DOLE/BWC/OHSD/OH-47 A
Republic of the Philippines
Department of Labor and Employment
Bureau of Working Conditions
Occupational Health and Safety Division
ANNUAL MEDICAL REPORT FORM
For Period January 1, 2022 to December 31, 2022 a
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
1. Name of the Establishment: SYTECS MANUFACTUIRNG PHILIPPINES INC.
_______________________________________________________________________________
2. Address: Unit 1B CCMC CMPD.1 L3&4 B-10A LISP III Sta. Anastacia, Sto. Tomas, Batangas 4234
_______________________________________________________________________________________________
TETSUYA SONODA
3. Name of Owner/Manager: _______________________________________________________________________________________
4. Nature of Business and Products/Service (Ex. Manufacturing, Textile)
Manufacturing of Plastic Injected Parts
_______________________________________________________________________________________________
5. Total Numbers of Employees: ___________
27 Number of Shifts: 2
6. Number Distribution of Employees as to nature of workplace, sex and workshift
Office Production/Shop
1st shift 2nd shift 3rd shift
Male: 4
_________ 7
________________ 3
_________________ __________________
Female: 2
_________ 6
________________ 5
_________________ __________________
Total: _________
6 ________________
13 _________________
8 __________________
7. Preventive Occupational Health Services: (Check or Cross)
a. Occupational Health Services is organized/provided by:
(X) the establishment/undertaking
( ) government authority/institution
( ) other bodies/groups/institution (specify) _______________________________________________
______________________________________________________________________________
b. Occupational Health services as described under 7a above, is organized/ provided as a service:
(X) solely for the workers of the establishment/ undertaking
( ) common to a number of establishments/undertakings
c. The employer engages the services of:
( ) Occupational health practitioner
Name: ______________________________________________________________________________
Address: ______________________________________________________________________________________
( ) Occupational health physician
Name: ______________________________________________________________________________
Address: ______________________________________________________________________________________
( ) Occupational health nurse
Name: ______________________________________________________________________________
Address: ______________________________________________________________________________________
d. The occupational health physician/practitioner/nurse/personnel conducts an inspection of the workplace:
(X) once every month ( ) once every three (3) months
( ) once every two (2) months ( ) once every three (6) months
( ) other details:________________________________________________________________________________
_____________________________________________________________________________
8. Emergency Occupational Health Services:
a. The employer provides a treatment room/medical clinic in the workplace with medicines and facilities:
(X) Yes ______________ ( ) No _________________
( ) others, please specify ______________________________________________________________________
______________________________________________________________________________
b. Schedule of attendance in the workplace:
Workshift
Occupational health physician: ___________________________ hrs/day ______________
Occupational health practitioner: _________________________ hrs/day ______________
Occupational health physician: ___________________________ hrs/day ______________
c. Schedule of attendance of full-time first aider:
(X) 1st workshift
(X) 2nd workshift
( ) 3rd workshift
d. The following occupational health personnel of this establishment have undergone training in occupational health and safety/ first aid:
( ) occupational health physician
( ) occupational health nurse
(X) first aider
( ) others, please specify ________________________________________________________________________________
________________________________________________________________________________________
9. Occupational Health Services:
a. The occupational health personnel of this establishment conducts regular appraisal of the sanitation system in the workplace:
( ) Yes ( ) No
b. Number of workers who underwent the following medical examinations:
Physical Exams X-rays Urinalysis
1. Pre-placement 2
_______________________ 2
_______________________ 2
_______________________
2. Periodic 23
_______________________ 23
_______________________ 23
_______________________
3. Return-to-work _______________________ _______________________ _______________________
4. Transfer _______________________ _______________________ _______________________
5. Special _______________________ _______________________ _______________________
6. Separation _______________________ _______________________ _______________________
Stool Exams Blood Test ECG others
1. Pre-placement _______________________
2 _______________________
2 _______________________
2. Periodic 21
_______________________ 23
_______________________ 4
_______________________
3. Return-to-work _______________________ _______________________ _______________________
4. Transfer _______________________ _______________________ _______________________
5. Special _______________________ _______________________ _______________________
6. Separation _______________________ _______________________ _______________________
10. Report of Diseases
a. Number of cases diagnosed/treated for the following diseases (/ or X):
Male Female Total Number of Cases
Skin:
( ) allergy _______________________ _______________________ _______________________
( ) dermatoses _______________________ _______________________ _______________________
( ) infection as follicuilitiis/ _______________________ _______________________ _______________________
Absecess/ paranychia
( ) others _______________________ _______________________ _______________________
Head
( ) migraine headache _______________________ _______________________ _______________________
