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DOLE/BWC/OHSD/IP-5 Report on Safety and Health Organization
BWC report form for safety and Health Organization
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Republic of the Philippines
Department of Labor and Employment
BUREAU OF WORKING CONDITIONS
Manila
REPORT ON HEALTH AND SAFETY ORGANIZATION
Date______________
Regional Labor Office No. ____
File Number _______________
Name of Establishment: _____________________________________________________________________
Address: _________________________________________________________________________________
Nature of Business: ________________________________________________________________________
Number of Persons Employed (Including Management) _______________________
1st Shift:
2st Shift:
3st Shift:
TOTAL:
Male: _______________
Male: _______________
Male: _______________
Male: _______________
Female: _______________
Female: _______________
Female: _______________
Female: _______________
A.
POLICY AND PROGRAM ON SAFETY AND HEALTH:
B.
COMPOSITION OF SAFETY AND HEALTH COMMITTEE:
CENTRAL SAFETY COMMITTEE
NAME
TYPE: ________________
POSITION IN ESTABLISHMENT
Chairman: ______________________________
Members: ______________________________
_________________________
______________________________
_________________________
______________________________
_________________________
Secretary: ______________________________
B.
_________________________
_________________________
TECHNICAL INFORMATION:
A.
Brief description of process operation and number and kind of equipment.
Submitted by:
______________________________
General Manager
