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Form2a 1

This document outlines the Construction Safety and Health Program (CSHP) form for private residential or small commercial construction projects directly administered by the owner. It requires the owner's contact information, project details including location, description, estimated start/completion dates and workforce details. The owner certifies the truthfulness of the information and commits to strictly implementing the attached CSHP, taking responsibility for any incidents and complying with occupational safety and health standards. No fees are required to file and evaluate the CSHP.

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3K views2 pages

Form2a 1

This document outlines the Construction Safety and Health Program (CSHP) form for private residential or small commercial construction projects directly administered by the owner. It requires the owner's contact information, project details including location, description, estimated start/completion dates and workforce details. The owner certifies the truthfulness of the information and commits to strictly implementing the attached CSHP, taking responsibility for any incidents and complying with occupational safety and health standards. No fees are required to file and evaluate the CSHP.

Uploaded by

ghi Yo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP

Revised Form: CSHP Form 2A- 2023


Date of revision: April 30, 2023
CONSTRUCTION SAFETY & HEALTH
PROGRAM (CSHP) FOR THE
CONSTRUCTION OF PRIVATE RESIDENCES
Department of Labor and Employment
REGIONAL OFFICE NO. ____ OR SMALL COMMERCIAL CONSTRUCTION
PROJECTS DIRECTLY ADMINISTERED BY
THE OWNER
Owner of Residential/small commercial building:

Address: Contact No:/Email address:

PROJECT DETAILS
Specific name of the project:

Address/location of the project:

Brief description of the residential/small commercial building (number of storeys, type of building,
purpose of the structure):

Number of workers on site: Estimated start date of construction:


________________
Male: _________________ Female:
________
Estimated duration of the construction: (calendar days):
Specific construction activities to be undertaken:
1. __________________________________________________________________________
__
2. __________________________________________________________________________
__
3. __________________________________________________________________________
_
4. __________________________________________________________________________
__
5. __________________________________________________________________________
__
I/WE HEREBY CERTIFY ON MY HONOR TO THE TRUTHFULNESS OF THE ABOVEMENTIONED
INFORMATION. I/WE, HEREBY COMMIT TO STRICTLY IMPLEMENT HEREIN ATTACHED
CONSTRUCTION SAFETY AND HEALTH PROGRAM DESIGNED FOR THIS SPECIFIC PROJECT.

I/WE SHALL BE HELD RESPONSIBLE FOR ANY INCIDENT/ACCIDENT THAT WILL HAPPEN
DURING THE CONSTRUCTION, ESPECIALLY FOR THE WELFARE OF THE WORKERS WHO ARE
EMPLOYED TO PERFORM THE CONSTRUCTION ACTIVITIES.

I/WE SHALL COMPLY WITH THE OCCUPATIONAL SAFETY AND HEALTH STANDARDS.

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NO FEES REQUIRED FOR THE FILING AND EVALUATION OF CSHP
Revised Form: CSHP Form 2A- 2023
Date of revision: April 30, 2023

Signature Over Printed Name Position Date

2 | Page

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