Comprehensive CHSP Template
Comprehensive CHSP Template
08-F-02
CHECKLIST FOR EVALUATION OF CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP)
per requirements of D.O. No. 13 series of 1998
NAME OF THE COMPANY/ MAIN/ GENERAL CONTACTOR:
Yes No Remarks
A. General Requirements
a. Two (2) copies of letter of intent.
b. Name of authorized contact person with telephone number/s.
c. Two (2) copies of the Safety and Health Program. One copy must
be original print.
Comments:
24. Standard Operating Procedure and Job Hazard Analysis for
the following activities and other hazardous work not outlined
herein.
a. Site Clearing
b. Excavations
c. Erection and dismantling of scaffolds and other temporary
working platforms
d. Temporary electrical connections/installations
e. Use of scaffolds and other temporary working platforms
f. Working at unprotected elevated working platforms or surfaces
g. Use of power tools and equipment
h. Gas and electric welding and cutting operations
i. Working in confined spaces
j. Use of internal combustion engines
k. Handling hazardous and/or toxic chemical substances
l. Use of hand tools
m. Use of mechanized lifting appliances for movement of materials
n. Use of construction heavy equipment
o. Demolition
p. Installation, use and dismantling of hoist and elevators
25. Penalties/Sanctions for violation of the provision/s of the
C. ATTACHMENTS
1. Photocopy of Registration Forms received and approved by the
concerned DOLE Regional Office:
- per Rule 1020 of the OSHS (one time Registration)
2. Photocopy of valid registration/license with DTI-PCAB
3. Photocopy of Notice of Award/ Notice to Proceed/ Project Contract
4. Photocopy of Certificate of Completion on required Training of all
designated OSH Personnel
- Safety Officer - Basic Occupational Safety and Health Training
for Construction Site Safety Officer/ Construction Safety Training
- First Aider - Standard First Aid Training and valid PNRC ID as
first-aider.
- OH Nurse - Basic Occupational Safety and Health Training for
Occupational Health Nurse (if applicable).
- OH Dentist - Basic Course on Occupational Dental Health. (if
- OH Physician - Basic Course on Occupational Medicine. (if applicable)
5. Certificate of Inspection and Testing of Construction Heavy Equipment
(CHE) conducted by a DOLE accredited inspection and testing
organization accredited by DOLE; (if any)
6. Skills Certificate of Construction Heavy Equipment operators
issued by TESDA (if any)
7. Contract with nearby hospital/clinic in lieu of the required infirmary
hospital. (if any)
PRE-EVALUATION SHEET
(To be filled-up by the DOLE-RO Frontliner/Pre-evaluator)
Return CSHP Application and documents submitted
______________________________________
(Signature over Printed Name and Position of the Client)
Date:_____________