SELSC-FM-SP2/SP1-2021

EFFECTIVITY DATE:01-01-2021
REVISION NO.3
CLIENT: URC-SP1
Period Covered: Jan. 2022- Mar. 2022

219 LYFE TOWER, Shaw Blvd. cor. E. Jacinto St. Brgy. Bagong Silang , Mandaluyong City
Tel.: 02-531-2445 / 02-531-2288

DEPLOYMENT CHECKLIST AND EVALUATION

Upon Deployment
MEMBER'S NAME : Safety Training
DATE : Health Card
POSITION: CGMP/HACCP/FSMS/COVID19

DATE HIRED: Company Orientation

Complete Requirements

CRITERIA
Requirement Actual Score Remarks
ATTENDANCE AND PUNCTUALITY 30%
1. Reports for work regurlarly & on time. 8

2. Reports for TBM (URC-SP2 requiresments-15mins. Prior time duty 6

3. Reports for respective work sched. Regularly and on time. 6

4. Request permission before getting absent / leave. 4

5. Reports for GA, Trainings and Seminar 6

Total: 30
GMP/ SAFETY COMPLIANCE 30% Requirement Actual Score Remarks
1. Proper wearing of GMP uniform

(GMP uniform are complete, unaltered, properly worn in good and sanitary
condition( free from rips, tears and traying). These includes shirts, pants shoes, 5
headcap and when applicable facemask, bunny suits, armband and apron

2. Personnel Uniform/PPE

Dedicated and appropriate PPE are availble for use in the work areas including but
not limited to earmuffs, safety hand gloves, safety shoes, reflectorize, shatter proof
masks/goggles, chemical proof apron. PPE are maintained in good and sanitary 5
condition. these are stored in designated area and worn at all timnes and whenever
its applicable.

3. Personnel appearance

No make-up, no objectionable smell, well trimmed beard/mustache, trimmed finger

nails, without nail polish, no false nails and eyelashes, no jewelries and other 3
unsecured objects that may fall into food equipment or containers.

4. Personnel Behavior

1. Implementation for proper hand washing and sanitation, upon entry to working
area, immediately after using the toilet, blowing of nose, touching any exposed parts
of the body and handling other potentially contaminated materials and or 5
equipment

2. no evidences of eating, drinking, chewing gums,candy throat candies and

lozenges, inside production areas. No spitting (expectorating), horse palying, and
sleeping during working hours inside working areas including offices, inside 3
production areas. only authorized/qualified personnel conduct online sensory in
authorized area.

3. No bringing of personal belonging n such as CP and electronic devices inside the

plant. 3

4. Controlled traffic personnel inside plant is observed to prevent cross

contamination 3

5. Cleanliness are maintained and observe in the workplace area at all the time 3

Total: 30
PERFORMANCE TO DUTIES AND RESPONSIBILITIES 20% Requirement Actual Score Remarks

1. Comply to the standard procedure, instructions and safety. 10

2. Able to do all task assigned/ can applies techniques for the improvement of
work/dependent to met demands of work 7

3. Keeping on the work place area during shutdown,start-up,CIP,change of flavor

and if on troubled 3

Total: 20

ADHERENCE TO THE PLANTS RULES AND REGULATION/COOPERATIVE

VALUES (SELSC SUPERIOR ASSESSMENT) 15%
Requirement Actual Score Remarks

1. Transparent bag 3
2. Updated Company ID and Health Card 3
3. Getting off on the prohibited places 3
4. Timecard/signing IN/OUT on Daily attendance 3

5. Carries with the values of the cooperative, sets as good example to the people in
the work place area, manifest the desire to improve the standing in the community 3
through hard work and living out the principles of the cooperative

Total: 15
IMMEDIATE SUPERIORS OBSERVATION 5% MISS OR HIT 5
100%
OVERALL SCORE

Prepared By: Evaluated By:

