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COR Toolkit: An Employer Guide to COR Certification

Certificate of Recognition (COR) Program

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COR Toolkit: An Employer Guide to COR Certification of 71

Table of Contents

Introduction .................................................................................................................. 3

Overview of the COR Program ....................................................................................... 4

Benefits of COR certification .......................................................................................... 5

Implementation and Maintenance of a Safety Management System ................................... 5

Importance of Communication ...................................................................................... 6

Effective Supervision.................................................................................................... 6

Safety Culture ............................................................................................................. 7

COR Process and Continual Improvement ....................................................................... 7

Element 1: Management and Leadership Commitment ........................................................ 8

Element 2: Hazard Identification and Control ................................................................... 15

Element 3: Safe Work Procedures and Written Instruction ................................................. 24

Element 4: Inspection of Premises, Equipment, Workplaces and Work Practices ................... 32

Element 5: Investigation of Incidents/Accidents ............................................................... 38

Element 6: Training and Instruction of Employees ............................................................ 44

Element 7: Program Administration ................................................................................ 50

Element 8: Joint Occupational Health and Safety Committee ............................................. 54

Element 9: Injury Management/Return to Work Programs ................................................. 58

Appendices .................................................................................................................. 70


Introduction The purpose of this document is to help employers understand the Certificate of Recognition (COR) process, giving an overview of what is needed to succeed, providing detailed explanations of the audit tool’s questions and giving practical examples of forms, policies and procedures that companies can use or modify based on their specific needs. By following this manual, companies can expect to improve their safety performance and reduce costs. Common themes running through this manual include the importance of:

• a formal safety management system (SMS), as opposed to a random collection of safety activities

• open communication across all levels of an organization • effective, fair, documented supervision that does not swamp a supervisor with

paperwork • an effective safety culture that helps all employees buy into the SMS • promoting safety as an integral part of the business for all employees, rather than

“something only a safety person does.” The manual is divided into three main sections: this introduction, which summarizes setting up an SMS; detailed explanations of each of the nine elements of the COR process, with tips and resources to help interpret the audit tool; and a final section that collects the various forms and templates that employers can use or modify. Of the nine elements, eight pertain to the Occupational Health & Safety (OHS) audit, and the ninth deals with the Injury Management/Return to Work (IM/RTW) audit. Each of these sections contains:

• an overview of the element and its importance in ensuring a safe and healthy workplace • relevant links to the OHS Regulation or the Workers’ Compensation Act • a list of resources supporting the element – such as booklets, brochures, posters, web

sites (go2, WorkSafeBC, and other reliable sources) • topic-relevant external training options for employers • a list of questions from the audit tool for each element with a clear description of what

an auditor looks for in each question • a list of any relevant documentation required, as well as sample resources, such as

policies, checklists, forms, etc. • best practices from leading employers on effective and practical approaches to safety,

focusing on the approaches auditors look for when on site.


Overview of the COR Program

The COR Program is a voluntary incentive program for employers in BC. Employers enrolled in the COR program develop management systems in OHS and RTW. By implementing these systems and verifying them through audits, employers can earn rebates up to 15 per cent of their WorkSafeBC premiums. The COR program consists of two elements:

• the Occupational Health and Safety Certificate of Recognition (OHS COR) • the Injury Management/Return-to-Work Certificate of Recognition (IM/RTW COR), which

may be earned at the same time as the OHS COR, or subsequently. The OHS COR recognizes that an employer has implemented an OHS management system that exceeds regulatory requirements, and ensures that there are comprehensive management systems in place to provide a safe work environment. This is the foundation of the COR Program. The IM/RTW COR is awarded to employers who have built injury management/return-to-work programs into their health and safety management systems. Return-to-work programs are a proactive way for employers to help injured workers stay at work or return to productive and safe employment as soon as physically possible. These programs are based on the fact that many injured workers can safely perform productive work during the process of recovery. Returning to work is part of the workers’ therapy and recovery, and workers who participate in a return-to-work program have better long-term health outcomes than those who don’t. When the company believes it is ready to proceed with the certification audit, it selects an external auditor. Auditors are experienced in the industry and in safety culture. Through the on-site audit process they develop a comprehensive picture of the situation and can provide meaningful recommendations to help a company improve further. The auditor measures the entire company’s performance using the go2 COR audit tool. For any topic that does not meet the standard, the auditor writes a clear recommendation to the company to help meet the requirements. If the company achieves 80 per cent, overall, and 50 per cent in each element of the audit, it is awarded COR certification. If the company is not successful the first time, it can use the auditor’s recommendations to improve its system and try again until it is successful. On the first and second anniversaries of certification, the company performs a maintenance audit using the same audit tool. This audit is usually performed by a certified internal auditor, a designated employee who acts as the company’s safety champion. In the third year after certification, an external auditor is again selected to perform a full external audit. This audit cycle repeats in subsequent years. A key thing to remember is that there is a full audit every calendar year.


Benefits of COR certification

There are three main reasons to seek COR certification:

• annual financial incentives paid by WorkSafeBC • reduced assessment payments as a result of improved safety performance and

experience rating • indirect financial benefits of the program achieved through higher productivity, lower

turnover rate, and overall reduction in physical and human operating cost. Financial incentives are provided to employers who achieve COR certification and who are in good standing with WorkSafeBC. Employers earning the OHS COR receive rebates of 10 percent of their WorkSafeBC base assessment. Employers earning the IM/RTW COR can receive additional rebates of five percent of their WorkSafeBC base assessment. Even more significant than financial incentives associated with certification, however, are the costs avoided by preventing workplace injury and illness, which in turn directly results in lower claim costs and reduced WorkSafeBC assessment premiums. A safe company can achieve up to a 50 per cent discount on the base assessment rate, compared to a 100 per cent surcharge on the base rate assessed on a company with poor safety performance. This means a top-level safety performer would only pay one quarter the annual assessment of the worst performers. Savings of this level can be substantial. The successful implementation of the OHS and the IM/RTW systems also contributes to a change in business culture. When employers recognize that health and safety are just as important as other critical business factors (production, quality and profit, etc.), a safer workplace will result. Safer workplaces lead to lower employee turnover and higher employee morale, and these factors in turn lead to higher customer satisfaction.

Implementation and Maintenance of a Safety Management System

Safety management systems are no more difficult to set up and maintain than any other system, be they accounting, maintenance or human resources. This resource manual is designed to help companies with even minimal safety experience achieve COR certification in a timely and efficient manner. Reviewing this material is an important early step in the process. go2 is available to help companies, both by direct consultation and by providing training to each company’s safety champions. A company can achieve success in five steps. The first step is for all senior managers to make an unconditional commitment to safety. They must not only say, but actually believe, that all injuries are preventable and that excellence in safety is necessary for excellence in business. Actions must always support these beliefs. The second step is for managers and supervisors to be personally involved in safety activities, such as meetings, inspections and giving feedback when observing workers. This is the main component of the safety system, but cannot occur in isolation. Safety champions frequently set up easy tools for supervisors to use for this purpose.