( ) tension headache _______________________ _______________________ _______________________
( ) others _______________________ _______________________ _______________________
Eyes
( ) Error of refraction _______________________ _______________________ _______________________
( ) Bacterial/Viral conjunctivities _______________________ _______________________ _______________________
(x) Cataract 1
_______________________ _______________________ 1
_______________________
( ) others _______________________ _______________________ _______________________
Mouth & ENT:
( ) Gingivitis _______________________ _______________________ _______________________
( ) Herpes Labiales/nasalis _______________________ _______________________ _______________________
( ) Otitis Media/Externa _______________________ _______________________ _______________________
( ) Deafness _______________________ _______________________ _______________________
( ) Meniere’s syndrome/ Vertigo _______________________ _______________________ _______________________
( ) Rhinitis/colds _______________________ _______________________ _______________________
( ) Nasal Polyps _______________________ _______________________ _______________________
( ) Sinusitis _______________________ _______________________ _______________________
( ) Tonsillopharyngitis _______________________ _______________________ _______________________
( ) Laryngitis _______________________ _______________________ _______________________
(X) Others _______________________ 5
_______________________ 5
_______________________
Male Female Total Number of Cases
Respiratory:
( ) Bronchitis _______________________ _______________________ _______________________
( ) Pronchial Asthma _______________________ _______________________ _______________________
( ) Pneumonia _______________________ _______________________ _______________________
( )Tubercolosis _______________________ _______________________ _______________________
( ) Pneumoconiosos _______________________ _______________________ _______________________
( ) Others _______________________ _______________________ _______________________
Heart and Blood Vessel:
(X) Hypertension 2
_______________________ _______________________ 2
_______________________
( ) Hypotension _______________________ _______________________ _______________________
( ) Angina Pectoris _______________________ _______________________ _______________________
( ) Myocardial infarction _______________________ _______________________ _______________________
( ) Vascular disturbances in _______________________ _______________________ _______________________
Extremeties due to continuous vibration
( ) others _______________________ _______________________ _______________________
Gastrointestinal:
( ) Gastroenteritis/Diarrhea _______________________ _______________________ _______________________
( ) Amoebiasis _______________________ _______________________ _______________________
( ) Gastritis/Hyperacidity _______________________ _______________________ _______________________
( ) Appendicitis _______________________ _______________________ _______________________
( ) Infectious Hepatitis _______________________ _______________________ _______________________
( ) Liver Cirrchosis _______________________ _______________________ _______________________
( ) Hepatic Absecess _______________________ _______________________ _______________________
( ) Cancer (Hepatic/Gastric) _______________________ _______________________ _______________________
( ) Others _______________________ _______________________ _______________________
Genito-Urinary:
(X) Urinary Tract Infection 4
_______________________ 2
_______________________ 6
_______________________
( ) Stones _______________________ _______________________ _______________________
( ) Cancer _______________________ _______________________ _______________________
( ) Others _______________________ _______________________ _______________________
Reproductive:
( ) Dysmenorrhea _______________________ _______________________ _______________________
( ) Infection (Cervicitis) _______________________ _______________________ _______________________
(Vaginitis)
( ) Abortion (Spontaneous) _______________________ _______________________ _______________________
(Threatened)
( ) Hyperemesis Gravidarum _______________________ _______________________ _______________________
( ) Uterine Tumors _______________________ _______________________ _______________________
( ) Cervical Polyp/Cancer _______________________ _______________________ _______________________
( ) Ovarian Cyst/Tumors _______________________ _______________________ _______________________
( ) Sexuallly-Transmitted Diseases _______________________ _______________________ _______________________
( ) Hernia (Inguinal) _______________________ _______________________ _______________________
(Femoral)
( ) Others _______________________ _______________________ _______________________
Neuromuscular/Skeletal/Joints:
( ) Perpheral Neuritis _______________________ _______________________ _______________________
( ) Torticolis _______________________ _______________________ _______________________
( ) Arthritis _______________________ _______________________ _______________________
( ) Others _______________________ _______________________ _______________________
Lymphatics and Circulatory:
( ) Anemia _______________________ _______________________ _______________________
( ) Leukemia _______________________ _______________________ _______________________
( ) Cerebrovascular Accidents _______________________ _______________________ _______________________
( ) Lymphadenitis _______________________ _______________________ _______________________
( ) Lymphoma _______________________ _______________________ _______________________
Infectious Diseases:
( ) Influenza _______________________ _______________________ _______________________
( ) Typhoid/Paratyphoid Fever _______________________ _______________________ _______________________
( ) Cholera _______________________ _______________________ _______________________
