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Workplace Safety Report Form

The document is a report on the safety organization of an establishment submitted to the Bureau of Working Conditions in the Philippines. It provides information on the establishment's name, address, nature of business, number of employees split by gender and shift. It also details the establishment's safety and health policy and program, the composition of its central safety committee including names and positions, and requests a brief description of its process operations and equipment. The report is signed by the general manager or employer of the establishment.

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Eduardo Haban
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607 views1 page

Workplace Safety Report Form

The document is a report on the safety organization of an establishment submitted to the Bureau of Working Conditions in the Philippines. It provides information on the establishment's name, address, nature of business, number of employees split by gender and shift. It also details the establishment's safety and health policy and program, the composition of its central safety committee including names and positions, and requests a brief description of its process operations and equipment. The report is signed by the general manager or employer of the establishment.

Uploaded by

Eduardo Haban
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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DOLE/BWC/OHSD/IP­5

Republic of the Philippines


DEPARTMENT OF LABOR AND EMPLOYMENT
BUREAU OF WORKING CONDITIONS
Manila

REPORT ON SAFETY ORGANIZATION

Date Filed _____________________


Regional Office No. XII
File Number ___________________

Name of Establishment _________________________________________________


Address _____________________________________________________________
Nature of Business ____________________________________________________
Persons Employed, including Management:

1st shift: Male _______ Female ________


2nd shift: Male _______ Female ________
3rd shift: Male _______ Female ________
TOTAL : Male _______ Female ________

A. Policy and Program on Safety and Health:

B. COMPOSITION OF SAFETY COMMITTEE: Type: _______________


Central Safety Committee

Name Position in Establishment

Chairman :

Secretary :

Members :

C. Technical Information:
a. Brief description of process operation and number and kind of equipment.

Submitted by:

_______________________________
General Manager/Employer

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