The third step involves empowering employees to have a substantial voice in safety actions. They must hold themselves and others accountable for actions and take pride in achievements. If a company responds negatively to employee concerns, this step quickly fails. Fourth, an objective evaluation of actions is needed to encourage positive behaviour and reduce the negative. These systems must be fairly and consistently applied every time. This is a key that leads to continual improvement. Finally, there must be established an effective reporting system that employees can and will use. It must focus on correcting issues and weaknesses before an injury or incident occurs, but also be able to help the company learn from experience when something goes wrong.

Importance of Communication

There is no single factor more important than communication in a safety management system. The safety champion could build the world’s best SMS, but if management and workers never know about it, it will be useless. As with all systems, management needs to communicate expectations to workers, coach them and train them. Workers need to be engaged in the company, communicating not only when things are wrong (unsafe, unusual, unexpected or unknown) but when things are going well. The communication needs to be open and without fear of reprisal. Management needs to close the loop with workers and let them know how their issue is being handled. The most common and effective method is simple informal talk, either one-on-one or in small groups. Signs, posters and message boards are semi-formal methods. Written policies, procedures and forms are the most formal methods of communication. Each company needs a balance of these methods and also needs to establish a system of recording communication when it happens. The manager’s notebook, whether paper or electronic, is a very useful tool. Simple, short notes that a particular worker was observed doing something (right, neutral or wrong) and that subsequent feedback was given can support more formal evaluation records. For minor issues, these notes may be the only record that anything even happened. They can establish patterns of behaviour by the supervisor or a particular worker that can be vital in investigations. The best communications are not categorized as “safety” or “not safety.” Each discussion about how to do a job properly is essentially a mini-safety meeting. Safety is just another part of the overall business, and open communication is critical to its success.

Effective Supervision

Effective supervision is an absolute key to workplace safety. In this context, supervision means someone who controls, instructs and directs people below them. It is not necessary to have the title of supervisor to be one. Most managers in hospitality are supervisors, as are some lead hands. Supervisors are legally responsible for the health and safety of their workers and are required by regulation to teach, train, inform, coach, watch, correct and even discipline them appropriately.


The number one trait of effective supervision is integrity. The supervisor needs always to act above the standards they are asking of their workers. They need to follow every safety rule to the letter, or better, and always have every required piece of personal protective equipment not only on but in good condition.

Safety Culture

Formally, a company’s safety culture is its shared beliefs, values, behaviour and attitudes. It is what the employees will do or say when they know no one is watching or listening. It is the consistent belief at all levels that all injuries are preventable and that incidents cannot simply be blamed on worker negligence by default. It is the belief that safe, happy employees have a positive impact on business. Safety is not a cost-benefit calculation, but always a benefit. There can be no cutting corners, and the job must be done right the first time, every time. Safety culture is something anyone without much industry experience can quickly spot, but even specialists struggle to define exactly what it is and how to measure it. People in the industry can usually tell within minutes of stepping onto company property if a business is running a tight ship. It shows in the little things, like housekeeping details in less public areas, crisp uniforms on maintenance staff, and everything put away in back-of-the-house areas. Tight companies are safer, have a lower environmental impact, lower costs and higher profitability, lower employee turnover, and higher employer loyalty and morale. New hires quickly adopt the culture of the organization, and they rarely consciously realize what aspects of the culture have had a subtle but crucial impact on them.

COR Process and Continual Improvement

One of the principles of COR is continual improvement. The 80 per cent minimum standard for COR certification is only the start of the next phase of the safety journey. The company needs to make a commitment that the only acceptable outcome is ultimately preventing any workplace injury or illness. This very lofty goal can only be approached slowly and systematically, dealing with all remaining issues identified in audits or by other company methods. Many companies manage to address half the deficiencies from each audit before the next. Each year, whittling away half the remaining issues results in getting closer and closer to the final goal. Usually, after several years of certification, companies realize there are safety issues they should address that are not covered in the audit. These companies then add the extra issues to their ongoing to-do safety issue list (otherwise known as a Corrective Action Log, or CAL). Continual Improvement also applies to the COR system itself. Companies are actively invited to give feedback on the COR system, the audit, auditor performance, this manual and any other COR issue.


Element 1: Management and Leadership Commitment

Overview

An effective occupational health and safety (OHS) program must demonstrate effective management leadership, a firm commitment to the program and a willingness to improve the workplace safety culture. Companies with good results in safety (or any other area) have leadership that will not allow a substandard result. While cooperation and consensus are very important in getting employee buy-in to programs, ultimately it is the leadership and commitment from management that drives the process. The audit will measure the level of leadership and commitment toward health and safety within the organization by assessing the following items:

• a current, written health and safety policy that clearly states the employer’s aims; the responsibilities of the employer, managers, supervisors and workers; and awareness of these individual responsibilities at all levels of the organization

• a system for accountability of health and safety roles and responsibilities at all levels of the company. This is often one of the toughest areas for any company – what to do when a valued employee is not following the system.

• the levels of senior and middle management and worker involvement in the program (where those levels exist in the company)

• the levels of knowledge and awareness of applicable legislation appropriate to an employee’s needs.

• the allocation of sufficient resources for health and safety • the level of commitment from senior management (CEO or most senior management)

toward improving the workplace safety culture. This is a key performance indicator – whether the senior people walk the talk.

This element has only one key document: the safety policy. Some companies may have safety as part of an overall mission statement or may have responsibilities for safety outside of the policy. The rest of the element is about showing that the policy is actually followed.

Key Concepts and Implementation Tips

In order to meet the above objectives, the audit determines whether:

• The employer has an established safety policy that fits what the company does and how it is organized.

• Employees are aware of the safety policy and their responsibilities. • Supervisors and managers are aware of the applicable legal, regulatory and other

requirements of their area. • Senior management fully supports the safety program with real resources and makes a

clear commitment through their actions.


• The company tracks safety statistics and develops plans based on how those statistics are trending. Examples include:

o injury rate o number of safety inspections done each month o percentage of first aid cases with an appropriate investigation o percentage of people on each safety inspection who are wearing the required

personal protective equipment (PPE).