Ms.Queenie Chelan Flores

URC-SP1 SELSC Safety Officer SP2-Line Coordator

Acknowledged by:

Members Name & Signature

Unit 4102 41st floor Summit One Tower 530 Shaw Blvd. Mandaluyong City/ San Lorenzo Comm.Bldg Grd. Floor Mayumi St. Brgy. San Antonio San Pedro, Laguna
Tel.: 02-531-2445 / 02-531-2288

MATERIAL REQUEST FORM NO.8

DEPARTMENT : SAN PEDRO 1 DATE:

ITEM DESCRIPTION QTY DATE NEEDED STATUS/REMARKS

NO.
PRODUCTION SUPPLIES
SAFETY SHOES
SIZE 36 25 PAIRS
SIZE 37 25 PAIRS
SIZE 38 25 PAIRS
SIZE 39 50 PAIRS
SIZE 40 50 PAIRS
SIZE 41 50 PAIRS
SIZE 42 25 PAIRS
SIZE 43 25 PAIRS
HARD HAT 8 PCS
1st QTR 2022 SP1 PLANT
EAR PLUGS 450 PCS
RUBBER GLOVES 1450 PAIRS
BACK SUPPORT 174 PCS
RAIN COAT 15 PAIRS
FULL BODY HARNESS (not built-in) 25
REFLECTORIZED VEST 10 PCS
SAFETY BOOTS
SIZE 39 5 PAIRS
SIZE 40 5 PAIRS
SIZE 41 5 PAIRS
OFFICE NEEDS
TAPE 20PCS
CANON PIXMA G2010 3 SETS
CORRECTION TAPE 10 PCS
BLACK BALLPEN 2 BOX
BROWN ENVELOP (LONG) 50 PCS
BROWN ENVELOP (SHORT) 50 PCS
PENTEL PEN (BLACK) 3 PCS
PENTEL PEN (RED) 3PCS
WHITE BOARD MARKER 3PCS
BOND PAPER (LONG) 1 BOX ASAP SP1 PLANT OFFICE
BOND PAPER (SHORT) 1 BOX
FOLDER (LONG) 50PCS
FOLDER (SHORT) 50 PCS
CLIP BOARD 6 PCS
LOGBOOK 6 PCS
STAPLES 2 BOX
PLASTIC ENVELOPE (SHORT) 50 PCS
PLASTIC ENVELOPE (LONG) 50 PCS
PAPER CLIPS 2 BOX

PREPARED and REQUEST BY: QUEENIE CHELAN B. FLORES

URC-SP1 SELSC SAFETY OFFICERS 2

CHECKED BY: MARK JEROME YOINGCO

URC-SP1 SELSC ACCOUNT OFFICER
 Unit 4102 41st floor Summit One Tower 530 Shaw Blvd. Mandaluyong City
Tel.: 02-531-2445 / 02-531-2288

MATERIAL REQUEST FORM NO.8

DEPARTMENT : SAN PEDRO 1 DATE:

ITEM DESCRIPTION QTY DATE NEEDED STATUS/REMARKS

NO.
AMOXICILIN 1 BOX
PARACETAMOL 1 BOX
LOPERAMIDE 1 BOX
IBUPROFEN 1 BOX
MEFENAMIC 1 BOX
NAPROXEN 1 BOX
AGUA OXINADA 1 BOTTLE ASAP FOR SP1 PLANT
BETADINE 1 BOTTLE
GAUZE BANDAGE 5 ROLLS
WHITE FLOWER 2 BOTTLES
ICE BAG FOR HOT AND COLD COMPRESS
MEDICAL TAPE 3 ROLLS
ALCOHOL 4 BOTTLES

PREPARED and REQUEST BY: QUEENIE CHELAN B. FLORES

URC-SP2 SELSC SAFETY OFFICERS 2

CHECKED BY: MARK JEROME YOINGCO

URC-SP1 SELSC ACCOUNT OFFICER