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Application Form - Simplified

The document outlines the requirements for filing and evaluating the Construction Safety & Health Program (CSHP) for residential or small commercial buildings, indicating that no fees are required. It includes sections for project details, owner information, and a certification statement for the truthfulness of the provided information. The signatory commits to implementing the safety program and complying with occupational safety standards.

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101 views2 pages

Application Form - Simplified

The document outlines the requirements for filing and evaluating the Construction Safety & Health Program (CSHP) for residential or small commercial buildings, indicating that no fees are required. It includes sections for project details, owner information, and a certification statement for the truthfulness of the provided information. The signatory commits to implementing the safety program and complying with occupational safety standards.

Uploaded by

Dole Qfo
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

CONSTRUCTION SAFETY & HEALTH


PROGRAM (CSHP)
Department of Labor and Employment
REGIONAL OFFICE NO.02

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:

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

Signature Over Printed Name Position Date

2 | Page

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