COMPREHENSIVE FORM

Complete Name of the Company/Main/ General Contractor*

Name of Project Manager/ Contact Person:*

Main Contractor PCAB License No.:*

PCAB Registration Number.:

PCAB Validity Date:*

Complete Address/Location:

Tel. Number / Mobile Number :*

Email:*

Number of Male:*

Number of Female:*

Main Contractor Total Employment:*

Letter of Intent:* Click to Download ORIENTAL MINDORO, OCCIDENTAL MINDORO, MARINDUQUE, ROMBLON, PALAWAN

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PCAB Certificate :*

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per Rule 1020, OSHS:*

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Name of OH	Date of BOSH training	Certificate / ID
Name of OH	Date of BOSH training	Certificate / ID
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		Choose file
		Choose file

Name of Subcontractors(If, any)	Scope of Work and Project Cost	Number of workers	PCAB LICENSE	VALIDITY Date
Name of Subcontractors(If, any)	Scope of Work and Project Cost	Number of workers	PCAB LICENSE	VALIDITY Date

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

Submit this form to : *

Name of the Project :*

Notice of Award :*

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Complete Address :*

Name of project owner :*

Tel No. :*

Fax No. :

Email :*

Project Classification :*

Total Project Cost :*

Estimated number of workers :*

Date of Estimated Start/Execution of the project :*

Estimated Completion of the project:*

Duration of the project : *

Brief Description of Activities/Work Flow (You may attach additional sheet, if necessary) :*

Additional Sheet:

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Name of Appointed Safety Officer	Date Issued of COSH Certificate	Certificate of Completion
Name of Appointed Safety Officer	Date Issued of COSH Certificate	Certificate of Completion			Choose file

Name of Appointed First-Aider	Date Issued of First-Aid Training Certificate	Validity
Name of Appointed First-Aider	Date Issued of First-Aid Training Certificate	Validity			Choose file

Name of Heavy Equipment Operator	Heavy Equipment to be used in the project	Inspection Certificate of Construction Heavy Equipment	Skills certification from TESDA
Name of Heavy Equipment Operator	Heavy Equipment to be used in the project	Inspection Certificate of Construction Heavy Equipment	Skills certification from TESDA

Contract with Nearby Hospital/Clinic : (if needed)

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Construction Safety and Health Program :* Click here to download

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Profile of the person who prepared the CSH Program for the abovementioned Project

Name:*

Educational Background:*

Work Experience in OSH:*

Other Qualifications:*

Submitted By:

Name:*

Position:*

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

INFORMATION

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

Profile of the person who prepared the CSH Program for the abovementioned Project

Submitted By:

NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

TERM OF SERVICE

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