Labor Inspction Checklist Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. _____

Labor Inspection Checklist

Authority Number._______________________
Date Issued._______________________
Date of Inspection._______________________
Valid Until._______________________

Instructions: This checklist shall be accomplished by the Labor Inspector (LI) with the participation of the duly authorized representative of employer and worker. Please put a
check (√) mark in the appropriate column to indicate compliance with labor standards.

Part I GENERAL INFORMATION

Name of Establishment  Head Office Address (Floor/Bldg. No./Street/Subdivision - Barangay - City/Municipality - Province - Region) GEO Code
 Branch
 Franchise  within economic zone
Tax Identification No. (TIN): Economic Activity/Principal Product PSIC Code
SEC / DTI Registration No.:
Registration Date: Specific Industry Industry
Owner/President/Manager  Contractor / Subcontractor  Sugar Mill Section:
 Manning Agency  Sugar Planter Division:
 Bus Company  Biofuel Plant Group:
 Private Employment Agency (PEA) Class:
Contact No/s. Email Address: Kind of Ownership
 Sole Proprietorship  Partnership  Corporation  Cooperative
Authorized Capitalization/Paid-up Capital (As of the latest date of audit)
Age Group Female Male Total No. of Shifts: ___
below 15 No. of Workers/Shift Total Assets (as of the latest date of audit)
15-17 yrs Shift Shift Start Shift End  BMBE
18-30 yrs Status:
31-59 yrs  Open  Already Inspected  Moved-Out  Family Business  WFH Arrangement
60-65 yrs  Denied  Cannot Be Located  Non-Operational  Gov't Entity  Virtual Office
TOTAL  Closed  Ceased Operation  Not Existing  JM Only  Transferred
Worker Type Worker Position No. of PWD:
No. of Regular: No. of Managerial: No. of Foreign National:
No. of Probationary: No. of Supervisory: No. of Apprentices:
No. of Fixed-Term: No. of Rank and File: No. of Learners:
No. of Casual: Total: No. of Trainees under DTS:
No. of Regular-Seasonal: No. of Trainees under DTP:
No. of Contractor Workers: No. of SPES Beneficiaries:
Total: No. of Job Start Beneficiaries:
Total: TOTAL:
No. of Contractors engaged: ____ Registered? No. of employees
Name of Contractors: Office Address Yes No deployed to Principal

No. of Principal Employers: ___ No. of employees

Name of Principal Employers: Office Address deployed to Principal

Type of Workplace:
 Low Risk  Medium Risk  High Risk
With Stay Safe App: Business Registration:  Yes - Type of Registration  No

 Yes  No  Other: _______________________  Mayor's Permit  DTI  SEC  DOLE

Safety Officer:  No Mode of Issuance of Safety Seal:
 Yes - Name:____________________________________________________________ Contact No.:__________________________  Email  Hardcopy
Mode of Inspection
 Routine Inspection  Complaint Inspection  OSHS Investigation  Technical Safety Inspection

For Verification of:  Alien Employment Permit Verification Emanating from:  Single Entry Approach
 Verification Inspection of DO-174 Registration  Anonymous Complaint
 OSH Covid Monitoring  Request for NCMB Conciliation-Mediation Proceedings
Date of Last Inspection Date of NR Name of Employer's Representative: Name of Employees' Representative:

Position: Position:
Page 1 of 10
Part II-A.1 GENERAL LABOR STANDARDS COMPLIANCE INDICATORS
Complying Required Correction
COMPLIANCE INDICATORS YES NO N/A Amount
Workers Involved
Schedule of Correction
Total F
Access Pursuant to Art.128 of LCP
Premises
Records
Workers Interview
Records Keeping (Employment records e.g. payrolls, DTR kept at
workplace for at least 3 yrs.)
Minimum Wage
Basic Wage Pay
Cost of Living Allowance (COLA), if applicable
Facility Evaluation Order, if applicable
Piece Rate/Production Standard Order, if applicable
Time of Payment of Wages (wages shall be paid not less than once every 2
weeks or twice a month at intervals not exceeding 16 days)
Meal Period (not less than one hour time-off for regular meals, which is not
compensable. Shorter meal period of not less than 20 minutes may be
given provided that it is credited as compensable hours of work and subject
to certain conditions)
Night Shift Differential pay (not less than 10% of regular wage for each hour
of work performed between 10pm - 6am)
Overtime Pay (additional 25% of hourly rate for work performed on ordinary
day; additional 30% for rest day, special or regular holiday)
Weekly Rest Periods (not less than 24 consecutive hours after every six (6)
consecutive normal workdays)
Holiday Pay (with pay even if unworked; work on regular holiday shall be
paid additional 100% of daily rate; work on regular holiday falling on
employee rest day shall be paid 200% plus 30% thereof)
Premium Pay for Special Day (no work no pay; work on special days shall
be paid regular wage plus at least 30%; special day work falling on
employee's scheduled rest day shall be paid additional 50% of daily rate)
Premium Pay for Rest Day (additional 30% of daily rate for work performed
on rest days; additional 50% for work performed on a rest day which is also
a special day; additional 30% of the regular holiday rate of 200%)
Service Charge (collected by most hotels, restaurants and similar
establishments. 85% shall be distributed equally among the rank-and-file
employees and 15% for management to answer for losses and breakages
and for distribution to managerial employees at the discretion of
management.)
Service Incentive Leave pay (five days with pay per year for those with at
least one year of service; commutable to its money equivalent if not used
within one year)
Non-Interference in the Disposal of Wages and Allowable Deductions (Art.
113-115 of the LCP and Labor Advisory No. 11, S.2014)
De Minimis Benefits (R.A. No. 9504)
(exemption of minimum wage earners from tax)
13th Month Pay (P.D. 851) (not less than 1/12 of total basic salary earned
within calendar year. Does not include COLA and other benefits not
integrated as part of basic salary. To be paid not later than 24 December of
each year.)
Maternity Leave (R.A. 11210) (60 days for normal delivery/ 78 days for
ceasarian section; benefit for first 4 deliveries, abortion/miscarriage)
Paternity Leave (R.A. 8187) (seven days with pay including allowance for
the first 4 deliveries; not convertible to cash)
Parental Leave for Solo Parent (R.A. 8972) (not more than 7 working days
every year)
Leave for Victims of Violence Against Women and their Children (R.A.
9262) (10 days with full pay)
Special Leave for Women (R.A. 9710) (2 months of leave with full pay
based on her gross monthly compensation due to gynecological disorder
surgery)
Social Security Act of 1997 (R.A.8282 as amended) Registration and
Remittance
SSS Coverage
SSS Remittance
Home Development Mutual Fund Law of 2009 (R.A. 9679 as amended)
Registration and Remittance
HDMF Coverage
HDMF Remittance
National Health Insurance Act of 1995 (R.A. 7875 as amended)
Registration and Remittance
Phil Health Coverage
Phil Health Remittance
Page 2 of 10
Part II-A.2 GENERAL LABOR STANDARDS COMPLIANCE INDICATORS
Complying Required Correction
COMPLIANCE INDICATORS YES NO N/A Amount
Workers Involved
Schedule of Correction
Total F
Flexible Work Arrangements (Dept. Advisory No. 2, Series of 2009)
Agreement
Notification to DOLE
Apprenticeship Program (Art.71 of the LCP and TESDA Circular No.
16, s. 2004)
Certificate of Registration from TESDA
Not more than 20% of the total regular employees
Allowance - 75% of the prevailing minimum wage
Learnership Program (duly appproved by TESDA)
Not more than 20% of the total regular employees
Wage/Salary Rate - not less 75% of the applicable minimum wage
Mandatory absorption of trainees under Learnership Program
Dual-Training System (TESDA Circular No. 31, s. 2012)
Training duration is based on the approved Training Plan
Alowance - it shall, in no way, start below 75% of the applicable minimum
daily wage for the number of days actually spent by the student/trainee in the
establishment for in-plan training. (Note: Under DTS 30% goes to the trainee
while 70% goes to the Training Institution).
Insurance coverage is provided for each trainee
Alien Employment Permit (D.O. No. 97, s. 2009 as amended by D.O. No.
120, s. 2012)

