BUSINESS INFORMATION - RENEWAL APPLICATION
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Instruction: Select the appropriate box (Yes/No), if the following requirement is provided:
REQUIREMENTS YES NO N/A
Valid Business Permit/Mayor’s Permit
Use of StaySafe.ph or any contact tracing tool integrated with the same. Please specify other contact tracing tool
Availability of temperature or thermal scanner (e.g. thermo gun) to assess employees, clients, and visitors.
Availability of health declaration sheet for employees and clients.
QR Codes for StaySafe.ph and any other contact tracing tool conspicuously placed for registration of employees and clients.
Availability of isolation area for identified symptomatic employees
BHERTs and other COVID-19 Emergency hotlines are placed in conspicuous area.
Availability of handwashing stations with soap, sanitizers, and hand drying equipment or supplies for employees and clients/visitors in strategic locations in the establishment.
Installed physical barriers in enclosed areas to maintain social distancing (blocking off chairs, markers, stickers on the floor for spacing).
Availability of personnel-in-charge for monitoring and maintaining social distancing, and ensuring the compliance of clients/visitors/employees to health protocols and areas in the establishment where people gather (e.g. queue).
Availability of windows for adequate air exchange in enclosed (indoor) areas as cited in DOLE Department Order No. 224-21 or the Guidelines on Ventilation for Workplaces and Public Transport to Prevent and Control the Spread of COVID-19.
Compliance to the disinfection protocol in accordance with DOH Department Memorandum No. 2020—157 and 0157-A or the “Guidelines on Cleaning and Disinfection in Various Settings as an Infection Prevention and Control Measure Against COVID019.
Conducts regular (at least twice a week) cleaning and disinfection in the establishment in compliance to the Cleaning and Disinfection of Environmental Surfaces in the Context of COVID-19 by the World Health Organization.
Personnel, employees, clients and visitors always wear facemasks and face shields especially in enclosed places.
Presence of designated Safety Officer with the following functions: a) coordinate with the appropriate bodies for support and referral to communitybased isolation facilities for confirmed cases with mild symptoms, and to health facilities for severe and critical care; b) undertake contact tracing or coordinate the conduct thereof; and c) monitor status of employees quarantined or isolated; and d) implement return to work policies.
Availability of storage facility for proper collection, treatment, and disposal of used facemasks and other infectious wastes
LIST OF SUPPORTING PROOF (e.g., photos, documents)

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DEFECTS / DEFICIENCIES NOTED DURING INSPECTION:
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RECOMMENDATIONS
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I hereby certify that the information provided above are true and correct and I understand that any false information provided above may warrant the denial/revocation of the Safety Seal, without prejudice to the imposition of appropriate penal/administrative sanctions as may be warranted.