHS)
Revision Code: 0 Page 1 of 1
FORM : EHS Attendance Sheet Effectivity : August 3, 2015

Ref. No.: _MDCBP-ASCT1-16-EHS-TBA_______________
Project Name: AMAIA SKIES CUBAO P1 Project location : CUBAO QUEZON CITY Date:
Check where applicable
Daily Toolbox Meeting
Orientation / Induction Meeting
EHS Committee Meeting
EHS Training & Seminar
Others, Please specify:
AGENDA / TOPICS
No. Name Company Position Signature
1 MELFER ARTHUR ABROGENA RALGO PROJECT IN CHARGE
2 GIRLIE TARAN RALGO SAFETY OFFICER
3 NOEL BARRO RALGO FOREMAN

4 JEROME CARINO RALGO WAREHOUSEMAN
5 RODRIGO AGRAVANTE RALGO INSTALLER

6 RYAN PANUYAS RALGO INSTALLER
7 ARDIE LANSANG RALGO INSTALLER
8 ALLAN ANONUEVO RALGO INSTALLER
9 POWELL DANCIL RALGO INSTALLER
10 JEFFREY GACITA RALGO INSTALLER
11 MANUEL BONGALOS RALGO INSTALLER
12 JEALMARL BELGIDA RALGO INSTALLER
13 GARCIA ELMER RALGO INSTALLER
14 FLOYD MIRA RALGO INSTALLER
15 ALVIN BANDAY RALGO INSTALLER
16
17
18
19
20
21
22
23
24
25
Conducted / Presided by:
EHS Personnel (Name with Signature)
EHS-MDCBP-F002
FORM : Safety Orientation Acknowledgement Effectivity : August 3, 2015
Ref. No.: __ MDCBP-ASCT1-16-EHS-SOA
Project Name: AMAIA SKIES CUBAO P1 Project location: CUBAO QUEZON CITY
Pangalan :
Kompanya :
Posisyon :
Lugar ng kapanganakan : Petsa ng kapanganakan :
Permanenteng tirahan :
Blood Type :
Taong maaring tawagan kung kinakailangan :
Relasyon sa empleyado :
Numero ng telepono na maaaring tawagan :
Lubos kong nauunawaan at naiintindihan ang mga patakaran at batas pangkaligtasan na ipinaliwanag sa
akin ng kinatawan ng MDCBP EHS Department gayundin ang mga kaakibat na kaparusahan na ipapataw
sa paglabag ng mga ito.
Lubos kong nauunawaan ang aking pang araw-araw na trabaho at mga posibleng panganib na kaakibat
nito sa loob ng lugar na pinagtratrabahuhan.
Aking isusuot ang I.D. ng kumpanya, uniporme, at paggamit ng tamang kagamitan pangkaligtasan (PPE’s)
sa lahat ng oras habang nasa loob ng lugar na pinagtratrabahuan. Ako’y responsable sa paggamit ng
tamang kagamitan pangkaligtasan (PPE’s) kaugnay sa maaaring maging disgrasya o kapahamakan.
Bahagi ng pahayag na nasa taas, sisiguraduhin ko na ang mga sumusunod:
a.) Lugar ng pinagtratrabahuhan
b.) Trabahong kailangang gawin
c.) Apakan sa pinagtratrabahuhan
ay laging ligtas at payapa at hindi nagdadala ng kapahamakan sa aking sarili at mga katrabaho.
Ako ay nangangakong susunod sa mga patakaran at alituntunin na ipinapatupad ng MDCBP hinggil sa
kaligtasan at aking tatanggapin ang ano mang kaakibat na kaparusahan na ipapataw sa akin sa paglabag
ng mga ito.
Lagda ng empleyado :
Petsa :
Conducted by:
EHS Personnel (Name with Signature) Date
EHS-MDCBP-F003
FORM : Personal Information Sheet Effectivity: August 3, 2015

Ref. No.: _____ MDCBP-ASCT1-16-EHS-PIS
Project Name : AMAIA SKIES CUBAO P1 Project Location: CUBAO Q, C Date:
Pangalan: Kasarian:
Apelyido Pangalan M.I.
Kapanganakan: Civil Status: Edad:

Tirahan:
Numero ng Telepono: SSS No.
Mobile No.: TIN No.
Posisyon sa Trabaho: Philhealth No.
Taong hahanapin sa oras ng kailangan :
Numero ng Telepono: Tirahan:
MEDICAL HISTORY
WALA Kung meron,isulat kung ano ito:
A. Kasalukuyang sakit
B. Kasalukuyang iniinom na gamot
C. Huling araw na nagpakunsulta sa doktor
D. Mga nakaraang sakit
E. Huling araw na naoperahan o nalagi sa ospital
F. Mga naging sakit ng magulang o pamilya
HEALTHY/UNHEALTHY PRACTICES-VICES
YES NO Remarks
A. Ehersisyo
B. Umiinom ng alak
C. Naninigarilyo
D. Mga pagkain na madalas kainin
Temperature: Height: Blood Type:

BP: Weight:
VITAL SIGNS BMI
PR: BMI Result:
RR: Remark:
REMARKS: (MEDICAL FINDINGS/RESULTS)
Lahat ng impormasyon naitala ay tama at totoo (Medical History/Healthy & Unhealthy Practices-Vices)
Lagda/Petsa
Taong nagsagawa ng pagsusuri:

Pangalan Lagda Petsa
EHS-MDCBP-F004
FORM : Skilled Workers Certificate Monitoring Effectivity : August 3, 2015

Ref. No.: ____________________________
Project : As of :
Location :
WELDER
Name Company Competency Issued by Date Issued Expiration Date Certificate No. Verified Authentic Remarks
ELECTRICIAN
Name Company Competency Issued by Date Issued Expiration Date Certificate No. Verified Authentic Remarks
Prepared by: Noted by:
EHS Personnel (Name and Signature) Project In-Charge/Project Manager

EHS-MDCBP-F005
FORM : Heavy Equipment Certificate Monitoring Effectivity : August 3, 2015
Ref. No.: ____________________________
Project : As of:
Location :
Item. Name Company Competency Equipment Type Issued by Date Issued Expiration Date Certificate No. Verified Authentic Remarks

EHS-MDCBP-F006
FORM : Heavy Equipment Certificate Monitoring Effectivity : August 3, 2015

Ref. No.: ____________________________
Name of Project: As of:
Project Location:
Heavy Equipment Third Party Certificate

Item
Comment Corrections Verified Remarks
No. Company Equipment Type Brand Model Capacity Issued by Date Issued Expiration Date
(Rating) Required Authentic

EHS-MDCBP-F007
FORM : Material Safety Data Sheet (MSDS) Monitoring Effectivity : August 3, 2015
RALGO INDUSTRIES INC. Ref. No.: _ MDCBP-ASCT1-16-EHS-MSDS
Project Name: AMAIA SKIES CUBAO P1 As of: JAN. 26,2016

Locatio : CUBAO QUEZON CITY
Item Contact PPE Reactivity Explosive Flammable Enviromental

Brand Name Supplier Location Storage Health Hazard First Aid Measure
Number Number Requirements Data Limit Content Hazard
Specified
800-255- Goggles,Gloves,pr Under Ambient Eye Irritant,Skin Toxic to aquatic
1 SpecSeal LE600 Sealant Technologies,Inc Site Use Stable N/A N/A Remove to fresh air,Wash throughly,Irrigate eyes running water
3924 otective gear Condition Contact organism
.
Cool,dry,well
Overalls ,safety
0932-900- ventelated Skin Contact,Eye Toxic to aquatic Remove and dispose contaminated clothing to prevent further skin
2 Super Vulcaseal Bostik Shoes, Site Use Stable N/A N/A
5656 area from Contact,Ingestion organism contact,Wash throughly w/ plenty of water
googles,gloves
direct sunlight
Cool,dry,well
Eye Irritant,Skin
MAP-Pro Premium Hand 800.424.9 Goggles,Gloves, ventelated toxic to aquatic Flush eyes w/plenty of water,Removed contamainated
3 Uniweld Site Use Stable Contact,Inhalation ,Inge
Torch Fuel 300 protective gear area from organism clothing,remove to fresh Air,Risk of ingestion is extremely low.
stion
direct sunlight
Rubber Store in a cool

gloves,Goggles, dry area,don't
Caloocan Gas Skin Toxic to aquatic Remove person to fresh air, If , Unconsciousness ,give a mouth to
4 Acetylene 90-69-80 Safety Site Use allow Stable
co. burn,Unconsciousness organism mouth ,Give supplementel oxygen if necessary
Shower,Safety temperatures
shoes ex13of
Rubber Store in a cool