SUPPORTING RESOURCES:

How to – Safety Policy

Guide to Writing an OHS Policy (CCOHS)

http://www.ccohs.ca/oshanswers/hsprograms/osh_policy.html

How to prepare OHS Policy (Min. of Labour)

http://www.labour.gov.on.ca/english/hs/pubs/ohsa/ohsag_appa.php

How to – Roles and Responsibilities

Safety on the Job is Everyone’s Business (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/safetyonthejob.pdf

20 Powerful H&S Motivation Actions for Senior Management (WorkSafeNB)

http://www.worksafenb.ca/522top8a_e.htm

Securing Commitment (HSA) http://www.hse.gov.uk/stress/standards/securing.htm










http://www.hse.gov.uk/stress/standards/securing.htm

http://www.hse.gov.uk/stress/standards/securing.htm


Supervising for Safety (WorkSafeBC)

http://www.supervisingforsafety.com/

How to – Due Diligence

Due Diligence Checklist (WorkSafeBC)

http://www2.worksafebc.com/PDFs/common/due_dil_checklist.pdf

Effective Health and Safety Programs (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/ph33.pdf

Due Diligence (CCOHS) http://www.ccohs.ca/oshanswers/legisl/diligence.html

How to – Safety Performance Tracking

Business Planning Toolkit (WorkSafeBC)

http://www.go2hr.ca/health-safety/program-tools/resources-links/worksafebc-enhanced-employer-portal

TRAINING OPTIONS:

Training – Management Responsibility for Safety

Employers’ Advisers Office http://www.labour.gov.bc.ca/eao/

WorkSafeBC database of training providers

http://www.ohstrainingbc.com/







http://www.ccohs.ca/oshanswers/legisl/diligence.html

http://www.ccohs.ca/oshanswers/legisl/diligence.html





http://www.labour.gov.bc.ca/eao/



RELEVANT REGULATION AND LEGISLATION:

Workers’ Compensation Act (BC Gov’t)

http://www2.worksafebc.com/Publications/OHSRegulation/WorkersCompensationAct.asp#SectionNumber:Part3Division1

Section 115, 116, 117 – General Duties of Employers, Supervisors, and Workers

Guidelines for Using the COR Audit Tool

QUESTION 1.1 Does the business have a written health and safety policy?

Auditor Guideline: • Review documentation to ensure there is a health and safety policy.

Employer Guideline: • This can be a mission statement or a corporate health and safety policy that outlines

the company’s goals. For companies that are branches of a large corporation, either a company or a corporate policy is acceptable.

Types of Documentation to Review: • Mission statement, corporate health and safety policy

QUESTION 1.2 Are the aims of the health and safety policy clearly stated?

Auditor Guideline: • Review documentation (health and safety policy). It must clearly state the aims of the

occupational health and safety program which must be consistent with the objectives of:

o creating a culture of health and safety in the workplace o preventing workplace injury and disease.

Employer Guideline: • The policy must include the objectives listed in the auditor guideline. This must be in

the policy itself, not in any supplemental documentation.


QUESTION 1.3 Does the health and safety policy clearly outline the responsibilities of the Employer, Managers, Supervisors, and Workers?

Auditor Guideline: • Review documentation (the health and safety policy) and ensure it clearly outlines the

responsibilities for the Employer, Managers, Supervisors, and Workers.

Employer Guideline:





• Often companies list the responsibilities separately, but this question requires the key points to be spelled out in the actual policy for all levels listed: employer, manager, supervisor and worker. If the company does not have supervisors, or all managers are the employer, then the extraneous levels could be omitted. Synonyms, such as using the term “associate” instead of “worker,” are acceptable but should match the terms used by the company. When outlining policies, try to distill them down to a couple of key points for each level, so that the policy can be an easily displayed one-page document.


QUESTION 1.4 Does the Employer inform Employees about the policy?

Auditor Guideline: • Interview Employees to verify they are aware of the policy.

Employer Guideline: • Because the interview asks employees to cite the key points in the corporate policy,

having a clear and concise policy can help workers remember the key points. The auditor doesn’t expect employees to recall the policy word for word but wants to see that they understand the general themes.

QUESTION 1.5 Does senior management ensure that ongoing resources are allocated to implement and maintain the health and safety program?

Auditor Guideline: • Interview Workers, Supervisors, and Managers. Resources could include health and

safety committee, employee training, communications and meetings, hazard controls, budget allocations, or scheduling concessions.

Employer Guideline: • The question asks the employees for examples of how senior management supports the

program. This could include the resources listed in the auditor guidelines, plus incentive programs, health and safety coordinator positions, and/or PPE availability and the right equipment required for the job. The auditor needs to provide detailed evidence to support the score awarded for this very large point allocation in the audit.

QUESTION 1.6 Are the following aware of their safety responsibilities:

1. Managers 2. Supervisors 3. Workers

Auditor Guideline: • Interview Managers, Supervisors and Workers.


Employer Guideline: • Employees at each level are asked for examples of their responsibilities. Managers

should be able to provide more exact details than supervisors, and workers the least amount of detail. The outlines of these responsibilities should not contradict the stated company program; legislated and regulatory requirements, especially for workers, are not expected to be a full listing of all responsibilities.

QUESTION 1.7 Are health and safety responsibilities carried out?

Auditor Guideline: • Interview Managers, Supervisors and Workers to ensure health and safety

responsibilities are carried out. Determine if their involvement is appropriate to their level in the organization.

Employer Guideline: • This is designed to see whether supervisors and managers are providing training and

guidance to workers, and whether workers are performing the appropriate level of work or are performing supervisory jobs as well.

QUESTION 1.8 Is there an effective system to ensure accountability for safety roles and responsibilities?

Auditor Guideline: • Review documentation to demonstrate that there is an effective system to ensure

accountability (e.g. performance evaluations, log books, training records, KPIs, etc.

Employer Guideline: • There needs to be a system that holds everyone accountable for their jobs. This can be

done with a spreadsheet that tracks inspections, evaluations, meetings, and investigations. There needs to be regular review showing there is an appropriate response when something is not being completed on time. Supervisors need to demonstrate that they are performing their jobs, while managers should have a documented record of how their supervisors are performing. Training records, journals, and logbooks can be used as well to show that there is follow-up being done for individual issues, but the pattern of issues needs to be tracked and understood by senior leadership. There needs to be documentation showing that senior leadership is meeting their legal and company requirements; this can be demonstrated through their journal notes, appearance in meeting minutes, co-signing of documents, etc. In the guideline, the phrase KPI refers to Key Performance Indicators – important items that the company monitors over time. Each company will develop its own set of useful KPIs.

