Code FM-CPM22-01

Rev No 2
Effectivity Date October 27, 2023
Issuance No 2

Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. 1
City of San Fernando, La Union

APPROVAL OF CONSTRUCTION SAFETY AND HEALTH PROGRAM (CSHP) for

SMALL CONSTRUCTION PROJECTS

APPLICATION FORM

ONLY for private construction projects with any of the following specifications/scope of work:
1) Two (2) storey and below such as residential houses and garages or any similar projects with fifteen
(15) workers or less;
2) Minor works or repair works such as but not limited to painting, patching, installation of roofs,
windows, fences, renovation/remodelling (interior/exterior) and any related/similar activities; and
3) Projects with an estimated cost of not exceeding Php 3,000,00.00.

Project Title:

Location:
Name of Project Owner/Contractor: Address: Tel. No. E-mail address:

PCAB License No. (if applicable) Estimated cost of project Total no. of workers Duration:

Safety Officer: (with contact no.) Date of start:

First Aider: Date of completion:

Submitted by:
____________________________________________________
(Signature over printed name)
Date:

STATEMENT OF COMMITMENT TO COMPLY WITH OSH REQUIREMENTS

I/We, __________________________________________________________,
(Name of Contractor’s Authorized Official and/or Project Owner)
do hereby commit and bind ourselves to comply with the applicable provisions of the Occupation Safety and Health
Standards (OSHS), Department Order No. 13-98 (Guidelines Governing Occupational Safety and Health in the
Construction Industry) and D.O. No. 198-18 (Implementing Rules and Regulations of R.A. No. 11058 Entitled “An
Act Strengthening Compliance with OSH Standards and Providing Penalties for Violations Thereof”). We hereby
commit to implement a suitable Construction Safety and Health Program designed for the abovementioned project.
We also acknowledge our responsibilities to provide the appropriate Personal Protective Equipment (PPE) and job
safety and health instructions and training to all our workers during the project.

_________________________
Contractor/Project Owner
(Signature over printed name)

Disclaimer: Evaluation/approval of CSHP is a free DOLE service. No fees collected.