gloves,Goggles, dry area,don't
OXYGEN GAS TECHNICAL Caloocan Gas Skin Toxic to aquatic Remove person to fresh air, If , Unconsciousness ,give a mouth to
5 90-69-80 Safety Site Use allow Stable
GRADE co. burn,Unconsciousness organism mouth ,Give supplementel oxygen if necessary
Shower,Safety temperatures
shoes ex13of
Keep
Coughing, Shortness of
container clse,
breath , dizziness ,
800.424- Gloves, do not store Toxic to aquatic Remove the victim in to fresh air, flush w/ large of water,use soap is
6 PVC SOLVENT RestorSeal Cor Site Use Stable central nervous
9300 mask .Goggles near organism available,Get promp medical attention
system ,Intoxication
heat ,sparks.or
and collapse
open flames
Keep
Skin Contact,Eye
0932-900- Gloves ,mask ,G container clse, Toxic to aquatic Remove and dispose contaminated clothing to prevent further skin
7 RUGBY Bostik Site Use Stable N/A N/A Contact,Ingestion ,head
5656 oggles do not store organism contact,Wash throughly w/ plenty of water
aches
near heat ,
Keep
container
628- Gloves, Skin Toxic to aquatic Remove person to fresh air, If , Unconsciousness ,give a mouth to
8 PAINT TAINER Briton Site Use close,do not Stable
4040041 mask .Goggles burn,Unconsciousness organism mouth ,Give supplementel oxygen if necessary
direct to
sunlight
full Protective Office ,& Site Do not direct Skin Toxic to aquatic Remove person to fresh air, If , Unconsciousness ,give a mouth to
9 Fire Extinguisher Gaerlan Man Inc. 927-2149 Stable
gear to use to sunlight burn,Unconsciousness organism mouth ,Give supplementel oxygen if necessary
Keep
container
628- Gloves, Skin Contact,Eye Toxic to aquatic Remove and dispose contaminated clothing to prevent further skin
10 B310 RED OXIDE Boysen Site Use close,do not Stable
3643505 mask .Goggles Contact,Ingestion organism contact,Wash throughly w/ plenty of water
direct to
sunlight
EHS Personnel (Name with Signature) Project In-Charge/ Project Manager
EHS-MDCBP-F008
FORM : Monthly Fire Extinguisher Monitoring Effectivity : August 3, 2015

Ref. No.: ____ MDCBP-ASCT1-16-EHS-FEI
NO. LOCATION BODY NO. CLASS TYPE CAPACITY STATUS REMARKS
1 OFFICE 1 ABC 10 LBs. 45kgs. OK TO USE GOOD CONDITION
2 WAREHOUSE 5 ABC 10LBs. 45kgs. OK TO USE GOOD CONDITION
3 SITE TO USE 2 ABC 10LBs. 45kgs. OK TO USE GOOD CONDITION
Additional Comments and Recommendation:
Inspected by: Noted by

GIRLIE TARAN MELFER ARTHUR ABROGENA
EHS Personnel (Name and Signature) Project In-Charge/ Project Manager
EHS-MDCBP-F009
FORM : Minutes of Meeting Effectivity : August 3, 2015
Ref. No.: ______________________________
EHS COMMITTEE MEETING

Minutes of Meeting No.
Date :
Time Started :
Time Adjourned :
Venue :
Attendees : 5
No. Name Position Project
1
2
3
4
5
Action By Date Raised Item No. Particulars

1
Prepared By: Noted By:
EHS Personnel (Name and Signature) Project Manager/ Project In-Charge

Environment Health and Safety EHS-MDCBP-F010
FORM : Excavation Permit Effectivity : August 3, 2015
Ref. No.: ____________________________
Project Name: Project location:

Contractor's Name: Date Issued: Validity Date: Weather Condition:
Time:
Type of excavation works Name of workers:
Manual Excavation
Tools to be use : _____________________________________
Equipment Use
Type of Equipment : __________________________________
Details of work to be undertaken: Specific Location:
CHECKLIST
REQUIREMENTS YES NO N/A REMARKS
Identification, protection and removal of existing
1
utilities and other "object concern".
Excavation site has been cleared for "object
2 concern" or excavation works are supervised by
"experts".
Approve soil erosion / collapse protection as required
3 on excavation works (slopping, benching, shotcrete,
shoring, sheilding, sheet piles, etc.)
Maintain safe distance of excavated materials,
4 machinery, equipment and construction materials from
the excavated area
All personnel are aware of the hazards present and
5
existing control on the excavation activity
Personnel and equipment are not directly working
6 below the excavation where another personnel or
equipment working above
Provided warning signs and barricades on the
7
activities
Workers protected from loose rock, soil and protruding
8
objects
9 Safe access / egress provided
10 Personal Protective Equipment provided to workers
11 Submersible pump is available on site
Emergency Preparedness and Response Equipment:
Fire Exinguisher Stretcher Stand by vehicle First Aider (Name:______________)
Emergency Lights First Aid Kit Oxygen tank Others: Pls. Specify _____________
PROTECTIVE EQUIPMENT REQUIRED

Hard Hat Caution / Danger Tapes Hand Gloves
Safety Googles Signal Flags / Whistle Full Body Harness
Hearing Protection Lightings Reflectorized Vest
Safety Shoes / Safety Boots Respirator Others: ________________
CONDITIONS
1. Processing of this permit must not continue if any of the above requirements is not complied.
2. The permit will be invalid for any changes of conditions and work environment
Requested by Designation Contact Number

WORK INSPECTION
Inspected by: Date Noted by: Date
MDC Build Plus Field Engineer MDC Build Plus Project-In-Charge
Approved by: Date Remarks:
MDC Build Plus EHS Personnel

NOTE: This permit must be posted at work area all times. Erasures, Tampering and/or Unauthorized assignatories will be considered as INVALID.
EHS-MDCBP-F011
FORM : Confined Space Entry Permit Effectivity : August 3, 2015
Ref. No.: MDCBP-ASCT1-16-EHS-CSEP-
Project Name: AMAIA SKIES CIBAO P1 Project location: CUBAO QUEZON CITY
Contractor's Name: Date Issued: Validity Date: Location: (indicate Block & Lot)
RALGO INDUSTRIES INC. Time:
Details of work to be undertaken: Name of workers:
Note: See attached Attendance Sheet EHS-MDCBP-F011A

Watchman (Name:_______________________________)
Activity to be perform:
Hot works Painting Mechanical Electrical Others : _________________
Gas Test Results:

________ Oxygen Level (O₂) ________ Carbon Monoxide Level (CO)
________ Hydrogen Sulfide (H₂S) ________ Lower Explosive Limit (LEL)

1 Inspection and monitoring of confined space activity is conducted
2 All workers involved understand the hazards of the activity
3 With adequate ventilation / blower and exhaust fan
4 With adequate illumination
5 Proper temporary electrical installation
6 Adequate and standard ladder for access and egress
7 Standard working platforms provided
8 Lifeline and full body harness are provided for emergency use
9 Assigned Watchman familiar with the job and ready to perform rescue in case of emergency
10 Means of communication available (Indicate)
11 Appropriate respirators for water proofing, spraying or painting (MSDS required if any)
12 Complete PPEs were issued and inspected
13
Appropriate barriers with warning sign boards are provided outside the opening of confined space.
14 Proper housekeeping and arrangement is observed before, during and after operation.

Fire Exinguisher Stretcher Stand by vehicle First Aider (Name:__________________________)
Emergency Lights First Aid Kit Oxygen tank Others: Pls. Specify ________________________

CONDITIONS
WORK INSPECTION

EHS-MDCBP-F012
FORM : Lock Out Tag Out (LOTO) Permit Effectivity : August 3, 2015
Ref. No.:________________________________

Contractor's Name: Date Issued: Time Duration: Location/s:
Details of work to be undertaken: Name of worker/s to perform LOTO Position
Type of activity:
Electrical Works Pressure Tank / Pipe Machinery / Equipment Others : _______________
(include type of hazards for lock and tag)
Type of locking device to be used:
Lock and Tag Valve Lock Circuit Breaker Lock Others: ________________
INSPECTION CHECKLIST
1 Is the activity coordinated with other concern/affected personnel
2 Are all personnel undergone proper training
3 Work supervision by competent person (Electrical Engr,Foreman,Safety Officer, etc.)
4 Is the work already provided/covered with Risk Register

6 Other permit required on the activity (i.e.: Hotworks, Scaffold, etc.)
7 Are all machinery, equipments, power lines, pipes, etc. de-energized.
8 Are all locks and tags secured
All information on the tag are complete, free from erasures and signed by
9 Authorized Personnel
10 All equipments/materials are inspected prior to use
Safety equipment and PPE have been provided, inspected and are in good
11 condition
12 Emergency Response Equipments are available on site

CONDITIONS

EHS-MDCBP-F013
FORM : Power Tools Inspection Checklist Effectivity : August 3, 2015
Ref. No.: MDCBP-ASCT1-16-EHS-ETI-
RALGO INDUSTRIES INC. SITE USE
Details of work to be undertaken: Name of workers: Position
INSTALLER
INSTALLER
CABLE YES NO N/A REMARKS