Types of Documentation to Review: • Performance evaluations (workers, supervisors and managers), machine log books,

training records, training matrix, management meetings and reports, annual reports, emails, memos, journal notes, documented observations of worker practices by


supervisors and managers that show both positive and negative observations and appropriate action plans to correct deficiencies are also acceptable.

QUESTION 1.9 Are Managers and Supervisors aware and knowledgeable of the applicable regulations?

Auditor Guideline: • Interview Managers and Supervisors to determine their awareness of the regulation that

applies to the organization and knowledge of regulation that applies to their area of responsibility (ex. BC OHS Regulations, Workers Compensation Act).

Employer Guideline: • This question looks to verify that managers and supervisors are aware of governing

bodies (and the applicable rules from those bodies) they need to be in compliance with outside of the company’s rules. This could include, but is not limited to, fire codes, employment standards, WSBC, BC Safety Authority, etc. The scope of this question is intended to be limited to safety-related issues. Non-safety issues (i.e. copyright law) are not germane. The auditor wants to see that managers and supervisors understand how regulations apply to their jobs as well. If interviewees believe they are knowledgeable and in compliance, but evidence elsewhere in the audit indicates non-compliance based on lack of knowledge by managers or supervisors, these are negative findings.

QUESTION 1.10 Does senior management demonstrate their level of commitment toward improving the workplace safety culture?

Auditor Guideline: • Interview the senior management (including the CEO or most senior management in

B.C.) to gauge the level of commitment toward improving the workplace safety culture.

Employer Guideline: • This question calls for a conversation with senior management to determine what kind

of initiatives they have implemented to support and improve a safety culture. Are they aware of the programs within their organization?. Managers need to be in touch with the program and have realistic and achievable plans for improvement. Senior management may delegate most of the company’s safety activities but still need to be the driving and authorizing force behind the program. Safety champions are often the eyes, ears and hands of the safety program and give advice to senior management, but ultimately senior management makes the large decisions and sets the ultimate direction.


Element 2: Hazard Identification and Control

Overview

A method to identify and control workplace hazards is important in order to eliminate, minimize or prevent unsafe or harmful conditions and work procedures. All jobs, equipment, machinery, worker activities and on-site conditions need to be included in the hazard-recognition process. The audit will measure if the company has implemented:

• a risk rating system to analyze jobs, equipment and conditions for potential hazards; this should be done once overall when building the system and then partially any time there is a change in a job, a piece of equipment or working conditions.

• a method to control the workplace hazards by o engineering controls ― proper use of controls, such as power machinery instead

of manual lifting by workers, and availability of standardized engineering controls

o administrative controls ― including having workers follow written safe work procedures for hazardous jobs, plus management enforcement of these practices

o personal protective equipment (PPE) controls ― including availability, training and maintenance of PPE (such as gloves) and enforcement of its use, where appropriate

• a method to communicate the risk assessment and the control procedures to workers and ensure that the controls are used.


In order to meet the above objectives, the audit checks whether:

• The employer performs hazard/risk assessments at the worksite. • Employees participate in the hazard/risk assessment, since they are the ones most

affected by hazards and risks. • People assessing the risk are adequately qualified to do so. A qualified individual is

someone who is knowledgeable about the work, the hazards involved and the means to control the hazards. This qualification can be earned through education, training or experience, or a combination of these things.

• Once hazards have been identified, they are prioritized and controls put in place to manage them.

• There is a process to review the effectiveness of the controls once they have been put in place.

• When operations change or new procedures are added, an assessment of the change is performed.

• Supervisors check that workers follow the safety procedures, providing coaching and corrective feedback where necessary.

• The employer has a written discipline policy when coaching and correction are not working.


• Employees have a method of reporting unsafe conditions, hazards or problematic activities and understand the process for refusing unsafe work.

• Employees are trained in the hazards and controls that affect them and how to report problems.

• Training is documented.


How to - Hazard Identification and Risk Assessment

What is Risk Assessment? (go2)

http://www.go2hr.ca/health-safety/program-tools/sector-specific-resources/accommodation#accomm-riskassess

Risk Assessment Tool for Accommodation (go2)


Risk assessment (CCOHS) http://www.ccohs.ca/oshanswers/hsprograms/risk_assessment.html

How to - Safe Work Procedures

Sample Hospitality Safe Work Procedures (WorkSafeBC)

http://www2.worksafebc.com/tourism/Hosp_SmBiz/add_res/Online-Sample_Procedures1.pdf

How to - Reporting Unsafe Conditions/ Refusal of Unsafe Work

The Right to Refuse Unsafe Work poster (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/posters/assets/pdf/right_refuse.pdf









http://www.ccohs.ca/oshanswers/hsprograms/risk_assessment.html

http://www.ccohs.ca/oshanswers/hsprograms/risk_assessment.html








Worker Rights and Responsibilities (WorkSafeBC)

http://www2.worksafebc.com/PDFs/YoungWorker/ApprenticePrograms/CulinaryArts/rights_student.pdf

Getting a Job? Ask Questions about Safety (WorkSafeBC)

http://www2.worksafebc.com/PDFs/youngworker/Getting_job.pdf

How to - Personal Protective Equipment

PPE (WorkSafeBC) http://www2.worksafebc.com/Topics/PPE/Home.asp

PPE (CCOHS) http://www.ccohs.ca/oshanswers/prevention/ppe/

TRAINING OPTIONS:

Training - Risk Assessment




CCOHS http://www.ccohs.ca/products/courses/hazard/

Training - Safe Work Practices



Training - Refusal of Unsafe Work








http://www2.worksafebc.com/Topics/PPE/Home.asp

http://www2.worksafebc.com/Topics/PPE/Home.asp

http://www.ccohs.ca/oshanswers/prevention/ppe/

http://www.ccohs.ca/oshanswers/prevention/ppe/



http://www.ccohs.ca/products/courses/hazard/





Occupational Health and Safety Regulation (WorkSafeBC)

http://www2.worksafebc.com/publications/OHSRegulation/Home.asp

Section 3.10 – Reporting Unsafe Conditions Section 3.12 – Refusal of Unsafe Work Part 8 – Personal Protective Equipment



Section 115, 116, 117 – General Duties of Employers, Supervisors, and Workers


QUESTION 2.1 Is there a process to analyze jobs, equipment, and conditions for hazards according to risk?

Auditor Guideline • Review documentation to ensure there is a process / policy for identifying and assessing

hazards in the workplace.

Employer Guideline • Provide a written policy and process for hazard identification and risk assessment that

identifies the tasks within all departments, then breaks down the tasks for each hazard and then says how it is going to be controlled. Each risk needs to show that it has been analyzed for frequency of exposure, potential consequences and hazard probability. These three combined provide a risk rating (low-, medium- or high-risk and up to multi-point scales). The controls need to use the order of:

1. eliminating the hazard 2. engineered controls 3. administrative controls 4. PPE.

