Simplified CHSP Template

1
1.0 Company Safety and Health Policy
It is the general policy of ALAN C. GOZON to perform work in the safest manner possible consistent with
good construction practices.
To achieve these objectives, we are committed to the following:
 Identification of potential hazards that may arise from the programmed/scheduled work
activities;
 Organizing the work activities so as to minimize the risk arising from them;
 Ensuring that all workers are given orientation/briefing or induction prior to deployment to the
site;
 Establishing a site safety committee to act as policy making body of the project on all issues
pertaining to safety and health;
 Ensure the conduct of daily toolbox meetings;
2.0 Project Details
Project description:
a. specific name of project: Proposed Three-Storey Mixed-Use Building with Deck

b. Address/location:15 M.L. Quezon St., Barangay San Miguel, Taguig City
c. classification of the project: construction of 3-Storey Mixed-Use Building
d. project owner: Sps. Alan C. Gozon and Ma. Josephine C. Gozon
e. name of main contractor and list of sub-contractors (if any) and PCAB License: None
f. estimated number of workers in the site: 15 workers
g. estimated start date of (execution of the project) construction: September 2020
h. duration of the project (no. of calendar days): 270 calendar days
i. specific scope of work to be undertaken: (scope of work attached)
3.0 Composition of Construction Safety and Health Committee (CSHC).
I, Alan C. Gozon, am committed to organize a CSH Committee at the project site to act as a policy making
body of the project on all issues pertaining to safety and health.
3.1 Composition of Construction Safety and Health Committee (SHC)

Our CSHC at the Proposed 3-Storey Mixed-Use Building consist of:
 Chairman – Alan C. Gozon
 Members : Carlos Gozon

Eddie Padua
Benjie Padua
 Secretary – Josephine C. Gozon
3.2 Functions of CSH Committee shall include but are not limited to the following:
 Plans, develops and oversees the accident prevention programs for the construction
project;
2
 Gather feedback, discuss, review safety policies, procedures and recommend

improvements;
 Conducts safety/toolbox meetings.
 Communicate safety and health concerns and information to management and staff
personnel;
 Reviews reports of accident investigation and implementation of program;
 Solicit, evaluate and confirm implementation of safety and health suggestions from
employees.
4.0 Composition of Health & Safety Personnel (if there is any)
 5.1 Complete Name of Safety Officer/s: ________________________________

(please attached the certificate of COSH training)
 5.2 Complete Name of First-Aider/s: __________________________________
(please attached the certificate of First-Aid training)
5.0 Duties and Responsibilities

a. Owner
 Responsible in operation, safety and health of the entire project.
 Delegate personnel for the implementation of safety
 Chairman of the safety and health committee. Arranges schedule and place of meeting and
notifies members.
b. Project Coordinator
 Ensures that all workers under his supervision understand safety responsibility.
 Ensures that proper use of PPE
 Acts without delay in addressing all hazards and unsafe conditions or actions within the scope of
their area of responsibility.
 Holds toolbox safety meeting with the workers.
c. Worker
 Consistently observes work conditions, operation, equipment and tools for the purpose of
accident prevention.
 Complies with all the regulations as well as safe work practices and safety rules.
 Uses all necessary personal protective safety equipment and other safe working practices.
 Corrects any unsafe practices within the scope of work operations and reports any unsafe
conditions.
 Attend all committee/toolbox meetings.
6.0 Conduct of Toolbox Meeting

To hold a daily safety toolbox meeting every morning before the start of work to attain the following
objectives:
 To discuss matters pertaining to the job;
 To provide briefing on the planned work;
 To predict potential hazards or actual occurrence of accidents at the site;
 To provide tips and suggestions on how to prevent possible accidents, and;
 To discuss other pertinent matters (e.g. accident prevention)
3
7.0 Personal Protective Equipment

The company will provide the following basic PPEs and enforce the use of the adequate and approved
type of personal protective clothing and equipment suited to the risk inherent in the work and operations
performed:
 Safety shoes - will be used for general works and to be worn at all times on the site.
 Safety helmet – all workers must wear an approved safety helmet while on the construction
site.
 Safety gloves - to be worn wherever possible for hand protection
 Safety goggles/Face shield – protection against flying objects from doing work such as chipping,
grinding, cutting, drilling works and alike.
 Safety belt/harness – to be used whenever working at height.
 Face Mask
8.0 First-Aid, Health Care Medicines and Equipment Facilities