1 Has no signs of mechanical damaged, overheating or corrosion
2 Has no signs of hardening of outer insulator
3 No kinking of cable
4 No coiling of long lengths of cable
5 Cable properly elevated when in use
6 Cable used is royal cord
PLUG YES NO N/A REMARKS
1 Wires properly connected to its terminals
2 Un-insulated ends of wires completely covered by the screws
3 Securing screws suitably tight
4 Fuse of correct rating is fitted (if applicable)
EQUIPMENT YES NO N/A REMARKS
1 Has no signs of metal casing damaged
2 No damaged or defective/substandard switches
3 Has no damaged to plastic casing of double insulated equipment
4 Machine guarding is in placed
PPE YES NO N/A REMARKS
1 Eye protection
2 Ear plugs/Ear muff
3 Gloves (appropriate to work being conducted)
4 Dust mask
5 Face shield (if necessary)
EXTENSION WIRE YES NO N/A REMARKS
1 Has no signs of hardening of outer insulator
2 No kinking of cable
3 No coiling of long lengths of cable
4 Cable properly elevated when in use
5 Cable used is royal cord
6 Female socket has no sign of damaged
7 Female socket is enclosed in a box using a 1/2" board as protection


CONDITIONS

EHS-MDCBP-F014
FORM : Working Near Energized Power Lines Permit Effectivity : August 3, 2015
Ref. No.: ____________________________

Contractor's Name: Date Issued: Validity Date: Location/s:
Time:
Details of work to be undertaken: Name of workers: Position
Minimum Safe Working Clearance Equipment/ Materials to be used Classification of controls applied on work activity
Voltage Min.Distance near energized power lines: Lock out Tag out
Ft M Backhoe: ________________ Rubber / Plastic insulators
Over 750V to 75KV 10 3 Crane: ________________ Insulated non-conductor wall / partition
Over 75KV to 250KV 15 4.5 Scaffolding: ________________ De-energized power lines / equipment
Over 250KV to 550KV 20 6 Others: ________________ Others: ____________________
INSPECTION CHECKLIST
1 Work supervision by competent person (Electrical Engr./Foreman etc.)
2 Orientation of workers prior to start of work
4 Warning signs and barriers are in placed
5 Certified Electrician (TESDA or any recognized Agency)
6 All equipments/materials are inspected prior to use
Safety equipment and PPE have been provided, inspected and are in good
7 condition
8 Proper housekeeping is done before start the activity

Is the power lines provided with insulation/ protection againts contact with
9 other structure/ person
10 Follow minimum safe working clearance
11 Consider the weather condition (wind speed higher than 20miles/hr, heavy rain and
other abnormal phenomena affecting safety)
12 Is the activity coordinated with Authorized Utility Provider (MERALCO, etc.)

13 Emergency Response Team are present on work area

CONDITIONS

WORK INSPECTION

EHS-MDCBP-F015
FORM : Hot Work Permit Effectivity : August 3, 2015
Ref. No.: MDCBP[-ASCT1-16-EHS-HWP-

Project Name: AMIA SKIES CUBAO P1 Project location: CUBAO QUEZON CITY
Contractor's Name: Date Issued: Validity Date: Location:
RALGO INDUSTRIES INC. Time: 07:00 - 04:00
Details of work to be undertaken: Name Authorized Welder: ________________________
Name of workers:
Equipment / Machine to be use:

Oxy-Acetylene Welding Machine Blow torch Power tools Others : ___________________
REQUIREMENTS Yes No N/A Remarks

No flammable/combustible materials near or within the work area
Work area with proper ventillation
With appropriate fire extinguisher (one each hotwork activity)
All workers involved understand the hazards of the activity.
Proper housekeeping is done during and after the activity.
Welding machine and accessories are in good condition.
Proper tapping of welding/electrical machines
Welder and fire watcher are complete with the required PPE
Warning signs and barriers are in placed
With flash protection
With fire blanket/catch
With flashback arrestor (for oxy-acy)
With proper platform( when activity is in critical area or elevated area)
Oxy-Acytelene / pressurized tank is properly secured in a rack.
Certified welder (by TESDA or any recognized Agency)
Others, please specify:


CONDITIONS

WORK INSPECTION

EHS-MDCBP-F016
FORM : Scaffolding Inspection Effectivity : August 3, 2015
Ref. No.: ____________________________

Details of work to be undertaken: Name of workers:
SCAFFOLD CHECKLIST YES NO N/A REMARKS

1 Sufficient and secured guardrails
2 Workers w/ fall protection devices
3 Provided working Flatform
4 Planks/ Flatform properly secured
5 With safe means of access and egress
6 Toe boards set on working platform (if applicable)
7 Fall protection structure are secured on areas with fall hazards
Structural Flaws YES NO N/A REMARKS
1 Set on properly compacted ground or flooring
2 Mudsill properly set & adequate
3 Base plates properly installed
4 Frames are plumb
5 Frame coupling (pins) are secured
6 Cross-braces are secured
7 Anchored and tied to rigid structure
Other Considerations YES NO N/A REMARKS
1 Scaffold system inspected prior to use
2 Warning signs installed
3 Set within 1 meter away from an insulated electrical line
4 Wind condition is observed


CONDITIONS
WORK INSPECTION

EHS-MDCBP-F017
Environment Health and Safety
FORM: Gondola Checklist Effectivity: August 3, 2015
Ref. No.: ____________________________

Project Name: Project Location:
GONDOLA CHECKLIST Equipment Tag No.
Constractor's Name: Date Issued: Validity Date: Location/s:
Details of work to be undertaken: Name of workers Designation Signature
INSPECTION
ITEMS FOR INSPECTION INSPECTION CHECK POINTS & DEFICIENCIES
YES NO
a. No ten randomly broken wires in one rope lay, or five wires in one rope stand in one rope lay
1. Wires & Rope Cable b. No kinking, crushing, unstranding, birdcaging

c. No strand displacement, core protrusion
d. No broken or cut strand, corrosion
a. No cracks
b. No nick (cut or scratch)
c. No gouges (hollow)
2. Platform
d. No cracks on welding joints
e. No substitution of parts
f. No cbending/ deformation
3. Drive Motors a. Functioning properly
4. Over running & Anti-
a. Functioning properly
tilting Safety Devices
a. Must be sound materials
5. Anchorage b. Good Mechanical Construction
c. No serious deformation
a. Properly installed
6. Lifeline
b. Must be secured in an independent structure
7. Legible Identification a. Has legible identification
8. Communications a. Operator provided with 2-way radio/ Whistle, Horn
Emergency Preparedness and Response Equipment

Fire Extinguisher Stretcher Standby Vehicle First Aider (Name:_____________)
Emergency Lights First Aid Kit Oxygen Tank Others: Pls. Specify____________
Inspected by: Re-inspected by: Approved by: Noted by:

EHS-MDCBP-F018
FORM: Critical Lifting Permit Effectivity: August 3, 2015

Ref. No. MDCBP-ASCT1-16-EHS-CLP
Project Name: AMAIA SKIES CUBAO Project Location: CUBAO QUEZON CITY
Weather Condition:
Area / Location : __________________________________________________ Date :
Pick up Point : _________________________________________________
Drop Off Point: Time :
Type of Lifting Equipment: Capacity of Lifting Equipment (kgs) : Type of Materials to be lifted
Tower Crane
Mobile Crane Weight:
Others Dimension:
Operator/s Name: ________________________________
Rigger/s Name:
RIGGING TOOLS AND EQUIPMENT CHECKLIST
Shackles Mode of Communication : ______________________
Work Load Limit : __________________
Type of Slings : ______________________
Work Load Limit : ___________________
LIFTING AND RIGGING INSPECTION
Yes No N/A
1. Has the weight of the load been documented or accurately calculated?
2. Are all items that will be lifted with the equipment(s) included in the weight?
3. Have the lifting equipment(s) that will be used to lift the load been designed for that purpose?
4. Will the lifting equipment(s) be used with the correct shackle?
5. Will the lifting equipment(s) be loaded only in the strong direction(s) of the load?
6. Has the load been checked for loose or unsecured items, which might fall off during the lift?
7. Will the crane hook be over the center of gravity at the initial pick?
8. Have the capacities of the slings and shackles been checked for the load?
9. Have the sling angles been considered when checking the capacity of the slings and shackles?
10. Has the center of gravity been considered when checking the capacities of the sling and shackles?
11. Has the crane received a daily inspection and operational check by the operator?
12. If the lift involves more than one crane, can it be made without any possibility of one of the cranes being overloaded?
13. Is the lift area free of operating process equipment, rebars, or live electrical lines?
14. Has the area under the lift been barricaded or everyone warned to stay away?
15. Is the lifting plan available and reviewed?
16. Is the lifting equipment(s) or appliances received a third party inspection?
17. Is there any barricade on the lifting area?
18. Weather conditions have been considered?
19. Public protection reviewed?
20. Are there any traffic aider that control the flow of vehicle
Emergency Preparedness and Response Plan:
Fire Exinguisher Stretcher Stand by vehicle First Aider (Name:________________)
Emergency Lights First Aid Kit Oxygen tank Others: Pls. Specify ______________
Permit Begins Date: ____________________ Permit Expiration: Date :