Persons with Disability (PWD) Accessibility in support of BP 344

Provisions for Night Workers (R.A. 10151 and D.O. 119-12) (Health-
Assessment, Mandatory Facilities, etc.)
Family Welfare Program (FWP) (Mandatory for large
establishments/establishments employing 200 or more workers)
With free planning services to workers (Art. 134, Labor Code )
With at least any two (2) dimensions of the nine other dimensions of the
FWP (D.O. 56-03)
With Family Welfare Committee (FWC) or similar body organized to
implement FWP activities (D.O. 56-03; DOLE Advisory No. 3-09)
Protection against workplace gender-based violence
With CODI or Committee on Decorum and Investigation (RA 7877 and
RA 11313)
Program and Policy in place on:
Republic Act 7877: Anti-Sexual Harassment Act of 1995
Republic Act 11313: Safe Spaces Act
Copy of RA 7877 posted/available for information in the workplace
Disseminated or posted in a conspicuous place in the workplace a
copy of RA 11313 and its IRR. (Section 19(a), IRR of RA 11313)
Dissemination may be done through:
1. Sending copies of the law and its rules through official notices or means
of communication to heads of different departments, bureaus, offices, units
or such subdivisions in a workplace for proper information of their members;
2. Posting a copy of the law and ist rules online or in the official website of
the workplace:
3. Conduct of orientations on the law and its rules and providing its
employees with copies in print or electronic form as well as preparing
information materials such as primers, frequently asked quastions and the
like

