NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

Revised Form: CSHP Form 2A- 2023

Date of revision: April 30, 2023
CONSTRUCTION SAFETY & HEALTH
PROGRAM (CSHP) FOR THE
CONSTRUCTION OF PRIVATE RESIDENCES
Department of Labor and Employment
REGIONAL OFFICE NO. ____ III OR SMALL COMMERCIAL CONSTRUCTION
PROJECTS DIRECTLY ADMINISTERED BY
THE OWNER
Owner of Residential/small commercial building:
Henedino M. Catacutan
Address: Contact No:/Email address:
Greenfields Executive, Sindalan, City of San Fernando 0968 698 7883
PROJECT DETAILS
Specific name of the project:
Proposed 2- Storey Commercial Bldg.

Address/location of the project:

Greenfields Executive, Sindalan, City of San Fernando, Pampanga
Brief description of the residential/small commercial building (number of storeys, type of building,
purpose of the structure):
2 Floor, Commercial

10 workers
Number of workers on site: ________________ Estimated start date of construction:
10 workers
Male: _________________ Female: ________ July 30,2023

Estimated duration of the construction: (calendar days): 180 working days

Specific construction activities to be undertaken:
Excavation Works
1. ____________________________________________________________________________
Structural and Foundation works
2. ____________________________________________________________________________
Roofing Works
3. ___________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________
I/WE HEREBY CERTIFY ON MY HONOR TO THE TRUTHFULNESS OF THE ABOVEMENTIONED
INFORMATION. I/WE, HEREBY COMMIT TO STRICTLY IMPLEMENT HEREIN ATTACHED CONSTRUCTION
SAFETY AND HEALTH PROGRAM DESIGNED FOR THIS SPECIFIC PROJECT.

I/WE SHALL BE HELD RESPONSIBLE FOR ANY INCIDENT/ACCIDENT THAT WILL HAPPEN
DURING THE CONSTRUCTION, ESPECIALLY FOR THE WELFARE OF THE WORKERS WHO ARE
EMPLOYED TO PERFORM THE CONSTRUCTION ACTIVITIES.

I/WE SHALL COMPLY WITH THE OCCUPATIONAL SAFETY AND HEALTH STANDARDS.

Timothy G. Moreno Representative

Signature Over Printed Name Position Date

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