Time: ____________________ Time: ________________________
Hard Hat Barricade Tapes Hand Gloves
Safety Shoes Respirator Others: ________________
NOTICE: Failure to comply/wear this requirements the permit will be canceled and voided.
I have personally inspected the working environment and check the condition PERMIT REQUESTOR
of the area. The above-described work is hereby permitted, provided the This person is available at all times and be able to monitor the lifting procedure.
specified requirements are accomplished.
MDCBP Superintendent/Engineer: ___________________________________
Person requesting: ___________________________ ( Name and Signature)
(Name and Signature)
AFTER WORK INSPECTION
Work is completed. Date : ________________ Time: _____________
Work is NOT completed. Date : ________________ Time: _____________
STATUS : _______________________________________________________________________________________________________
Approved by: Noted by :
MDCBP EHS Personnel : _____________________________ ______________________________________

(Name and Signature) MDCBP Project In Charge / Project Manager
NOTE: This permit must be carried by the Permit Requestor at all times. Erasures, Tampering and/or Unauthorized assignatories will be considered as INVALID.
EHS-MDCBP-F019
FORM : Sling Inspection Checklist Effectivity : August 3, 2015
Ref. No.: ___ MDCBP-ASCT1-16-EHS-SIC-
Name of Company: RALGO INDUSTRIES INC. Date of Inspection:
Name of Project : AMAIA SKIES CUBAO P1 Work Load Limit (WLL) :
Location to be use: Serial Number Reach
Sling Type :
Damage Inspection Yes No N/A Comments

Chain
1. Reach Measurement (within manufactures specification)
2. Worn Links
3. Deformed Links
4. Cracked Links
5. Corroded Links
Hook
1. Deformation (exceeding 10 degrees)
2. Throat opening (exceeding 15 % of original)
3. Wear (exceeding 10 % of original)
4. Crack or Nicks
Master Links
1. Long Axis (within manufactures specification)
2. Short axis (within manufacturer specification)
3. Wear (exceeding 10 % of original)
4. Crack or Nicks
Synthetic Fibre Web
1. Edge Cut (exceed web thickness)
2. Abrasion (exceeds 15% of web thickness)
3. Thread Damage
4. Stitches Damaged
5. Corroded (acid or base)
6. Melted
End Fitting Synthetic Fibre Web
1. Pitted
2. Cracked
3. Distorted
4. Broken
Wire Rope
1. Birdcage
2. Damaged/Worn Fitting
3. Kink
4. Crushed
5. Corrosion/Heat Damaged
6. Worn Wire/Strand
7. Broken Wire/Strand
8. No illegible tag
9. End attachment fitting
10. End attachment broken wires
Shackle
PIN
1. Wear exceeding >10 % origin
2. Any bend
BOW
1. Wear exceeding >10 % origin
2. Any change in shape
OTHERS
1. Any cracks or sharp nicks
2. Any modification or parts missing or other notes
Note:
1. User must perform a pre-use ispection (once per shift) for the items listed above.
2. Any lifting materials found to be unsatisfatory must be removed from service.
Inspected BY: NAME SIGNATURE DATE
RIGGER
EHS-MDCBP-F020
FORMS : Safety Observation Report (SOR) Effectivity: August 3, 2015
Ref. No.: ____________________________

SAFETY OBSERVATION REPORT

Contractor : Date :
Work Item : Time :
Location : SOR No. :
Unsafe Condition
Unsafe Act / Unsafe Practices
Non Compliance
Others (Specify): ____________________________
Item No. Particulars Recommended Corrections
References/Attachment:
STOP WORK REQUIRED:

YES Specify particular activity/area :
NO
Issued by : Noted by:
EHS Personnel Project Manager / Project In-Charge

Date : Date :
Received by :
Date : Date :
Corrections to be undertaken: Target date of completion:

EHS-MDCBP-F021
FORMS : Safety Corrective Action Report Effectivity: August 3, 2015
Ref. No.: ____________________________

SAFETY CORRECTIVE ACTION REPORT
Contractor : Date / Time :

Work Item : SCAR No. :
Location : SOR No. :
SAFETY CONCERN / ISSUE

Unsafe Condition
Unsafe Act/Unsafe Practices
Non Compliance / Non Conformance

Others (Specify): ____________________________
Item No. Particulars Corrections Undertaken
References/Attachment: (Proof of corrections made)
Item No. CORRESPONDING CORRECTIVE ACTION PLAN
References/Attachment:
Action Taken by: Verified by:
MDCBP Field Engineer

Date: Date:
Inspected by: Noted by:
MDCBP EHS Personnel MDC BP Project Manager/ PIC

Date: Date:
Other Instruction : ________________________________________________________________________
________________________________________________________________________
EHS-MDCBP-F022a
FORM : EHS Violation Notice Monitoring Effectivity : August 3, 2015
Ref. No.: ____________________________________________________

Project Name: As of:
Project location:
EHS Date of
Date of EHS Rule Recommende Date endorsed to
Notice Name of Violators Company Position Project Description d Sanction PHR
action by Sanction Imposed by PHR
violation Number PHR
Number

MDCBP EHS Personnel Project In-Charge/ Project Manager
EHS-MDCBP-F022b
FORM : EHS Violation Notice Monitoring Effectivity : August 3, 2015

Ref. No.: _______________________________
Project Name: As of:

Project location:
Total Number of Issued NOV: 0

Number of Resolved/ Closed: 0
Number of Resolution Rate: #DIV/0!
MDC Build Plus Personnel
ACTION TAKEN
Number of EHS Number of notice

Number of notice with lighter sanction vs recommendation Number of notice with appropriate sanction vs Number of notice with heavier sanction Number of notice Pending/ No action
Violations Issued with late PHR
(per EHS Rules) recommendation (per EHS Rules) vs recommendation (per EHS Rules)
action
Subcontractors Personnel
ACTION TAKEN
Number of EHS Number of notice

Number of notice with lighter sanction vs recommendation Number of notice with appropriate sanction vs Number of notice with heavier sanction Number of notice Pending/ No action
Violations Issued with late PHR
(per EHS Rules) recommendation (per EHS Rules) vs recommendation (per EHS Rules)
action
Total (MDCBP and Subcontractor Personnel)

ACTION TAKEN
Total Number of
EHS Violations Total Number of notice with heavier Total Number of Total Number of notice Pending/ No action
Total Number of notice with lighter sanction vs Total Number of notice with appropriate sanction vs
Issued sanction vs recommendation (per EHS notice with late
recommendation (per EHS Rules) recommendation (per EHS Rules)
Rules) PHR action
Prepared by:
MDCBP EHS Personnel
EHS-MDCBP-F024
FORM: EHS Audit Report Effectivity: August 3, 2015

Ref. No.: ____________________________
Project: Location: OpCen:

Type of Project: PIC: PM:
EHS Score prior to audit: Date of EHS Checklist:
Validated/Audited EHS Score: Date of Audit: Variance:
% of Applicable Requirements: % of Complied Requirements:
Name of Auditors:
EHS Audit Activities:

1 Opening Meeting with EHS Auditor and Project Team
•Introduction of EHS Audit Team, Project Team/EHS Committee
•Summarize the audit plan
•Project team to briefly discuss project status/accomplishments
•Site Safety Supervisor to provide update about the scorecard and other relevant safety issues
2 Site Inspection (Together with the project team and using the EHS Inspection Checklist as guide,)
•EHS Audit team will observe activities and condition at site
•Conduct interview, take photos
•EHS Auditors to advise outright work stoppage for activities with imminent danger and provide suggestion for corrective actions
3 Document Verification
•Conduct interviews examine the documents, records and materials
•Determine the adequacy of documentation as compare to daily checklist requirements
4 Discussion of EHS Audit Findings
•EHS auditors to discuss the site observations through photographs taken during walkthrough and provide suggestions about the EHS requirements.
5 Input of actual / validated scorecard to EHS Inspection Checklists
•EHS auditors will validate the scoring and explain about the non-conformity
6 Closing Meeting
•EHS Auditors to prepare Audit report and discuss summary of audit findings, summary of recommendations and highlights the good points observed
•Project Team to provide actions plan and commitment dates
Audit Findings
Non-Conformance/s: Equivalent Weight (%) Particulars Photos (where applicable) Recommendation/s
Good Practices
No. Particulars Photos
Auditor/ EHS Department: Signature Auditee/ Project Team: Signature

1 1
2 2
3 3
4 4
5 5
EHS Personnel EHS Head

EHS-MDCBP-F025
FORM : Accident, Investigation Report (AIR) Effectivity : August 3, 2015

Ref. No.: __________________________
Project: Type of Project:

