Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office – NCR, Makati/Pasay Field Office
2/F ECC Bldg., 355 Sen. G.J. Puyat Ave., Makati City
310-88-15/336-50-62

___________________________________
Name: Date
Address:
Date

NOTICE OF ASSESSMENT

In order to make my visit more meaningful and successful, may I request that the following are made available for our
JOINT ASSESSMENT/COMPLIANCE VISIT on

__ __1. Roster of the workers, (regular, probationary, temporary, casual, piece rate, contractual, etc.) their designation, date
hired, and wage rate.
_____2. Payroll and/or vouchers from last inspection to present or three years back to present.
_____3. Daily Time Records and/or Time Sheets.
___ _4. Pay envelopes, or payslips.
___ _5. Last Notice of Results.
__ _ _6. Proof of payment of 13th month pay and Service Incentive Leave pay.
___ _7. Proof of payment/remittance of SSS/PHILHEALTH/HDMF contributions.
___ _8 Registration under Rule 1020 of the Occupational Safety and Health Standards.
__ _ _9. Certificate of Accredited/Trained Safety Officer and First Aider.
___ _10. Organization of Safety and Health Committee. (Rule 1040 of the OSHS)
___ _11. Annual Work Accident/Illness Exposure Data Report and Annual Medical Report.
___ _12. Drug-Free Workplace Policy and Program, HIV-AIDS Program, Hepatitis-B Program, TB in the Workplace Program, Anti-
Sexual Harassment Policy and Breastfeeding Policy.
____13. Apprenticeship Agreements/Learnership Agreements, if any.
____14. List of Resident & Non-resident alien workers, citizenship, nature of employment & status of stay.
____15. Employment permit for non-resident alien(s).
____16. Registration of resident alien(s).
____17. Collective Bargaining Agreement, if Unionized establishment.
____18. Labor Contract(s) with Job Contractor and Contract between the contractor and Contractual employees(s).
____19. Contractor's Bond to answer for wages due to the workers.
____20. Medical and dental services, employment with physicians, dentists, nurses and first aiders, if applicable.
____21. Contract with infirmary and emergency hospitals, if applicable.
____22. Proof of service charge distribution, if applicable.
__ __23. Records on maternity and sick leave benefit / Paternity benefit / Solo Parent leave.
__ _ _24. Latest Financial Statement.
____25. Company policy and/or practice on benefits voluntarily given to workers.
__ __26. Registration with Securities and Exchange Commission or Department of Trade and Industry or CDA and Mayor’s
Permit.
__ __27. Registration under Department Order 18-A for Job Contractors/PCAB REGISTRATION.
__ _ _28. Others : valid Fire Safety Inspection Certificate .

Please be informed that REFUSAL/DENIAL OF ACCESS may result to the filing of appropriate criminal action as Article
128(d) of the Philippine Labor Code, as amended, declared unlawful for any person or entity to obstruct, impede, delay or
otherwise render ineffective the Orders of the Secretary of Labor or his/her duly authorized representative issued pursuance to
his/her visitorial and enforcement power.

Very truly yours,

Labor Laws Compliance Officer
Received by: _____________________________ Job Title/Designation: _________________________Date:________