CSHP Compre.-Application Form
CSHP Compre.-Application Form
Instructions: This form shall be duly accomplished and submitted by the MAIN/GENERAL
CONTRACTOR in applying for an approval of a Construction Safety and Health Program intended for
a specific construction project.
Only an application form with a complete requirements and attachments will be processed. Application
found with incomplete requirements will be given 15 calendar days to comply. Failure to comply
within the prescribed period, the application will be deemed disapproved.
Fax No.
Name of Project Manager/Contact Person: Email:
Date of Validity:_______________________
DOLE Registration of Main Contractor ( Pls. attach photo copy of Registration forms received and approved by
the concerned DOLE Regional Office)
Date Registered/Approved DOLE-RO
a. per DO 18-02 ( requires yearly renewal) __________________ __________
2.
3.
4.
5.
Email : _____________
Brief Description of Activities/Work Flow (You may attach additional sheet, if necessary)
____________________________________ ______________________________________
Date of his/her BOSH training: _________________ Date of First –Aid Training: _______________
(Pls. attach photo copy of Certificate of Completion on the Basic Validity of ID: __________________
OSH Course for Construction Site Safety Officers issued by DOLE-
BWC accredited Safety Training Organizations or recognized (Pls. attach photo copy of Certificate of First-Aid Training
institutions) and Valid First Aider ID from PNRC
Other OH personnel (if more than 50 workers will be deployed in the project)
Name Date of BOSH Training
OH Nurse
OH Physician
Dentist
Profile of the person who prepared the CSH Program for the abovementioned Project:
Name and Signature Educational Background:
Submitted By:
Position: ______________________________________________________
Date: ______________________________________________________