Location: A.I.R. No.
A. ACCIDENT REPORT
Date of Accident: Time of Accident: Specific Location of Accident:
Nature of Accident:
Near-Miss Injury Property Damage Illness
Potential for: First Aid Project Use/Owned Specify:
Injury Medical Treatment Private Use/Owned Others
Property Damage Others: Specify:
Type of Accident:
Fall (of person) Contact with Caught (on/in between) Overexertion
Fall (of object) Engulfment Structure Collapse Others
Struck (against/by) Fire/Explosion Ingestion/Inhalation Specify:
Personnel Involved:
Years of Experience
Name Age C/S Company Position Type of Injury Affected Body Part(s)
In Company In Position
Material/Equipment Involved:
Qty. U/M Description Ownership Estimated Cost (PhP)
Specific activity being undertaken at the time of accident:
Supervisor/s on site at the time of the accident:

MDCBP Subcontractor
Name Position Location/Activity Name Position Location/Activity
1 PIC 1 PIC
2 FE 2 FE
3 S.O. 3 S.O.
4 4
Summary of Accident:
Immediate Action Taken:

1
2
3
4
5
Accident Report Prepared by: Noted by: Reviewed/Concurred by:
Name:
Position:
Signature:
Date:
Page 34 of 53
EHS-MDCBP-F025
B. INVESTIGATION REPORT
Emergency Preparedness and Response Plan followed?
Cause(s) of Accident (Deficiencies)

Unsafe Condition(s) Unsafe Act(s)
1 1
2 2
3 3
4 4
5 5
Cause(s) of Accident (Non-Conformances):
Process/Procedure(s) Not Followed EHS Rule(s) Violated
1 1
2 2
3 3
4 4
5 5
Risk Assessment Accident Classification

Potential Severity Probability of Recurrence Injury/Illness Property Damage
Major Frequent Recordable Major
Serious Occasional Non-Recordable Minor
Minor Rare N/A N/A
Root Cause: (Attached the Root Cause Analysis)
Attachment(s):
No. Description No. Description
1 5
2 6
3 7
4 8
Action(s) to be taken to correct the non-conformances/deficiencies to prevent recurrence:

No. Particulars Responsible Target Completion Signature/Acknowledgement
1
2
3
4
5
Other Instruction(s):
1
2
Investigator(s) Witness(es)
No. Name (and Signature) Company Position No. Name (and Signature) Company Position
1 1
2 2
3 3
4 4
5 5
Investigation Report Prepared by: Noted by:
Name:
Position:
Signature:
Date:
Page 35 of 53
EHS-MDCBP-F025

Report Distribution:
-EHS Dept. (Head Office) - Project Docs Con - Project EHS File - Others:
Page 36 of 53
EHS-MDCBP-F026
FORM : Post Drill Evaluation Effectivity : August 3, 2015

Ref. No.: __________________________
Project Name: Project Location: Date: Time:
Emergency Drill Classification:
Fire Drill Confined Space Emergency
Emergency Evacuation Multiple Emergency Incident
Medical Evacuation Others (Specify): ___________________
Chronology of Event
Time: Event and Procedure
Photos
Review and Recomendation

Action Item/s Recomendations Commited Date Responsible Person
Prepared by: Prepared by:
EHS Personnel Project In-Charge/Project Manager

EHS-MDCBP-F027
FORM : Self Monitoring Report (SMR) Effectivity : August 3, 2015

Ref. No.: ____________________________
NAME OF PROJECT:
LOCATION:
DATE STARTED:
DATE OF COMPLETION:
EXPECTED TOTAL MANHOUR:
EXPECTED TOTAL MANPOWER:
SAFETY HEALTH ENVIRONMENT OTHERS
TOTAL MANPOWER ACCUMUL ACCIDENTS WASTE WASTE

(for the month) TOTAL MANHOURS ATED ELECTRIC
MONTH MEETINGS CONDUCTED WATER FUEL GENARAT RECYCLE Contractor Contractor
(for the month) MANHOU WORK ITY # New
AVERAGE AVERAGE ED D Work Monthly
RS RELATED Workers
MDCBP SubCon (male) (female) NLTI Activity EHS
ILLNESS Inducted
Training Training
LTI
total since
Male Female Indirect Direct Male Female TOTAL Indirect Direct Subcon TOTAL FA MT Monthly Weekly ToolBox in m3 in kwH in Li in m3 in m3
start
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER 0 0
TOTAL: 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00
MONTH
WASTES Jan Feb Mar Apr May June Jul Aug Sep Oct Nov Dec
Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled Generated Recycled
1. Soil (m3)
2. Wood (m3)
3. Plastic (m3)
4. Metal (m3)
5. Tiles / Ceramic (m3)
6. Masonry
a. Acotec Panel (m3)
b. Concrete Debris(m3)
c. Paver Blocks (m3)
7. Papers (m3)
8. Garbage (m3)
TOTAL: 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Prepared by : Checked by: Approved by:
EHS Personnel EHS Personnel Project In-charge/ Project Manager

EHS-MDCBP-F028
FORM : Project EHS Performance Monitoring Effectivity : August 3, 2015
Ref. No.: _______________________________

Project Name:
Location/ OpCen:
Project EHS Performance Monitoring

As of : August 20, 2014
TOTAL
TRIR Previous Years JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Accumalated
Injuries n/a n/a n/a 0 0 0 0 0 0 0
Manhour Exposure n/a n/a n/a 2,330 5,840 10,700 15,576 18,812 11,010 64,268
TRIR - - - 0.00 0.00 0.00 0.00 0.00 0.00 - - - - 0.00
TOTAL
EHS Scorecard Previous Years JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Accumalated
Construction n/a n/a n/a 60.91% 63.78% 69.23% 80.69% 90.05% 89.57% 90.05%
DARWIN P. DAVID ABELARDO H. MALATASTAS

EHS Personnel Project In-Charge / Project Manager
EHS-MDCBP-F029
FORM: List of EHS Legal Requirements and Compliance Monitoring Effectivity: August 3, 2015
Ref. No. : ___________________________________________
Evidence of
Compliance
Applicable
Details of Enforcing Status of
Document
Practice
Code& Title Requirement Environmental Responsible Issuance Date Renewal Date
Permit
Compliance Agency Compliance
Aspect/OHS Hazard
General Environment
PD 1151 ● Environmental Impact
Philippine Statement Environmental Impact
Environmental Policy Statement/
C/O
of 1977 √ Initial Environmental DENR-EMB
PROPONENT
Examination Report/
IEE Checklist
PD 1152 ● Air Quality Management Smoke Refer Air Quality

Philippine ● Water Quality Management ● Emission/Wastewater Management, Water
Environmental Code Land Use Management ● Discharge/Disposal of Solid Quality Management/
of 1977 Natural Resources Management Wastes/Disposal of Solid Waste
and Conservation ● Waste Hazardous Wastes Management & Toxic C/O
DENR-EMB
Management Substances & PROPONENT
Hazardous Wastes
Management
PD 856 ● Sanitary Requirement for Sanitary Permit to

Sanitation Code of Operating an Industrial √ Operate LGU COMPLIED
1975 Establishment (Permit #: XXXX)
Sanitary Permit to
√ Operate for Canteen LGU COMPLIED
(Permit #: XXXX)
PD 984 ● National Policy to Prevent, Air Emissions, Discharges
Pollution Control Law Abate and Control Pollution of to Water & Land No Permit/Report
DENR-EMB N/A
of 1976 Water, Air and Land Required
DAO 2014-02 ● Accreditation of Pollution

Revised Guidelines Control Officer PCO Accreditation
for Pollution Control √ Certificate (Accreditation DENR-EMB COMPLIED
Officer Accreditation #: XXXX)
DAO 2003-27 ● Preparation & Submission of

Amending DAO 26, Quarterly Self-Monitoring Report
DAO 29 and DAO 81 (SMR) &Semi-Annual
Among Others on the Compliance Monitoring Report Quarterly Self-
Preparation and C/O
√ Monitoring Report DENR-EMB
Submission of Self- PROPONENT
(SMR)
Monitoring Report
(SMR)
Semi-Annual
Compliance Monitoring C/O
√ DENR-EMB
Report (CMR) PROPONENT
Environmental Impact Statement

PD 1586 Establishing ● Environmental Impact Environmental Impact
an Environmental Statement Statement/Initial
Impact Statement ● Environmental Compliance Environmental
System Including Certificate Examination Report/IEE
Environmental Checklist
Management Related C/O
√ DENR-EMB
Measures and for PROPONENT
Other Purposes
DAO 1996-37
Further Strengthening
the Implementation of
Environmental Impact
Statement System
Environmental
√ Compliance Certificate DENR-EMB COMPLIED
DAO 2003 - 30 (ECC #: XXXX)
Implementing Rules
and Regulations (IRR)
for the Philippine
Environmental Impact
Statement (EIS)
System
Air Quality Management

