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1. Form Identification: Form number, date, and revision number for document control
2. Facility Information: Name and complete address of the workplace, type of business/industry, total number of workers
3. Evaluation Team: Names, positions, and qualifications of personnel conducting the evaluation
4. Purpose of Evaluation: Reason for conducting the hazard evaluation (routine, incident-based, or complaint-based)
5. Area/Process Description: Detailed description of the workplace area or process being evaluated
6. Hazard Categories Assessment: Systematic evaluation of chemical, physical, biological, ergonomic, and psychosocial hazards
7. Exposure Assessment: Documentation of exposure levels, duration, and frequency for identified hazards
8. Control Measures: Existing control measures and their effectiveness
9. Risk Assessment: Evaluation of risk levels based on likelihood and severity of health impacts
10. Recommendations: Specific corrective actions and preventive measures
11. Compliance Status: Assessment of compliance with relevant DOLE and DOH regulations
1. Emergency Response Procedures: Required when evaluating high-risk areas or processes with potential for immediate health emergencies
2. Environmental Impact: Include when operations may affect community health or environment
3. COVID-19 Risk Assessment: Required for workplaces with high human interaction or as per current health protocols
4. Noise Level Assessment: Required for industrial or manufacturing facilities
5. Air Quality Monitoring: Include for indoor workplaces or facilities with potential air contaminants
6. Special Population Considerations: Required when workplace includes pregnant women, PWDs, or other vulnerable groups
1. Appendix A: Hazard Measurement Data: Detailed measurements, sampling results, and technical data from hazard assessments
2. Appendix B: Photographic Documentation: Visual evidence of hazards, control measures, and workplace conditions
3. Appendix C: PPE Requirements: Detailed list of required personal protective equipment for identified hazards
4. Appendix D: Reference Standards: Applicable DOLE, DOH, and international standards used in the evaluation
5. Appendix E: Testing Equipment Calibration Records: Certification and calibration records for measurement equipment used
6. Appendix F: Previous Assessment History: Summary of previous evaluations and status of implemented recommendations
Manufacturing
Construction
Mining
Healthcare
Chemical Processing
Agriculture
Pharmaceuticals
Food Processing
Automotive
Electronics Manufacturing
Textile Industry
Oil and Gas
Shipping and Maritime
Waste Management
Laboratory and Research
Health and Safety
Occupational Health
Risk Management
Compliance
Operations
Quality Assurance
Production
Facilities Management
Human Resources
Environmental Management
Medical Services
Emergency Response
Industrial Hygiene
Legal
Worker Representatives
Safety Officer
Industrial Hygienist
Occupational Health Nurse
Environmental Health Officer
Risk Management Specialist
Compliance Manager
Quality Assurance Manager
Production Supervisor
Facility Manager
Operations Director
HSE Coordinator
Plant Manager
Laboratory Supervisor
Medical Officer
Safety Engineer
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