Types of Documentation to Review: • Hazard identification and risk assessment process or policy

QUESTION 2.2 Is the process to analyze risks outlined in Question 2.1 being followed?

Auditor Guideline • Review documentation (hazard / risk assessments) to determine if the process for

identifying and assessing hazards in the workplace is being followed.

Employer Guideline • Provide documentation that proper hazard/risk assessment is complete for all positions

and tasks, according to the method in question 2.1. The documents sampled need to be internally consistent and logical (i.e., sweeping the floor after hours is lower risk than









dealing with an argumentative, impaired person). Questions 2.7, 2.8 and 2.13 use some of the sampled risk assessments for further examination.

Types of Documentation to Review: • Job safety breakdowns, completed assessments

Possible Secondary Document Source: • Area inspections (with risk assessment)

QUESTION 2.3 Is there a process for reporting unsafe conditions?

Auditor Guideline • Review documentation for a formal or informal process (e.g. unsafe conditions report

form or verbal reporting).

Employer Guideline • The process for reporting unsafe conditions is clearly identified ― in writing ― in a

policy-handbook form that outlines general rules and specific responsibilities.

Types of Documentation to Review • Policy on reporting, hazard report form, supervisor journal notes

Possible Secondary Document Source • Corrective action log, maintenance records

QUESTION 2.4 Do Workers report unsafe conditions?

Auditor Guideline • Interview a representative number of Workers to determine their understanding of the

process.

Employer Guideline • This question aims to verify that workers understand the procedure or policy that

guides their actions when reporting an unsafe condition. Do they know what to do? There is no audit requirement for workers to fill out a form unless the company policy directs them to do so.

QUESTION 2.5 Do qualified individuals participate in the hazard identification process?

Auditor Guideline • Review documentation to confirm qualified individuals participate in hazard

identification process. • Interview Supervisors and Workers to verify qualified individuals participate in the

hazard identification process.


Employer Guideline • Employees involved in hazard/risk analysis must have received training in the process.

This could be demonstrated by a certificate or some other record of training. Training can be done in house, but proof of completed training is still required. The questions posed to supervisors and workers are intended to show whether the people doing the risk assessments have received training to perform them adequately.

Types of Documentation to Review • Training records or certificates compared to people listed on Hazard Identification

Forms,

Possible Secondary Document Source • Joint Occupational Health & Safety Committee (JOHSC) minutes

QUESTION 2.6 Are the hazard identifications, assessments and controls reviewed regularly?

Auditor Guideline • Review documentation (hazard identification process / policy) to ensure hazards are

reviewed as per the process / policy. • Interview a representative number of Supervisors and Managers to determine if the

process is reviewed.

Employer Guideline • This question requires a policy outlining how often risk assessments are reviewed, and

proof that the policy has been followed. This can be proven with creation and revision dates on the risk assessments, JOHSC meeting minutes showing a review of the risk assessments, a safety schedule showing when the review is to be done and the resulting changes. To count positively in the audit, documents must be dated within the past two years (or more recently if the company policy requires more frequent review); undated documents count as negative.

• The interview is looking to verify that the hazards are reviewed at least every two years or when there is a change in processes, equipment or jobs, etc. The interview evidence can still be fully positive even if there is no documentation evidence within this question.

Types of Documentation to Review: • Policy manual, work area inspections (with risk assessments), job safety breakdowns,

job safety analysis, JOHSC minutes, crew safety meeting minutes


QUESTION 2.7 Are engineering controls identified in the hazard identification process available and being used?

Auditor Guideline • Observe a representative sample of engineering controls from the hazard identification

process and verify they are available and being used or other effective controls are in place.

Employer Guideline • During the documentation review in question 2.2, auditors are looking at the risk

assessments for engineering controls that have been put in place to control a hazard. The list is verified during the observation tour. The auditor should select at least three (preferably more) engineering controls that would reasonably be expected to have something observable (i.e., a railing added to a balcony rather than a wiring change inside a sealed electrical panel). The auditor should focus on significant or large controls where possible. There is no defined timeline for when the control was put in place. For example, railings added around a chair-lift cable wheel a decade ago due to a risk assessment when the lift was installed are still positive findings for a current audit if the railings are still present and in use.

QUESTION 2.8 Do Workers work according to safe work procedures and job practices?

Auditor Guideline • Observe Workers engaged in work activities for which safe work practices and job

procedures have been developed.

Employer Guideline • During the documentation review in question 2.2, auditors are looking at the safe work

procedures for specific details, such as the PPE required for a certain job, steps for performing jobs safely, etc. During the observation tour, auditors verify that safe work procedures are being followed.

QUESTION 2.9 Does the employer have a method to ensure compliance with the rules, safe work practices, and job procedures? Is it being followed?

Auditor Guideline • Review documentation for a method to ensure compliance. • Interview Managers, Supervisors, and Workers to verify the application of compliance

procedures.

Employer Guideline • This question is looking for a progressive discipline policy. Does the organization have

a clear policy that shows what will happen if someone is not compliant with the health


and safety program, and is the policy documented? Typical steps include coaching or education, verbal and written warnings, suspension and ultimately termination of employment. It is acceptable to have a policy where some offenses are more serious than others and have higher disciplinary penalties.

• The interview seeks to determine if the discipline policy is used consistently. Interview evidence may still be fully positive even if the documentation is negative, provided all interviewees report a standard uniform method of discipline. Interviewees who are not aware of actual discipline having been needed but have a correct expectation that it would be used if necessary, are considered to have provided positive responses.

Types of Documentation to Review: • Discipline policy

NOTE: Actual records of discipline being applied are confidential human resources documents and are NOT to be included in the audit process or report by internal or external auditors.

QUESTION 2.10 Are hazards and controls communicated to Workers?

Auditor Guideline • Interview a representative number of Workers to determine if they have been made

aware of the hazards associated with their position.

Employer Guideline • This question asks workers to identify hazards that are part of their jobs. What kinds of

things could hurt them in the course of their work, and do they know how to protect themselves? The auditor needs to have evaluated the hazard/risk assessment for the job(s) applicable to the interview.

QUESTION 2.11 Are Employees who use PPE trained?

Auditor Guideline • Review documentation to verify formal or informal training.

Employer Guideline • Auditors are looking for current documentation of training that includes use of and care

for PPE. Examples of acceptable documentation are training records, a spreadsheet that tracks training and shows that employees have been trained in the proper use of their protective equipment, or records demonstrating that specific PPE requirements have been reviewed in departmental meetings. While training records are preferred for ease of recall in future years, meeting minutes are equally acceptable for this question.