RA 8749 ● Emission Testing of Air Smoke Emission
Philippine Clean Air Pollution Sources –Standby Permit to Operate
Act of 1999 Generators (Air Pollution Sources)
√ DENR-EMB N/A
Generator 1
(PTO #: XXXX)
DAO 2000-81
Permit to Operate
Implementing Rules
Internal Combustion
and Regulations of
√ Engine LGU N/A
RA 8749
Generator 1
(PTO #: XXXX)
DAO 2004-26
Amending Rule XIX of Training Certificate of
DAO 2000-81 IRR for CFC Handling
√ DENR-EMB N/A
RA 8749 Technician
(Certificate #: XXXX)
DAO 2010-23 ● Emission Testing of Motor Smoke Emission

Revised Emission Vehicles
Standards for Motor Emission Test Result of
Vehicles Equipped Service Vehicles
with Compression- √ LTO COMPLIED
Service Vehicle 1
Ignition and Spark- (Test Result #: XXXX)
Ignition Engines
Water Quality Management

RA 9275 ● Testing of Effluent Wastewater discharge Annual Effluent Test
Philippine Clean ● Discharge Permit √ Result DENR-EMB N/A
Water Act of 2004 (Test Report #: XXXX)
DAO 2005-10
Implementing Rules Quarterly Effluent Test
and Regulations for √ Result DENR-EMB N/A
RA 9275 (Test Report #: XXXX)
● Testing of Effluent Wastewater discharge
● Discharge Permit
DAO 1990-35
Revised Effluent
Regulations of 1999
DAO 1990-35 Discharge Permit

√ DENR-EMB N/A
Revised Water Usage (Permit #: XXXX)
and
Classification/Water
Quality Criteria
Toxic Substances and Hazardous Wastes Management

RA 6969 Toxic ● Hazardous Waste ID Number Disposal of Hazardous
Substances and ● Use of Accredited Hazardous Wasters
Hazardous and Waste Haulers ●
Hazardous Waste ID
Nuclear Waste Use of Accredited Hazardous
√ Certificate DENR-EMB NOT COMPLIED
Control Act of 1990 Waste Treaters
(HW ID #: XXXX)
● Procedure in Handling and
Storage of Hazardous Wastes
DAO 1992-29
Implementing Rules &
Regulations for RA
6969 Accreditation Certificate
DAO 2013-22 √ of HW Transporter DENR-EMB N/A
Revised Procedures (Accreditation #: XXXX)
and Standards for the
Management of
Hazardous Wastes
DAO 2005-27 Accreditation Certificate

Revised Priority of HW Treater
Chemical List √ (Certificate #: XXXX) DENR-EMB N/A
DAO 1997-38 Hazardous Waste

Chemical Control Handling & Storage
Order for Mercury and Procedure
√ √ DENR-EMB N/A
Mercury Compounds
DAO 1997-39:
Chemical Control
Order for Cyanide and Hazardous Waste
Cyanide Compounds √ √ Treatment Certificate DENR-EMB N/A
DAO 2000-02: Hazardous Waste

Chemical Control √ √ Treatment Certificate N/A
Order for Asbestos (Certificate #: XXXX)
DAO 2004-01:
Chemical Control
Hazardous Waste
Order for
√ √ Treatment Certificate N/A
Polychlorinated
Biphenyls (PCBs)
DAO 2013-24:
Chemical Control Hazardous Waste
Order for Lead and √ √ Treatment Certificate N/A
Lead Compounds (Certificate #: XXXX)
DAO 2013-25:
Revised Regulations
on the Chemical Hazardous Waste
Control Order for √ √ Treatment Certificate N/A
Ozone Depleting (Certificate #: XXXX)
Substances (ODSs)
Solid Waste Management

RA 9003 ● Segregation of Solid Wastes Disposal of Solid Wastes
Ecological Solid ● Barangay Solid Waste
Solid Waste
Waste Management Management Plan √ LGU COMPLIED
Management Plan
Act of 2000 ● Disposal of Solid Wastes to
Sanitary Landfill
DAO 2001-34 ● Use of Accredited Solid Waste
Implementing Rules Hauler Accreditation of Solid
and Regulations for √ Waste Hauler DENR-EMB N/A
RA 9003 (Accreditation #: XXXX)
LGU/Barangay Solid
Waste Management Environmental
Plan Compliance Certificate
√ (ECC) of Sanitary DENR-EMB N/A
Landfill
(ECC #: XXXX)
Solid Waste
Management Procedure DENR-EMB/
√ √ COMPLIED
LGU
International Protocols/Conventions
Montreal Protocol ● Reduction and eventually Discharge of Ozone
Elimination of emissions of man- Depleting Substance CFC Phase-out
made ozone depleting √ √ DENR-EMB N/A
Program
substances (ODS)
Kyoto Protocol – ● Second commitment for the Smoke Emission

Doha Amendment collective reduction of emissions
of greenhouse gases by the
period January 2013 – December Refer to Air Quality
2020. Note: Not yet √ DENR-EMB N/A
Management
enforced. Waiting for acceptance.
The Basel Convention ● Control for the conservation of Disposal of Hazardous

on the Control of transboundary movements of Wastes
Trans-Boundary hazardous wastes and their Refer to Toxic
Movement of disposal Substances and
Hazardous Wastes √ DENR-EMB N/A
Hazardous Wastes
and their Disposal Management
OHS Requirements
PD 442 Labor Code ● Rule 1020 Registration -
of the Philippines Registration of business with the
Book IV Occupational Regional Labor Office Business Registration
Safety & Health √ Certificate DOLE-NCR COMPLIED
Standards (Certificate #: XXXX)
● Rule 1030 Training of OSH

Personnel
- Training and Personnel Accreditation of Safety
Complement Officers Safety Officer 1
Hazardous Workplace √ DOLE-BWC COMPLIED
(Accreditation #:
Number of Workers: 6000 - XXXX)
Seven (7) full-time Safety Man
● Rule 1040 Health & Safety
Committee Report on Health &
√ DOLE-BWC COMPLIED
Typed A: >400 workers Safety Committee
● Rule 1050 Notification and

Records Keeping for Accidents
&/or Occupational Illnesses
- Report
Requirement All work
accidents or occupational
illnesses in places of
employment, resulting in Employer’s Work
disabling condition or dangerous Accident/Illness Report
occurrence will be reported to the
Regional Labor Office on or
before the 20th day of the month
following the date of occurrence

&/or Occupational Illnesses
- Report
Requirement Accident or
Employer’s Work
illness resulting in death or √ DOLE-BWC COMPLIED
Accident/Illness Report
permanent total disability are
notified to the Regional Labor
Office within 24 hours after
occurrence

&/or Occupational Illnesses √ Annual Medical Report DOLE-BWC COMPLIED
- Keeping of
Records Maintain
and keep an accident or illness
records which will be open all Annual Work Accident/
times for inspection to authorized √ Illness Exposure Data DOLE-BWC COMPLIED
personnel Report
● Rule 1060 Premises of

Establishments -
General Provision
Safety signs – adequate fire,
emergency or danger sign and Safety Signage
√ √ COMPLIED
safety instructions of standard Guidelines
colors and sizes visible at all time

Establishments - Housekeeping
Maintain good housekeeping √ √ DOLE-BWC COMPLIED
Guidelines
practices

Establishments
Personal Facilities
Adequate comfort
rooms and lavatories
separate for male and
female
Adequate dressing
rooms for female
workers and locker
rooms for male workers
(Refer to Article 132, Chapter I,
Title III, Book III of the Labor
Code of the Philippines)
Establishments
Space Requirement
Workroom height: at
least 2.7 meters or 2.4
meters for air- Work Area
conditioned rooms √ √ DOLE-BWC NOT COMPLIED
Measurement Report
Area per worker: 11.5
cubic meter per person
Distance between
machines: not less than
0.60 meters
● Rule 1070 Occupational
Health & Environmental Control
Work Environment
Measurement
Perform working
environment measurement
periodically as may be
necessary but not longer Work Environment
than annually √ √ DOLE-BWC NOT COMPLIED
Measurement Report
Working environment
measurement includes
temperature, humidity,
pressure, illumination,
ventilation, concentration
of substances and noise
● Rule 1080 Personal Protective

Equipment - General
Provisions Furnish
workers with protective
equipment for the eyes, face, √ √ PPE Guidelines DOLE-BWC COMPLIED
hands and feet, protective shields
and barriers
● Rule 1090 Hazardous Material

-
Reduction of hazards for
workplaces in which hazardous
substances in solid,iquid or
gaseous forms are Chemical Handling
manufactured, handled and used √ √ Guidelines/ DOLE-BWC COMPLIED
or in which flammable, PPE Guidelines
irritating,offensive or toxic dusts,
fibers, gases, mists or vapors are
generated or leased
● Rule 1100 Gas and Electric
Welding and Cutting Operations Welding Safety
- Control of hazards for welding √ √ Guidelines/ Cutting DOLE-BWC COMPLIED
and cutting operations Safety Guidelines
● Rule 1120 Hazardous Work

