Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
(Regional Office/District Office/Provincial Ext. Unit)
ESTABLISHMENT TERMINATION REPORT
National Capital Region
Month/Year____________________
Instructions:
1. Accomplish this form upon filing of notice of termination
2. Make sure that your answer are true and complete
3. Page 1 should contain general information about the establishment and the nature of
workers retrenched or terminated
4. Page 2 (pls. see List of Affected Employees) should include the list and information on
workers affected.
NAME OF ESTABLISHMENT:___________________________________________________
ADDRESS:_____________________________________________________________________
PRINCIPAL PRODUCT/MAIN ACTIVITY:_________________________________________
TOTAL EMPLOYMENT:_________________________________________________________
Number of Workers
Affected
GEOCODE
PSC CODE
Effectivity
Duration
Date
(in weeks
Use code Below)
1.Total workers affected due to shutdown/
Closure of establishment
______________________
____________
___________
Permanent Closure/Shutdown
Temporary Closure/Shutdown
______________________
______________________
____________
____________
___________
___________
2.Total workers affected due to
retrenchment/termination/dismissal
______________________
____________
___________
Permanent Layoffs
Temporary Layoffs
______________________
______________________
____________
____________
___________
___________
Rotation of Workers
Reduced Worktime/workdays
______________________
______________________
____________
____________
___________
___________
3. Reason for shutdown/closure/retrenchment of workers (Use Code Below
Main reason:____________________
Other reason:___________________
Duration
CODING SYSTEM
Reason for Establishment Closure/Layoffs/Retrenchment
1-Less than one week
2-1 to 2 weeks
3-3 to 4 weeks
4-5 to 12 weeks
5-13 weeks to less than 6 months
6-6 months
7-Indefinite
8-Not stated
Economic Reasons
MR-Increase in minimum wage rate
CI-Competition from imported products
UCP-Uncompetitive price of product
R-Redundancy
CMM-Change In Management/Merger
RDS-Company reorganization/
Downsizing
FL-Financial Losses
LM-Lack of Market/slump in demand
LRM-Lack of raw materials
LC-Lack of Capital
HCP-High cost of production
PD-Peso Devaluation
OTH-Others (Specify)___________
Non-Economic Reasons
NCL-Calamities (fire, typhoon, etc.)
SM-Serious Misconduct
NIV-Inventory
AWOL-Absence without Leave
NRM-Repair general Maintenance
PC-Project completion
RES-Resigned
RET-Retirement
GHN-Gross Habitual Neglect
OTHS-Others (specify)__________