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DOLE - BQF - WAIR - COVID - 19excelver1 - 02 - REVISED (1) .XLSX - REVISED WAIR COVID 19

The form must be certified by an occupational health personnel or safety officer and employer/representative to confirm the accuracy of the information and that it complies with relevant laws on reporting of notifiable diseases and data privacy.

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Steve Lopena
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324 views1 page

DOLE - BQF - WAIR - COVID - 19excelver1 - 02 - REVISED (1) .XLSX - REVISED WAIR COVID 19

The form must be certified by an occupational health personnel or safety officer and employer/representative to confirm the accuracy of the information and that it complies with relevant laws on reporting of notifiable diseases and data privacy.

Uploaded by

Steve Lopena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DOLE-BQF-WAIR 1.

02

REPUBLIC OF THE PHILIPPINES


DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. _____

Workplace COVID-19 Prevention and Control Compliance Report


To be submitted at the end of the month

(Mark with an X the appropriate box)


Period Covered by Report (Month / Year)
Does the company have a policy on workplace COVID-19 prevention and control? Yes No
Is the policy communicated to all workers and clients? Yes No
Section I. Company Profile to be filled in by Employer or Representative (as indicated in the DOLE Registration)
Establishment Name:
Address of Establishment:
Name of Employer:
Nature of Business:
Number of Workers: Male Female Total
Principal 0
Subcontractor 0
Section II. Details of COVID-19 Prevention and Control
Report on Use of the Health Checklist
Worker Details: Screened: Denied Entry: Referred: Death if any:
Guest / Client Details: Screened: Denied Entry: Referred:
BHERT Health Facility (specify)
Where were workers referred?
Others (specify)

Report on Testing (optional) performed


Did the establishment perform an optional diagnostic test prior to return to work of workers?
Yes No. Please proceed to signature
If yes, mark Type of Test Number of Test/s Done No. of Workers Confirmed to have COVID-19
type of test RT-PCR
done. Gene Xpert
Rapid
Other (Specify) Testing
Total cost for the referrence month: P

We hereby certify that the information above is accurate to the best of our knowledge. We understand that
data contained herein is compliant with RA 11469 Bayanihan to Heal as One Act, RA 11332 Mandatory
Reporting of Notifiable Diseases and Health Events of Public Health Concern Act, and protected by
RA 10173 Data Privacy Act of 2012.

OH Personnel / Safety Officer Employer / Representative


Signature beside printed name Signature beside printed name
Date: Date:

Note: WAIR COVID-19 to be submitted every month with or without any COVID-19 to DOLE office
with jurisidicton over the establishment, copy furnishing the DOH at the following email addresses:
[email protected] AND [email protected]

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