INDUSTRY

CATEGORY
Date Filed:
OSHC / Regional Extension Unit CAR

No. File No.

CATEGORY: Private sector Public sector Micro-enterprises/ Informal sector

COMPANY DETAILS

Name of company

Owner of company

Address

Telephone No. Mobile No. E-mail address:

` Date established

Nature of business

Type of industry

q Accommodation and food service activities

q Activities of extraterritorial organizations and bodies
q Activities of private households as employers and undifferentiated goods and services and producing activities of
households for own use
q Administrative and support service activities
q Agriculture, forestry and fishing
q Arts, entertainment and recreation
q Construction
q Education
q Electricity, gas, steam and air-conditioning supply
q Financial and insurance activities
q Human health and social work activities
q Information and communication
q Manufacturing
q Mining and quarrying
q Professional, scientific and technical services
q Public administrative and defense; compulsory social security
q Real estate activities
q Transportation and storage
q Water supply, sewerage, waste management and remediation activities
q Wholesale and retail trade; repair of motor vehicles and motorcycles
q Other service activities (Please Specify) ___________________________________________
INDUSTRY
CATEGORY
OSH budget (Total amount and percent allocation vis-à-vis total company’s budget)

Category (Please check):

A. Based on the number of workers
Micro (1 to 9 workers) * q✔ Medium (100 to 199 workers)
q Large (200 and more workers)
Small (10 to 99 workers)

B. Based on Assets/Capitalization *
Micro (up to P3 M)
Small (> P3 M up to P15 M)
q
✔
Medium (> P15 M up to P100 M)
q Large (> P100 M)
*NOTE: as defined by SMED Council, January 2003

TOTAL NUMBER OF WORKERS (including casual / contractual)

COMPANY NAME MALE FEMALE TOTAL

PRINCIPAL:

LIST OF CONTRACTOR (S):

TOTAL

q Unionized

◆ Non-Unionized

By filling out this registration form and signing below, I am giving my consent to the OSHC
to collect, process, retain, store, and dispose my personal data in accordance with the
provisions of Republic Act 10173 – Data Privacy Act of 2012.

I certify that the information I provided are true and correct to the best of my knowledge
and belief. I authorize OSHC and other agencies to investigate the authenticity of all the
information provided.

________________________________
Company Representative Signature Over Printed Name
SIGNATURE OVER PRINTED NAME