Types of Documentation to Review • Training records, training spreadsheets, crew safety meeting documentation


QUESTION 2.12 Is there a system to ensure Employees wear appropriate PPE? Is it being followed?

Auditor Guideline • Review documentation to determine if there is a system to ensure Employees wear

appropriate PPE. • Observe use of PPE during site tour.

Employer Guideline • This question is looking for a policy or procedure that provides guidance to supervisors,

managers and workers on their responsibilities regarding PPE training, usage, supply, maintenance and storage. The observation tour is done to see if workers are following the safe work procedure requirements for PPE for the task they are performing. Safety signage can be part of an effective system but cannot be the whole system. A policy or procedure is still needed to support the signage.

Types of Documentation to Review • PPE policy or manual, documented observations on use of PPE by supervisors and

JOHSC

Possible Secondary Documentation • Signs, journal notes, inspections, log books, worker observations

QUESTION 2.13 Is PPE identified in the hazard identification process available and being properly maintained?

Auditor Guideline • Observe a representative sample of PPE identified in the hazard identification process

and verify it is available and being properly maintained.

Employer Guideline • On the observation tour, the auditor checks to see whether PPE listed in the safe work

procedures is available and in good condition. PPE needs to be clean, dry, sanitary and uncontaminated (at least on the side that the employee touches). If gloves or footwear are designed to be non-slip, the grip or traction should not be worn off. Specialized PPE, such as cartridge respirators, fall protection equipment and some emergency response PPE, must have documentation of the correct maintenance when documentation is required by regulation or company policy.


Element 3: Safe Work Procedures and Written Instruction

Overview

Making safe work procedures and practices part of standard operating procedure may seem a matter of common sense, but in fact an effective health and safety program for workers is required by the Occupational Health and Safety Regulation Without a written standard to refer to, whether for bed-making or respirator-wearing, there is no consistent guidance for workers or supervisors. Measurement of these items in the audit will include written safe work procedures, practices and/or instructions including:

• all routine and non-routine expected operations of the company • a Workplace Hazardous Materials Information System (WHMIS) • instructions that direct the first aid services, supplies and equipment to be provided and

how employees receive that service • procedures addressing possible emergencies, training of workers in those procedures,

testing their effectiveness, and evaluating and revising the procedures based on drills and actual emergencies.

The audit also measures whether the procedures are the right ones for the tasks the workers perform. The procedures need to flow from the risk assessments in the previous element of the audit to ensure that the procedures actually address the hazards of the job. As with other sections, communication and supervision are underlying themes. Workers need to be told the procedures, and supervisors need to coach the workers to help ensure that the work is done to right way the first time, every time.



• The employer has safe work procedures based on the hazard/risk assessments done at the worksite.

• Employees participate in the hazard/risk assessment, since they are the ones most affected by the hazards or risk.

• There is a first aid assessment done for each site that the company operates. • The company has appropriate first-aid supplies, equipment, rooms and personnel. • There is a procedure for workers to follow when they are injured (or observe an injury)

and need first aid. • There is a set of emergency-response procedures appropriate to the company’s

activities and risks. Examples of risk factors include: o blood-borne pathogens, fire, injury, fatality, natural disasters. o workplace violence, working alone, wildlife encounters, crisis management,

power failure, major equipment failure, major substance spills, robberies, assaults, bomb threats, car accidents, rescue from remote locations, heights or depths, etc.


• Employees know their roles in the first aid and emergency-response plan, whether they are responders, reporters or bystanders.

• Emergency drills are held annually to test whether the various response plans actually work for the company.

• The company has a WHMIS program. • Training is documented.


How to - Safe Work Procedures

Sample Hospitality Safe Work Procedures (WorkSafeBC)


Safe Work Procedures (Safe Work Manitoba)

http://www.safemanitoba.com/uploads/bulletins/bltn249(3).pdf

How to – First Aid Assessment

First Aid Assessment (WorkSafeBC)

http://www2.worksafebc.com/PDFs/firstaid/First_aid_assessment_worksheet.pdf

How to – First Aid Procedures

First aid (WorkSafeBC) http://www2.worksafebc.com/Topics/FirstAid/Home.asp









http://www2.worksafebc.com/Topics/FirstAid/Home.asp

http://www2.worksafebc.com/Topics/FirstAid/Home.asp


How to – Emergency Response Plans

Emergency Response Plan (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/emergency_response_guide.pdf

How to – WHMIS

WHMIS (WorkSafeBC) http://www2.worksafebc.com/Topics/WHMIS/Home.asp

WHMIS at Work (WorkSafeBC) http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/whmis.pdf

WHMIS (CCOHS) http://www.ccohs.ca/oshanswers/prevention/whmis/

Getting WHMIS Program Started (Saskatchewan Labour)

http://www.lrws.gov.sk.ca/getting-whmis-program-started

TRAINING OPTIONS:

Training - Risk Assessment and Safe work procedures




CCOHS http://www.ccohs.ca/products/courses/hazard/

Training – First Aid




http://www2.worksafebc.com/Topics/WHMIS/Home.asp

http://www2.worksafebc.com/Topics/WHMIS/Home.asp

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/whmis.pdf



http://www.ccohs.ca/oshanswers/prevention/whmis/

http://www.ccohs.ca/oshanswers/prevention/whmis/





http://www.ccohs.ca/products/courses/hazard/




Training – WHMIS



CCOHS (online) http://www.ccohs.ca/products/courses/whmiscourse/




Safe Work Procedures • Section 3.3 ( c )

First Aid • Sections 3.14 – 3.21

Emergencies and drills • Sections 4.13 - 4.16

WHMIS • Section 5.3 – 5.19



Reporting injuries • Section 172


QUESTION 3.1 Have safe work practices and job procedures been written for the identified hazards as required?

Auditor Guideline • Review a representative sample of documentation (safe work practices / job

procedures) and compare to hazard identification and assessment. The percentage cannot exceed the percentage scored in Question 2.2 (i.e. If only 50% of the assessments have been completed in Question 2.2, 50% is the maximum that can be scored)

Employer Guideline • This question looks at the risk assessments completed for the company to see whether

there are corresponding safe work procedures. If only a fraction of the risk assessments have been completed, the number of points available for this question is that the same fraction. Without having a risk assessment, the company has no real way to determine whether the safe work procedure it has developed is actually appropriate for the job. It may be, but it might not be.

Types of Documentation to Review • Safe work practices/job procedures

QUESTION 3.2



http://www.ccohs.ca/products/courses/whmiscourse/







Are qualified individuals involved in the development / maintenance of safe work practices and job procedures?