The owner/employer will provide the following basic first-aid kit and health care medicines and
facilities for workers in the site:
Plasters in a variety of different sizes and shapes
Sterile gauze dressing – various sizes
Disposable sterile gloves
Tweezers
Scissors
Alcohol-free wipes
Sticky tape
Thermometer
Antiseptic cream
Painkiller – paracetamol, aspirin and/or ibuprofen
Cough medicine
Antihistamine cream and/or tablets
Distilled water for cleaning wounds
9.0 Workers Welfare Facilities

The following welfare facilities will be provided in the site to ensure humane working conditions:
a. Adequate supply of safe drinking water
b. Adequate sanitary, washing and sleeping facilities separate for men and women workers
c. Adequate facilities for changing and for the storage and drying of work clothes.
d. Adequate accommodation for taking meals.
10.0 Working Hour & Break Time (Indicate the maximum number of work hours per day).
Maximum number of work hours per day - 150 days (including overtime
8:00am – Start of work; 5:00pm – end of work (2 hrs of overtime allowed if necessary)
Break time: 10:00am to 10:15am; 12:00pm to 1:00pm and 3:00pm to 3:15pm
11.0 Construction Waste Disposal
The main constructor including subcontractors will be responsible for minimizing waste generated
during the implementation of the project. The following procedures for disposal of wastes will be
implemented in the site:
1. Ensure that the construction wastes are segregated from that of domestic waste.
2. All domestic wastes are to be collected on a daily basis.
4
3. Construction debris (broken hollow blocks, spoiled concrete, loose concrete, etc) should
be taken out on the staging area.
4. Oil spills and spoiled greases should be wrapping in the black garbage bag and will be
properly disposed.
5. Application of good housekeeping.
12.0 Safety Work Practices - (indicate safety work practices based on the scope of work to be undertaken. Use
additional sheet if necessary)
Always look out for hazards
Always use PPEs
No-Smoking
Keep work area clean and tidy at all times
No-entry/work under the influence of drugs or alcohol
13.0 Enumerate/describe other safety procedures in accomplishing the project.

Frequent handwashing
Proper wearing of PPEs
High visibility of Safety Officers
Strict implementation of safety guidelines
14.0 Penalties/Sanctions – as a matter of policy and to ensure that the safety and health rules specified herein are
complied with, the owner recommended the following sanctions/penalties for any violations of CSH program(Please
attach company policy on penalties, if there are any). :
 First offense warning – (written)______
 Second offense penalty – (one (1) day salary deduction)
 Third offense penalty – (three (3) days salary deduction)
 Fourth offense dismissal
ALAN C. GOZON ___________________

Name of Project Owner Date
Signature over Printed Name
CARLOS GOZON ___________________

Project Supervisor Date
Signature over Printed Name

Simplified CHSP Template

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Simplified CHSP Template

Uploaded by

Copyright:

Available Formats

1

1.0 Company Safety and Health Policy

To achieve these objectives, we are committed to the following:

2.0 Project Details

a. specific name of project: Proposed Three-Storey Mixed-Use Building with Deck

3.0 Composition of Construction Safety and Health Committee (CSHC).

3.1 Composition of Construction Safety and Health Committee (SHC)

 Chairman – Alan C. Gozon

 Members : Carlos Gozon

 Secretary – Josephine C. Gozon

 Gather feedback, discuss, review safety policies, procedures and recommend

4.0 Composition of Health & Safety Personnel (if there is any)

 5.1 Complete Name of Safety Officer/s: ________________________________

5.0 Duties and Responsibilities

6.0 Conduct of Toolbox Meeting

7.0 Personal Protective Equipment

8.0 First-Aid, Health Care Medicines and Equipment Facilities

9.0 Workers Welfare Facilities

13.0 Enumerate/describe other safety procedures in accomplishing the project.

ALAN C. GOZON ___________________

CARLOS GOZON ___________________

You might also like