Provided anti-sexual harassment seminars, trainings on gender

sensitivity and orientation on gender-based violence to all employees,
regardless of rank and status (Section 19(b), IRR of RA 11313)
Developed and disseminated, in consultation with all persons in the
workplace, including employees or their representatives and union, if
any, a code of conduct or workplace policy which shall:
1. expressly reiterate the prohibition on gender-based sexual
harassment
2. describe the procedures of the internal mechanism created under
Section 17(c) of the law; and
3. set administrative penalties (Section 19(d), IRR of RA 11313)
Awareness-raising activities on the problem of violence and the
elimination of all forms of violence against women and children (R.A.
10398)
Page 3 of 10
OSH INDICATORS COMPLYING REQUIRED CORRECTION
Workers Schedule of
YES NO Remarks Correction
Involved
Part II-B.1 (Pursuant to D.O. 198 s.18 )
Registration of Establishments (Rule 1020, OSHS)
OSH Program pursuant to Section 12
1. Company Commitment to comply with OSH requirements
2. General Safety and Health Programs
- Hazard Identification Risk Assessment and Control (HIRAC)
- Medical Surveillance
a. Annual Physical Examination
b. Special Examination
c. Random drug-testing for establishments w/ > 10 workers
- First Aid and Emergency Medical Services
3. Policy and Program on Promotion on Drug Free, Mental Health, Healthy Lifestyle
4. Policy and Program on Prevention and Control of HIV/AIDS, Tuberculosis and Hepatitis B
5. Composition of OSH Committee in accordance with Section 13
6. OSH Personnel and Facilities
- Safety Officer/s
- OH Personnel
a. First Aider
b. Nurse
d. Physician
c. Dentist
- Health Facilities
a. Emergency medicines
b. Treatment room
c. Clinic w/ sufficient number of clinic beds (Section 15 )
d. Hospital (or w/ MOA)
e. Dental Clinic (or w/ MOA)
7. Safety and Health Promotion, Training and Education
- Orientation of all workers on OSH (8hrs)
- Conduct of HIRAC
- Continuous Training of OSH Personnel
- Work Permit System Education
8. Conducted Safety Orientation/toolbox meeting
9. OSH Reports
- Report on Safety and Health Organization/s (RSHO )
- Annual Medical Report (AMR)
- Employer's Work Accident/Injury Exposure Data (for every disabling injury ) (WAIR )
- Annual Work Accident/Injury Exposure Data (whether or not there is an accident/illness )
10. Provision of appropiate PPE
- Provision of PPEs
- No Cost to Employee
- Tested and Approved
11. Provision for Safety Signages
- Visible safety signages
- Understandable signages to all workers
12. Workers Welfare Facilities (Section 19)
- Adequate supply of safe drinking water
- Adequate sanitary and washing facilities
- Suitable living accomodation if applicable
- Separate sanitary, washing and sleeping facilities for all gender, if applicable as may be
- Lactation Station
a. With designated area for lactation station in the workplace
b. With facilities such as refrigerator/cooler, table and chair, sink with running water or access
c. Observes Lactation Equivalency Guide if a designated area for workplace lactation station
d. With workplace breastfeeding policy
e. Observes lactation period
f. With Certificate of Exemption issued by DOLE for qualified establishments (D.O. 143, s.
- Ramp, railings and the like
13. Emergency Drills
- Fire drill
- Earthquake drill
14. Solid Waste Management System
15. Control and Management of Hazards (refer to HIRAC )
16. Dust Control and Management System
17. Provision of penalties for OSH Company Policy violation/s
18. Cost of Implementing company OSH Programs is provided
Part II-B.2
Imminent Danger Situation (condition that could cause death or serious physical harm ) (Rule
1012.02, OSHS )
Fire Safety Inspection Certificate (FSIC ) issued by BFP
Fire Protection Equipment/Facilities (Rule 1940, OSHS )
- Fire extinguishers (inspected monthly)
- Fire hoses (properly mounted, accessible and maintained)
- Fire detection devices (installed and functional)
Emergency Exits (2 per floor with no obstructions) (Rule 1943.03, OSHS)
Adequate Aisles/Passageways (sufficient width and height and with signs and markings) (Rule
1060, OSHS)
Proper Office Spacing (between workers and machines)(Rule 1060, OSHS)
Permit/s to Operate for industrial machines covered by DOLE TSI (Rule 1160, 1170, 110, 1210. 1220, 1230/1240, OSHS )
- Boiler - permit to operate
- Pressure Vessel - permit to operate
- Internal Combustion Engine - permit to operate
Page 4 of 10

Page 1 of 2
OSH INDICATORS COMPLYING REQUIRED CORRECTION
Workers Schedule of
YES NO Remarks Correction
Involved
Part II-B.2
- Elevators and other Related Equipment - with permit to operate
- Power Piping Lines Inspection - permit to operate
- Crane and Hoist Equipment - permit to operate
- Turbine - permit to operate
- Electrical Wiring Installation Inspection (Rule 1210) (Cert. of electrical inspection)
Good Housekeeping (conditions of floors, walls and storage rooms) (Rule 1060, OSHS)
Proper Handling and Storage of Materials (e.g. appropriate labels, dotting and storage)(Rule 1150 &
1090, OSHS)
Work Environment Measurement Conducted (maintenance of WEM monitoring report)(Rule 1070,
OSHS)
Adequate Lighting (in Work Areas, in aisles and passageways) (Rule 1070, OSHS on Illumination)
Noise Exposure Control (provide appropriate PPE or isolation of work area)(Rule 1070, OSHS)
Radiation Exposure Control (provide PPE, examination of work area)
Waste Disposal System (waste receptacle and its removal; drainage system)
Proper Ventilation (provision of natural or artificial air supply)(Rule 1070, OSHS)
Airborne Contaminants Control (Rule 1070, OSHS)
Defined Procedure in Performing Hazardous Work (Rule 1120, OSHS)
Approved Work Permit Sytem
Provision of safety measures when operating machines (railing or casing of moving parts) (Rule
1200, OSHS)
Provision of control/safety measures when Hazardous Materials are used (Rule 1090, OSHS)
Stated Safety Measures when Working on Electrical Installations
Safety Guidelines When Perfoming Gas and Electric Welding and Cutting Operations (Rule 1100)
With DOLE-approved Constrution Safety and Health Program (CSHP)
For contractors/subcontractors in the construction industry
- Registration with Philippine Contractors Accreditation Board (PCAB)
- Construction Safety Signages
- Construction Heavy Equipment (CHE) Testing
- Construction Heavy Equipment Operator TESDA Certified
- Construction Worker's Skills Certificate for Critical Occupations
Defined Safety Program When in use of Scaffoldings
Available ECC Logbook
Department Order No. 184-17 "Safety and Health Measures for Workers Who By The Nature of Their
Work, Have to Spend Long Hours Sitting
Department Order No. 178-17 "Safety and Health Measures for Workers Who By The Nature of Their
Work have to Stand at Work"