Process
- Precautionary and safety
measures for hazardous work Confined Space Work
√ √ DOLE-BWC COMPLIED
processes – underground tank Safety Guidelines
and similar confined space work.
● Rule 1150 Material Handling & Material Handling and

√ √ COMPLIED
Storage Storage Guidelines
● Rule 1200 Machine Guarding Machine Guarding
√ √ COMPLIED
Guidelines
● Rule 1210 Electrical Safety Electrical Safety
√ √ COMPLIED
Guidelines
● Rule 1960 Occupational Occupational Health
√ √ COMPLIED
Health Services Service Guidelines
DO 13 series of 1998 ● Section 5. Construction Safety
Guidelines Governing and Health Program -
Occupational Safety & Establishment of Construction Construction Safety and
Health in the Safety and Health Program √ DOLE-BWC COMPLIED
Health Program
Construction Industry
● Section 6. Personal Protective

Equipment - Furnish
workers with PPE in accordance √ √ PPE Guidelines DOLE-BWC COMPLIED
with Rule 1080
● Section 7. Safety Personnel

- Construction project site is
required to have the minimum Safety Officer 1
required Safety Personnel (Accreditation #: XXX)
● Section 8. Emergency Registered Nurse (PRC

Occupational Health Personnel License #: XXX)
and Facilities (Occupational Nursing
- Provision of competent Certificate #: XXX)
emergency health personnel
within the worksite duly √ √ DOLE-BWC COMPLIED
complemented byadequate Certified First Aider X
medical supplies, equipment and (Certificate #: XXX)
facilities
● Section 9. Construction Safety

Signage -
Provision of Safety Signage to
Safety Signage
warn the workers and the public √ √ DOLE-BWC COMPLIED
Guidelines
of hazards existing in the
workplace
● Section 10. Safety on

Construction Heavy Equipment Third Party Certificate of
- Appropriate certification from Heavy Equipment/
DOLE duly accredited Tesda Certificate of
organizations for Heavy Heavy Equipment
Equipment Operator and Heavy Operator
Equipment.
Maintenance of a separate √ √ Refer to Heavy DOLE-BWC COMPLIED

logbook for data on maintenance, Equipment Certificate
repairs, tests and inspections for Monitoring
each heavy equipment.
Heavy Equipment
Control Guidelines
● Section 11. Construction

Safety and Health Committee -
Establishment of Construction Composition of Health
Safety and Health Committee and Safety Committee
● Section 12. Safety and Health

Information Health Training and
- Safety and health awareness √ √ DOLE-BWC COMPLIED
Seminar Guideline
seminar for workers
● Section 13. Construction Safety Officer 1
Safety and Health Training (Training Certificate #:
- Safety personnel involved in a XXX)
construction project are required
to complete (40)-hour Basic √ DOLE-BWC COMPLIED
Construction Safety and Training
course as prescribed by the BWC
● Section 14: Construction

Safety and Health Reports
- Submission of monthly Monthly summary of all
construction safety and health safety and health
report to the BWC or to the committee meeting
DOLE Regional Office concerned agreements
Summary of all accident

investigations/ reports
√ and periodic hazards DOLE-BWC COMPLIED
assessment with the
corresponding remedial
measures/action for
each hazard
DOLE/BWC/HSD-IP-6
for major accident
resulting in death or
permanent total
disability
● Section 15: Construction

Workers Skill Certificate
- Construction workers in critical Refer to List of
occupations undergo mandatory Construction Workers
skills testing for certification by Skill Certificate
TESDA Monitoring
● Section 16: Workers Welfare
Facilities
-Provision of adequate supply Construction Site
of safe drinking water, sanitary √ √ DOLE-BWC COMPLIED
Sanitary Guidelines
and washing facilities
● Section 17: Cost of

Construction and Safety and
Health Program
-Total cost of implementing a
Construction Safety and Health Budget for implementing
Program be a mandatory integral the Construction Safety DOLE-BWC
part of the project's construction and Health Program
cost as a separate pay item.
RA 9514 Revised Fire ● Fire Safety Inspection √ Fire Safety Inspection

PEZA/LGU-Fire
Code of the Certificate Certificate COMPLIED
Bureau
Philippines (FSIC #: XXXX)
Emergency
● Organization of Fire Response PEZA/LGU-Fire
√ Preparedness & COMPLIED
Team Bureau
Response Team
● Conduct of Semi-Annual Fire
Drill Fire Preparedness &
√ √ Response Procedures/ LGU-Fire Bureau COMPLIED
Fire Exit Route
Monthly Checking of
√ √ LGU-Fire Bureau COMPLIED
Fire Extinguisher
√ √ Fire Drill Result/Report LGU-Fire Bureau COMPLIED
RA 7920 New ● Complement of Professional

Electrical Engineering Electrical Engineer, Registered Professional License
Law Electrical Engineer or Registered (PRC License No:
√ LGU COMPLIED
Master Electrician XXXX)
(PTR #: XXXX)
RA 8495 Philippine ● Complement of Resident

Mechanical Professional Mechanical Professional License
Engineering Act of Engineer, Registered Mechanical (PRC License No:
√ LGU COMPLIED
1988 Engineer or Certified Plant XXXX)
Mechanic (PTR #: XXXX)
RA 9165 ● Formulation of Drug Free

Comprehensive Workplace Policy
Dangerous Drugs Act Drug Free Workplace
of 2002 Policy
Department Order No.

53-03 Guidelines for
the Implementation of
a Drug-Free
Workplace Policies √ √ DOLE-BWC COMPLIED
and Programs for the
Private Sector

37-03 Amendment of
DOLE Administrative
Order No. 89 Series HR/ Clinic Annual Drug Testing
of 1998 (Creating an
Inter-Agency
Committee on the
Prevention of Drug
Abuse in the
Workplace) to include
other government and
private offices
RA 8504 The ● Formulation of HIV/AIDS

Philippine AIDS Prevention & Control Policy HIV/AIDS Prevention &
Prevention & Control √ √ DOLE-BWC COMPLIED
Control Policy
Act
RA 7877 Anti Sexual ● Promulgation of appropriate
Harassment Act of rules and regulations in
1995 consultation with and jointly
approved by the employees
through their duly designated
representatives, prescribing the Anti-Sexual Harassment
procedure for the investigation Control Policy
of sexual harassment cases and
the administrative
sanctions therefore.
DO 73-05 Guidelines ● Formulation of Workplace

for the Policy & Program on TB
Implementation of Prevention and Control.
Policy & Program on Workplace Policy &
Tuberculosis (TB) √ √ Program on TB DOLE-BWC COMPLIED
Prevention and Prevention and Control
Control in the
Workplace
DA 05 series of 2010 ● Formulation of Workplace

Guidelines for the Policy & Program on Hepatitis
Implementation of a B Prevention and Control Workplace Policy &
Workplace Policy and √ √ Program on Hepatitis B DOLE-BWC COMPLIED
Program on Hepatitis Prevention and Control
B

57-04: Guidelines in
Ensuring the Effective
Implementation of the
Labor Standards
Framework

44-03
Commemoration of
April 28 every year as
the "World Day for
Safety and Health at
Work", pursuant to the
mandate of the
International Labor
Organization (ILO)
Other EHS Requirements
●
●
EHS-MDCBP-F030
FORM : DEMOLITION INSPECTION CHECKLIST Effectivity : August 3, 2015

Ref. No. : __________________________________
Name of Company Date
Area Validity
DESCRIPTION YES NO REMARKS

1 All demolition operations of building or other structure high shall be under supervision of a
competent person.
2 No person except the workers who are directly engaged in the demolition shall enter a
demolition area to within a distance equal to 1 1/2 times the height of the structure being
demolished, where this distance is not possible the structure shall be fenced around and no
3 Danger signs shall
unauthorized be shall
person postedbearound
allowedthe structure
within and allarea.
the fenced doors and opening giving access to
the structure shall be kept barricaded or guarded.
4 Identify the type and location of site utilities such as gas, electric, water service lateral, public
sewer lateral, on-lot well or on-lot sewer system on the site plan.
5 All existing gas, electrical and other services likely to endanger a worker shall have been shut
off or disconnected.
6 Asbestos are identified and removed in accordance with DENR-EMB regulations.
7 Glass are removed, transferred to another or protected so that there is no possibility of
breakage at any stage of the demolition.
8 Shoring or other necessary measures shall be taken to prevent the accidental collapse of any
part of the building or structure being demolished or any adjacent building or structure
endangering the workers.
9 Demolition shall proceed systematically, storey by storey, in a descending order and the work
on the upper floors shall be completely over before removing any of the supporting members
of the structure on the lower floor.
10 No building or any part of the structure shall be overloaded with debris or materials to render
it unsafe and hazardous to persons working.
11 No workers shall stand on top of wall, pier or chimney more than six (6) meters (18 ft.) high
unless safe flooring or adequate scaffolding or staging is provided on all sides of the wall,
three (3) meters (9 ft.) away from where he is working.
12 A truss, girder, or other structural member shall not be disconnected until it has been: (a)
relieved of all loads other than its own weight, and (b) provided with temporary supports.
13 Stairs and stair railings, passageways and ladders shall be demolished last.
14 When demolition is suspended or discontinued all access to the remaining part of the building
shall be fenced or barricaded.
15 Supervisors and workers conducts daily pre-activity session about work activity, hazards and
accident prevention.
16 Workers have complete personal protective equipment, such as: hard hat, safety shoes,
gloves, safety vest, mask, and goggles. (earplug or earmuffs if necessary)
Fire Exinguisher Stretcher Stand by vehicle First Aider (Name:____________________)
Emergency Lights First Aid Kit Oxygen tank Others: Pls. Specify __________________