Auditor Guideline • Interview Supervisors and Workers identified in the safe work practices and job

procedures to verify their involvement.

Employer Guideline • The question is designed to see whether workers and supervisors have been part of the

process for reviewing or developing the safe work procedures (SWP). It is not necessary for every worker performing a particular task to be involved in the development of SWP, but at least one needs to have been. The auditor should look at the SWP document to determine who was involved and then seek out interviewees to support that outcome. If there is no documentation assigning names, then the auditor should attempt to determine if any worker was involved and if possible interview that worker. A manager’s notebook can be an excellent supplement to a formal SWP.

QUESTION 3.3 Has a first aid assessment been completed for the site and the results implemented into a program?

Auditor Guideline • Review documentation to determine if a first aid assessment has been completed and

outlines first aid services, supplies, and equipment to be provided.

Employer Guideline • http://www2.worksafebc.com/PDFs/firstaid/First_aid_assessment_worksheet.pdf

This process is a WorkSafeBC annual requirement. It assesses the requirements of your site and determines what first aid supplies, personnel and equipment are required based on the location and level of risk. The process must be completed and dated, indicating that it has been reviewed in the past year. A company may develop its own form, but the process of determining the correct level of attendants, equipment and services must be followed. Note that non-workers on the site are excluded from the personnel counts. While hospitality companies need to care for guest first aid in many cases, this is not the scope of the question. Note that for companies with more than one site, one assessment per site needs to be completed. Some companies may need multiple assessments for the same overall site; for example, at a ski resort, it is not practical for a mountaintop injury to have first aid available only at the base. For companies with mobile crews (such as guide-outfitters), the crew needs an assessment as well.

QUESTION 3.4 Are the first aid equipment and supplies available as required?

Auditor Guideline • Observe condition and availability of first aid equipment and supplies.

Employer Guideline



• The observation tour determines whether the first aid supplies, personnel, equipment and facilities that were identified in the first aid assessment meet the requirements. Kits should be clean, neat, organized and not contain expired or otherwise unsuitable contents. Eyewashes and showers should be clean and useful for treating contamination.

QUESTION 3.5 Do the Employees know the procedure for obtaining first aid?

Auditor Guideline • Interview Employees to verify knowledge of the procedure to obtain first aid services.

Employer Guideline • This question tests to see whether employees are aware of how to get help if they

require first aid for themselves or for co-workers, and what procedures they would follow.

QUESTION 3.6 Is there a procedure for rendering and reporting of first aid services?

Auditor Guideline • Review documentation (First Aid Procedures).

Employer Guideline • This requires a policy, procedure or guideline on how to get first aid and what the

subsequent steps should be. Details could include how to get a worker to medical aid, what paperwork needs to be filled out, where the first aid stations are located, what supplies are available, who the on-duty first aid providers are, supervisor contact information, who needs to be notified, etc.

Types of Documentation to Review • First aid procedure, medical aid procedure

QUESTION 3.7 Are there written emergency response plans? Is the emergency response plan readily available to all employees?

Auditor Guideline • Review documentation (emergency response plans). Ensure that each plan is

appropriate for the worksite(s). • Observe the location of the emergency response plan to ensure it is accessible to all

staff.

Employer Guideline • Mandatory emergency response plans can include the risk of blood-borne pathogens,

fire, injury, fatality and natural disasters. Depending on the company, other emergency response plans may be required to address workplace violence, working alone, wildlife encounters, crisis management, power failure, major equipment failure, major


substance spills, robberies, assaults, bomb threats, car accidents, rescue from remote locations, heights or depths, etc.

• The entire plan in all its detail does not need to be instantly available to every worker, but key concepts do need to be posted, including some signage and information readily available in paper or electronic version. Hard copies of the master plan need to be readily accessible in case of power and/or computer failure.

Types of Documentation to Review • Emergency response plans

QUESTION 3.8 Have all Employees been made aware of the emergency response plans?

Auditor Guideline • Interview Workers, Supervisors, and Managers to verify training. This training could be

during orientation or refresher training, department meetings, job-specific training, or "emergency response" training.

Employer Guideline • This question aims to determine whether the employees know what the procedures are

for an emergency, and if they understand their roles and responsibilities. Individual auditors ask different questions of each interviewee, but typically people should know what to do in the major types of emergency (fire, injury, etc.), especially where their meeting location is in an emergency and whether the plan requires them to do anything other than get to the meeting area.

QUESTION 3.9 Are emergency response plans evaluated to identify deficiencies and revise accordingly?

Auditor Guideline • Review documentation (JOHSC meeting minutes, emergency drill records) to ensure the

effectiveness of the emergency response plan was reviewed and deficiencies were corrected.

• Interview Supervisors and Managers to verify there is a method to evaluate the effectiveness of the plan.

Employer Guideline • The company is required to have a documented emergency drill at least annually to test

the plans in place. The auditor is looking to see that a drill happened and that a debriefing followed. If there was any corrective action required to tweak the plan, or correct a procedure, the auditors are looking to see that it was documented. This documentation could be demonstrated in the JOHSC meeting minutes, the minutes of a management meeting, in a newsletter or even an email, depending on the company style.


QUESTION 3.10 Does the organization have a workplace hazardous materials information system (WHMIS) program?

Auditor Guideline • Review documentation to ensure there is a WHMIS program and that responsibility for

the program been assigned. • Observe that the program is being followed. Ensure all elements have been successfully

implemented including labeling and signage. • Interview a representative number of Employees to determine if they are familiar with

their responsibilities in the WHMIS program.

Employer Guideline • WHMIS must be reviewed annually. The company should have documentation that the

review happened with the appropriate personnel, and that there is someone assigned to oversee this process. The auditor’s observation tour includes looking at containers and noting if proper labeling has occurred, if there is appropriate signage available to guide workers in the use of chemicals, if the MSDS are readily available and up-to-date (no older than 3 years from issue date). The auditor’s interview aims to determine whether the employees understand what is required of them in terms of labeling, handling and storing chemicals. The employee needs to be able to describe such key concepts as the hazards of the materials being handled, the appropriate precautions to avoid harm and, in the event of an emergency, the immediate actions that should be personally taken before the worker sees a first aid attendant.