Page 5 of 10
Note: * OSH Programs considered pre approved once stamp received by DOLE RO/FO having jurisdiction over the company

Page 2 of 2
Part III LABOR RELATIONS CONCERNS
No. of Unions: ___
Name of Union SEBA No. of Members
1 Local Yes Supervisory _____
Independent No Rand-and-File
2 Local Yes Supervisory _____
Independent No Rand-and-File
3 Local Yes Supervisory _____
Independent No Rand-and-File

With Collective Bargaining Agreement (CBA)

Yes
No

Productivity/Performance-Based Scheme
Monetary Non-monetary Others, pls. specify____________________
Facilities Provided
Meals
Lodging

With Workplace Cooperation and Partnership

Date Created No. of Membership No. of Union
with Labor Management Cooperation ___________ _______________ Management: ___ Union: ___
with Other Similar Mechanisms ___________ _______________ Management: ___ Union: ___

With Labor Dispute Management Mechanisms

Organized Date Created No. of Membership
with Grievance Machinery in a CBA ___________ _______________ Management: ___ Union: ___
with GM as Sub-committee of LMC ___________ _______________ Management: ___ Union: ___

Unorganized
with Grievance Machinery ___________ _______________ Management: ___ Union: ___
Other Similar Mechanisms ___________ _______________ Management: ___ Union: ___
with GM as Sub-committee of LMC ___________ _______________ Management: ___ Union: ___

With Pending Preventive Mediation Case

Resolved Date: _______

With Pending Notice of Strike

Resolved Date: _______

With Pending Notice of Lock Out

Resolved Date: _______

Unfair Labor Practice

Cite: ________________________________
________________________________

Freedom of Association

With Personnel/Employee Handbook on Company Policy

Page 10 of 10
Part II-C ANTI-CHILD LABOR LAW COMPLIANCE INDICATORS (REPUBLIC ACT 9231)
COMPLYING? REQUIRED CORRECTION
COMPLIANCE INDICATORS YES NO Remarks
Workers Schedule of
Involved Correction

Employment of children below 15 years of age

With work permit from the DOLE
Work is not more than 4 hours a day / 20 hours a
week
Work is not between 8:00 pm to 6:00 am of the
following day

Employment of children 15-17 years of age

Work is not more than 8 hours a day / 40 hours a

week
Work is not between 10:00 p.m. to 6:00 a.m. of the
following day
Children below 18 years of age are NOT engaged
in any of the following:
Prostitution
Obscene or lewd shows
Production of pornography or for pornographic
performances
Slavery or any similar practices, such as sale or
trafficking of children, debt bondage, serfdom, forced
labor, recruitment of children for armed conflict

Illegal or illicit activiies such as production/trafficking

of dangerous drugs or volatile substances

Work which, by its nature or the circumstances in

which it is carried out, is hazardous or likely to be
harmful to the health, safety or morals of children
(DO 149-A series of 2017)

As a model in any advertisement directly or indirectly

promoting alcoholic beverages,intoxicating drinks,
tobacco and its by-products, gambling or any form of
violence or pornography
Violation, if any, did NOT result to:
Death of child
Insanity of child
Serious physical injuries of child