Company Profile/License/Registration of Main/General Contractor



 DOLE Registration of Main Contractor

(Please attach photo copy of Registration forms received and approved by the concerned DOLE Regional Office.)





  Sub-contractor's Profile/License →



Name of Subcontractors(If, any) Scope of Work and Project Cost Number of workers PCAB LICENSE VALIDITY Date Date of DOLE Registration

 Project Profile/Description


















 Osh Personnel assigned to the project



Name of Appointed Safety Officer Date Issued of COSH Certificate Certificate of Completion




Name of Appointed First-Aider Date Issued of First-Aid Training Certificate Validity


  Other OH Personnel  if more than 50 workers will be deployed in the project. Put N/A if not applicable.




Name of OH Date of BOSH training Certificate / ID

  (If Heavy Equipment will be used in the Project)  Put N/A if not applicable



Name of Heavy Equipment Operator Heavy Equipment to be used in the project Certificate of Construction Heavy Equipment Photo copy of skills certification from TESDA





  Critical Skills (such as Mason, Carpentry, Scaffolding Erector etc.)*



Name of Skilled Person Skills Copy of Skills Certification from TESDA








 Profile of the person who prepared the CSH Program for the abovementioned Project








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