Student Name:
Course, YR & Section:
Name of Interviewee: (Alias only, not real name)
Position in Company/Type of Work:
Job description/role in the company:
Department (if any):
Company Name: (Alias only, not real name)
Description of Business/Company engaged in/
Description of Services or products being offered by company:
Estimated No. of Workers:
1. How long have you been working in the company? How long do you work as ___(his or
her position in company___)?
2. Do you consider the company or environment you work in as safe?
a. Why do you think so? / Why not?
3. What are the working conditions or work practices that you think are considered health
and safety hazards?
a. What are the controls/safety measures your company does to address these
hazards?
[Link] your company require you to undergo medical or health examination before being
employed or considered fit to work?
a. Do they have regular health examinations or check-ups?
b. What are these health examinations? (ex. CBC, chest x-ray, urine/stool sample...see No.
2.2 of Health Program form)
5. Does your company have first-aid, health care medicines and equipment facilities?
a. Do you have first-aid rooms or area?
b. Do you have clinic in the workplace? How many?
c. Are you affiliated with any hospital? How many?
6. Do you promote a drug-free workplace?
a. Do you have routine drug tests?
7. Do you have a Health and Safety Committee?
a. Do you have a safety officer? How many? What are his/her/their trainings and how many
hours?
b. Do you have emergency health personnel and facilities? Nurse? Doctor? Dentist?
Treatment rooms if ever any accidents happen? Is it equipped with medicines and
necessary first-aid?
8. Are you familiar and are the workers oriented with OSH Standards of DOLE?
a. Do you conduct tool box meeting? Is health and safety being discussed?
b. Do you especially discuss health protocols and measures in relation to COVID-19??
c. Are your safety officers (if there is any) attend regular OSH trainings?
9. Do you record accidents and injury on-site/in the workplace? Who records them?
a. Can you give examples of work-related accident have you encountered or happened in
the workplace? Was this recorded and made into a report?
10. What PPEs are being provided and required in your workplace? (especially that we are now
in a pandemic).
11. Do you have any safety signages in the workplace? Related to workplace safety, COVID-
19? Can you give examples?
12. Refer to No. 13 of the OSH Form and ask the ff:
FACILITIES PROVIDED? REMARKS
YES NO
a. Adequate supply of drinking
water
b. Adequate sanitary and
washing facilities
c. Suitable living
accommodation (if applicable)
d. Separate sanitary, washing
and sleeping facilities (if
applicable)
e. Lactation station (in
consonance with DOLE D.O.
143-15)
f. Ramps, railings, and the like
g. Other workers’ welfare
facilities as prescribed by
OSHS and other related
issuances
13. Refer to No. 14 of OSH program and ask the ff:
14.1Written Emergency and Disaster Program Yes____ No_____
14.2Types and number of Drills conducted
Type of Drills (fire, Date Responsible
earthquake) person/position
14. Refer to No. 15 of OSH program and ask the ff:
13.0 Solid Waste Management System
Written Pollution Control Program: Yes:____ No: _____
Name of Pollution Control Officer:__________________________
15. Refer to No. 18 of OSH program and ask existing company sanctions for violations on
OSH)
18.0*Prohibited Acts and Penalties/sanctions for violations on OSH
*(Applicable for medium to high risk establishments with 10 to 50 workers and low to high risk
establishments with 51 workers and above)
(Example of Company violation policies)
Safety Violation 1st offense 2nd offense 3rd offense
1. Not using issued PPE warning 3 day suspension 5 day suspension
2. littering and loitering warning 3 day suspension 5 day suspension
3. smoking at prohibited warning 3 day suspension 5 day suspension
area
4. illegal dismantling of warning 3 day suspension 5 day suspension
safety signages and
paraphernalia
5. Not following safety 3 day 5 day suspension Dismissal
rules suspension
19. Ask if they have idea of any estimated cost allotted for health and safety:
OSH Item Estimated Cost/year
PPEs
OSH trainings
Safety Signages
Machine Guards and
related equipment
Medical examinations
Medical
supplies/medicines
Others: Specify