CONDITIONS
WORK INSPECTION

Environment Health and Safety EHS-MDCBP-F0011A
FORM : Confined Space Entry Attendance Effectivity : August 3, 2015
Ref. No.: ________________________
Name of Project Validity / Duration
Watchman Location
NAME POSITION TIME IN SIGNATURE TIME OUT SIGNATURE
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
EHS-MDCBP-F031
FORM : EHS Committee Inspection Report Effectivity : August 3, 2015
Ref. No: _______________________________
Name of Project Project Location
Time Start: Date:
No. Particulars Location Corrective Actions Name of Responsible Remarks / Status

Person
Prepared by: Approved by:
EHS Committee Secretary EHS Committee Chairman

EHS-MDCBP-F032
Environment Health and Safety (EHS) Revision Code: 0 Page 1 of 1

Effectivity : August 3, 2015
FORM : EHS Risk Register
Ref. No.: __________________________________
Date: Rev. No: Prepared by: Reviewed by: Approved by:
Department/Section:
Outstanding
Probability
Detection
Condition Control Aspects / Severity Affected Regulation
Activity/Area/ Environmental Aspects/ Environmental Impact/ Complaint
Hazards Existing Control RPN Conclusion
Infrastructure/Equipment OHS Hazard OHS Effect
N/R A/NR E Di In CODE EN HS BC Title/Code C NC Yes No
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Note: N - Normal, R - Routine, A - Abnormal, NR - Non Routine, E - Emergency, Di - Direct, In - Indirect, C - Compliant, NC - Non Compliant, Env - Environment, HS - Health & Safety, BC - Business Concern, RPN - Risk Priority Number
EHS-MDCBP-F033
Environment Health and Safety (EHS) Revision Code: 0

Effectivity : August 3, 2015
Page 1 of 1
FORM : EHS Residual Risk Register

Ref. No.: ____________________________________________________
Department/Section: Date: Rev No.: Prepared by: Approved by:
Residual Risk
Heirarchy of Control
Environmental Aspect/ OHS Hazard Environmental Impact/ OHS Effect Proposed Control Responsible S Remarks
P DC RPN
1 2 3 4 5 EN HS B
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Note: P - Probability, DC - Detection & Control, S - Seriousness, Env - Environment, HS - Health & Safety, B - Business Concern, RPN - Risk Priority Number
Heirarchy of Controls:
Environment: 1 - Avoid, 2 - Replace, 3 - Reduce, 4 - Re-use/ Re-cycle, 5 - Responsibly Dispose
Health & Safety: 1 - Eliminate, 2 - Subtitute, 3 - Engineering Control, 4 - Administrative Control, Signage and/ or Warning, 5 - Personal Protective Equipment
EHS-MDCBP-F034
FORM : EHS Object Target Program (OTP) Effectivity : August 3, 2015

Ref. No. : ____________________________________
Subject :
Significant EHS Aspect:
Objective :
Target :
TIME
No. Actions Responsible Resource Requirement
Jan Feb Mar Apl May Jun Jul Aug Sep Oct Nov Dec
P
1
A
P
2
A
P
3
A
P
4
A
P
5
A
P
6
A
P
7
A
P
8
A
P
9
A
P
10
A
Prepared By: Reviewed by: Approved by:

EHS-MDCBP-F035
FORM : Use of Powder Actuated Tool Effectivity : August 3, 2015

Ref. No. : __________________________________
Area Name of Certified Person to perform
Type of activity: Type of installation to be taken:
REQUIREMENTS YES NO REMARKS

1 Powder actuated tools are inspected and tested prior to use
2 Is the user is certified and trained personnel to perform the activity
All personnel performing the activity reads and understand the manual instructions,
3
safety precaution and MSDS
4 Is the work already provided/covered with Risk Register
5 Powder tools are no signs of defects and alteration
6 Type of materials and location to be fastened are clearly marked and identified
7 Are all cartrige / shells are free from damages and defects
8 Cartridges or shells are kept in the original containers or in the carrying case
Warning signs and barricades are clearly posted and notification on affected
9
employees has been made
10 Complete Standard Personal Protective Equipment are properly worn.

Fire Exinguisher Stretcher Stand by vehicle First Aider (Name:____________________)
Emergency Lights First Aid Kit Oxygen tank Others: Pls. Specify __________________

CONDITIONS

WORK INSPECTION


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Environment Health and Safety EHS-MDCBP-FOO8

(EHS) Revision Code: 0 Page 1 of 1

No. Documents I.D Number Description Revision Number

FORM : EHS Attendance Sheet Effectivity : August 3, 2015

No. Name Company Position Signature

1 MELFER ARTHUR ABROGENA RALGO PROJECT IN CHARGE

2 GIRLIE TARAN RALGO SAFETY OFFICER

3 NOEL BARRO RALGO FOREMAN

5 RODRIGO AGRAVANTE RALGO INSTALLER

Lugar ng kapanganakan : Petsa ng kapanganakan :

Taong maaring tawagan kung kinakailangan :

Numero ng telepono na maaaring tawagan :

sa paglabag ng mga ito.

nito sa loob ng lugar na pinagtratrabahuhan.

tamang kagamitan pangkaligtasan (PPE’s) kaugnay sa maaaring maging disgrasya o kapahamakan.

Bahagi ng pahayag na nasa taas, sisiguraduhin ko na ang mga sumusunod:

a.) Lugar ng pinagtratrabahuhan

b.) Trabahong kailangang gawin

c.) Apakan sa pinagtratrabahuhan

Ako ay nangangakong susunod sa mga patakaran at alituntunin na ipinapatupad ng MDCBP hinggil sa

FORM : Personal Information Sheet Effectivity: August 3, 2015

Project Name : AMAIA SKIES CUBAO P1 Project Location: CUBAO Q, C Date:

Kapanganakan: Civil Status: Edad:

B. Kasalukuyang iniinom na gamot

C. Huling araw na nagpakunsulta sa doktor

D. Mga nakaraang sakit

E. Huling araw na naoperahan o nalagi sa ospital

F. Mga naging sakit ng magulang o pamilya

D. Mga pagkain na madalas kainin

Temperature: Height: Blood Type:

Taong nagsagawa ng pagsusuri:

FORM : Skilled Workers Certificate Monitoring Effectivity : August 3, 2015

Prepared by: Noted by:

EHS Personnel (Name and Signature) Project In-Charge/Project Manager

FORM : Heavy Equipment Certificate Monitoring Effectivity : August 3, 2015

Ref. No.: ____________________________

Prepared by: Noted by:

FORM : Heavy Equipment Certificate Monitoring Effectivity : August 3, 2015

Heavy Equipment Third Party Certificate

Prepared by: Noted by:

RALGO INDUSTRIES INC. Ref. No.: _ MDCBP-ASCT1-16-EHS-MSDS

Project Name: AMAIA SKIES CUBAO P1 As of: JAN. 26,2016

Item Contact PPE Reactivity Explosive Flammable Enviromental

Rubber Store in a cool

Rubber Store in a cool

FORM : Monthly Fire Extinguisher Monitoring Effectivity : August 3, 2015

NO. LOCATION BODY NO. CLASS TYPE CAPACITY STATUS REMARKS

1 OFFICE 1 ABC 10 LBs. 45kgs. OK TO USE GOOD CONDITION

2 WAREHOUSE 5 ABC 10LBs. 45kgs. OK TO USE GOOD CONDITION

3 SITE TO USE 2 ABC 10LBs. 45kgs. OK TO USE GOOD CONDITION

4 SITE TO USE 3 ABC 10LBs. 45kgs. OK TO USE GOOD CONDITION

5 SITE TO USE 4 ABC 10LBs. 45kgs. OK TO USE GOOD CONDITION

Additional Comments and Recommendation:

Inspected by: Noted by

EHS COMMITTEE MEETING

Action By Date Raised Item No. Particulars

Prepared By: Noted By:

EHS Personnel (Name and Signature) Project Manager/ Project In-Charge

Project Name: Project location:

Details of work to be undertaken: Specific Location:

PROTECTIVE EQUIPMENT REQUIRED

Requested by Designation Contact Number

MDCBP EHS Personnel : _ __________