( ) Measles _______________________ _______________________ _______________________
( ) Mumps _______________________ _______________________ _______________________
( ) Tetanus _______________________ _______________________ _______________________
( ) Malaria _______________________ _______________________ _______________________
( ) Schistosomiasis _______________________ _______________________ _______________________
( ) Herpes Zoste _______________________ _______________________ _______________________
( ) Chicken Fox _______________________ _______________________ _______________________
( ) German Measles _______________________ _______________________ _______________________
( ) Rabies _______________________ _______________________ _______________________
( ) Others _______________________ _______________________ _______________________
Diseases due to Physical Environment:
( ) Diseases due to abnormalities _______________________ _______________________ _______________________
in temperature and humidity
( ) Diseases due to abnormalities _______________________ _______________________ _______________________
In air pressure
( ) Poisoning/Over dosage to _______________________ _______________________ _______________________
Chemicals
TOTAL NUMBER . . . . . . . . . _______________________ _______________________ _______________________
11. Report of Occupational Accidents/Injuries
Male Female Parts of Body Affected
Total Number of Cases
Contussion, bruises, hematoma _______________________ _______________________ _______________________
Abrasions _______________________ _______________________ _______________________
Cuts, Lacerationsm, punctures _______________________ _______________________ _______________________
Concussion _______________________ _______________________ _______________________
Avulsion _______________________ _______________________ _______________________
Amputation, loss of body parts _______________________ _______________________ _______________________
Crushing injuries _______________________ _______________________ _______________________
Spinal inuries _______________________ _______________________ _______________________
Cranial inuries _______________________ _______________________ _______________________
Sprains _______________________ _______________________ _______________________
Dislocatio/Fractures _______________________ _______________________ _______________________
Chemical burns _______________________ _______________________ _______________________
12. Immunization Program (indicate the number)
Tetanus Taxoid injection _______________________ _______________________ _______________________
Tetanus Antitoxin injection _______________________ _______________________ _______________________
Tetanus Globulin injection _______________________ _______________________ _______________________
Anti-Cholera, Anti-Typhoid Triple Vaccine _______________________ _______________________ _______________________
Others (Please specify) _______________________ _______________________ _______________________
13. Keeping of Medical-Records of Workers (Please check) (X) done ( ) not done
14. Health Education and Counselling by Heatlh and Safety personnel:
(Please check one or more)
(x) done individually as each worker comes to the clinic for consultation
( ) done in organized group discussions/seminars
( ) done with the use of visual displays and/or promotional material, leaflets, etc.
15. Other Health Programs
Use of Visual Aid/
Seminar Counselling
Materials
Nutrition Program
Maternal and Childcare Program
Family Planning Program
Mental Health Activities
Personal Health Maintenance
Physical Fitness Program: (Please Check)
Sport Activities ( ) Yes ( ) No
Morning Exercise-
Recreational Activities ( ) Yes ( ) No
Rajio Taiso
Others (Please Specify)________________________ (X) Yes ( ) No
16. Hazards in the Workplace: (Please check and give details of the activities substance)
Substances and/or Sources Number of Workers Exposed
a. Chemical Hazards:
( ) dust (Ex. Silica dust) ______________________________ ________________________________
( ) liquids (Ex. Mercury) ______________________________ ________________________________
( ) mist/fumes/vapors ______________________________ ________________________________
(Ex. Mist from paint spraying)
( ) gas (ex. CO, H2S) ______________________________ ________________________________
( ) Others (please specify) ______________________________ ________________________________
b. Physical Hazards:
(X) noise Deburring Process
______________________________ 2 Production Operator
________________________________
(X) temperature/humidity Molding operation
______________________________ 6 Technicians
________________________________
( ) pressure ______________________________ ________________________________
( ) illumination ______________________________ ________________________________
( ) radiation/ultraviolet/microwave ______________________________ ________________________________
( ) others (please specify) ______________________________ ________________________________
c. Biological Hazards:
( ) Viral ______________________________ ________________________________
( ) Bacterial ______________________________ ________________________________
( ) Fungal ______________________________ ________________________________
( ) Parasitic ______________________________ ________________________________
( ) Others ______________________________ ________________________________
d. Ergonomic Stress:
( ) Exhausting physical work ______________________________ ________________________________
( ) Prolonged Standing ______________________________ ________________________________
( ) Low Back Pain ______________________________ ________________________________
( ) Unfavorable work posture ______________________________ ________________________________
( ) Static/monotonous work ______________________________ ________________________________
( ) Others, specify ______________________________ ________________________________
Submitted by:
DARRYL ROBLES, SO2 February , 2023
Medical Personnel/ Title Date
Noted by:
TETSUYA SONODA
Employer
