Ref.

#: CMO-F-078
Rev. #: 0
Rev. Date: 10 November 2020

COVID-19 DAILY SAFETY CHECKLIST

Project Name: Contractor:

Type of work activity: Supervisor:

DESCRIPTION YES NO REMARKS

Have all personnel temperature checked and recorded
1
before starting the work activity?
There are NO workers/staff that has temperature
2
higher than 37.5C?
Are all wearing prescribed COVID-19 protective mask
3
at all time?
Are all wearing prescribed clothing of the DOLE-
4 OSHC? (Shirt w/ sleeves, Pants, Closed-toe boots,
Hard Hat and High visibility vest)

Are all wearing prescribed COVID-19 additional PPE

5
if necessary? (gloves, goggles and face shields)
Is there an adequate alcohol dispensers or alcohol-
6 based hand sanitizers located at the entrance of the
working area?
Have all washed or sanitized their hands before going
7 to their working area?
Have all personnel passed through the footwear
8 disinfection treatment (foot bath) prior to entering
working area?
Are all equipments and tools clean and disinfect prior
9 to issuance to personnel?
Is Social Distancing (1 Meter minimum) observed at
10
all times?
Is there an adequate available water and soap for
11
washing near the working area?
The working areas must be clean and disinfect after
12
work.

I/We hereby commit to check/inspect daily in accordance with the above checklist and adhere to
implement standards policies and procedures, relating COVID-19 Safety and Security Guidelines

Inspected by:

(Date of Inspection)

Noted by:

DCCD Engineering Corporation (Date of Inspection)

LEGEND:
Ref. #: CMO-F-078
Rev. #: 0
Rev. Date: 10ANovember
- Reqt. Upon Entry
2020 B - Compliance during Construction
AB - both