Element 4: Inspection of Premises, Equipment, Workplaces and Work Practices

Overview

Regular inspection of the premises, equipment, work methods and work practices must be included in an effective health and safety program. The audit checks for the following:

• written instructions that specify: o the intent of inspections o who is to inspect (including worker representation from the health and safety

committee) o what is to be inspected o inspection frequency

• records of regular inspections carried out as outlined in the written instructions by designated personnel

• a system to ensure that unsafe or harmful conditions and work procedures are identified, reported, corrected and followed up without delay

• whether adequate training is provided for personnel responsible for inspection. This is an element where informal documentation, such as manager notebooks, can be very useful in showing that inspections have occurred and that the journal’s owner participated. Inspecting the work practices (i.e., observing workers doing their normal tasks) is the most overlooked and most important part of the inspection process. The overloaded cart with the bent wheel won’t hurt anyone until someone tries to use it. More likely it won’t even be noticed until it is seen in use.



• The employer has a written inspection policy that describes all the different types of inspections that are performed, including

o Joint Occupational Health & Safety Committee monthly inspections o annual inspections of fire and life safety equipment and elevating devices o routine tours by management and supervisors of the facility or work area o daily equipment inspections by workers o inspection of critical equipment prior to use o utility and food-related inspections as required by regulation.

• The inspections required in the policy, regulation and law are actually being done by the appropriate people.

• When problems are found, they are fixed properly in a reasonable time


• There is a method for workers to mark and report problem tools and equipment when discovered during their duties, so that no one is subsequently hurt by that tool or equipment.

• Training is documented.


How to – Inspections

Safety Inspections (WorkSafeBC) http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/safety_inspections.pdf

Effective Workplace Inspections(CCOHS)

http://www.ccohs.ca/oshanswers/prevention/effectiv.html

How to Conduct workplace Inspections (IAPA)

http://www.iapa.ca/pdf/inspect.pdf

How to Implement a Formal Health and Safety Program (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/howtoimplement_ohs.pdf

TRAINING OPTIONS:

Training – Inspections




CCOHS http://www.ccohs.ca/products/courses/workplace_insp/

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/safety_inspections.pdf





http://www.iapa.ca/pdf/inspect.pdf






http://www.ccohs.ca/products/courses/workplace_insp/



Occupational Health and Safety Regulation (WorkSafeBC) Note that this list of inspection regulations is a partial list of items most likely to be applicable to the hospitality industry. It is NOT a comprehensive list of every inspection required for every company.


Inspections General

• Sections 3.5-3.10 • Section 4.3 (2) • Section 4.9

PPE • Section 8.5

Confined Space • Section 9.7 • Section 9.24

Fall Protection • Section 11.9

Laundry • Section 12.150

Work platforms • Section 13.22

Cranes and lifting machines • Section 14.12-14.14

Mobile Equipment • Section 16.7 • Section 16.34

ATV’s • Section 16.53

Transporting workers • Section 17.2 • Section 17.24

Emergency equipment Section 32.5


QUESTION 4.1 Is there a written policy/procedure for inspections?

Auditor Guideline • Review documentation (inspection policy/procedure) to ensure it identifies who, what,

and when inspections of premises, equipment, workplaces, and work practices are to be performed.

Employer Guideline • This requires a policy or a procedure that outlines:

o What is to be inspected? Have checklists been created for each area, and do they specifically mention premises, equipment, workplaces and worker observations?

o Who performs inspections? Perhaps the JOHSC goes out in teams, or the manager is responsible, or the safety coordinator, etc.




o How often are the inspections to be done? (Monthly, quarterly, before every shift, before a piece of equipment is used?)

o How are they conducted? (Formally or informally, scheduled or random, focusing on improvements rather than assigning blame?)

• The company policy should incorporate actual company practices, whereby managers tour the operations and individual workers inspect their work area on an ongoing basis, in addition to the JOHSC inspections.

Types of Documentation to Review • A formal policy or procedure is required, and it must mesh with other parts of the

overall safety management system, such as investigation and discipline.

QUESTION 4.2 Are inspections being performed as per the inspection policy / procedure?

Auditor Guideline • Review documentation (inspection records). Inspections may be done according to a

formal or informal schedule. • Interview Employees to ensure inspections are occurring as per the policy / procedure.

Employer Guideline • This question checks whether the company has documentation proving that the

inspections are occurring following the rules that the policy and Regulation set out. For example, if the policy states that inspections will be done monthly in each department, and only 60 per cent have met that requirement, the question will be scored as 6 out of 10. However, if the company system does not meet regulatory requirements, this is a negative finding. For example, if the company system says that fall protection equipment is to be inspected monthly ― whereas the regulatory requirement is to inspect it before every use ― then documentation evidence is negative. The auditor’s interview tests employee knowledge of the expected frequency of inspections, and the auditor must conclude that the inspections are being completed properly. The interview is negative if, to continue the example, the workers state that the fall protection equipment is inspected monthly, even though that may be the company’s instruction. Evidence of non-compliance can never be a positive finding for any audit question.

Types of Documentation to Review • A selection of inspection records needs to be reviewed. These should reflect different

types of inspections and also include inspections that the company should perform by regulation but do not actually perform (if any exist). Supervisor/manager journals are often examined to show management’s inspection.


QUESTION 4.3 Do the individuals identified in the policy participate in the inspection process?

Auditor Guideline • Review documentation to verify involvement in the inspection process.

Employer Guideline • This question compares names on the inspection sheet or record with whoever the

policy lists as responsible for the inspections. Note that JOHSC or worker representative is required to participate in monthly inspections as per OHS Regulation.

Types of Documentation to Review • This continues from the previous question.

QUESTION 4.4 Is there a system to ensure that unsafe or harmful conditions and work procedures are corrected, and followed up without delay? Is the system being followed?

Auditor Guideline • Review documentation (JOHSC meeting minutes, maintenance records, etc) to ensure

there is a system. • Observe corrective action from a sample of completed current inspection records during

the site tour.

Employer Guideline • The company needs to demonstrate a systematic corrective action plan for items

identified during the inspection (and from employee reports or supervisor observations). The plan needs to specify:

• what needs to happen • who is required to either lead or perform the plan • what the deadline is • the date on which it was completed. • This action plan can be tracked in the JOHSC meeting minutes, through a maintenance

program or in a corrective action log. The audit tests the system to see whether items are being corrected and followed up on in a timely manner. During the documentation review, an auditor will note a few of the corrective actions that are said to be complete ―and the auditor should be able to see something tangible that can be checked ― and will look to see whether the items have been completed as stated during the observation tour.


QUESTION 4.5 Are the individuals performing inspections trained to do them?

Auditor Guideline • Review documentation (training records) and verify if formal or informal inspection

training has occurred.

Employer Guideline • This requires a tracking system for completed training. The training can be done in

house, but it needs to be documented. This can be shown with a spreadsheet, training records in employee files, a certificate, or a PowerPoint presentation with the sign-in sheet indicating who attended, etc. Workers should be trained in the inspection of their work areas as part of their regular duties, using their regular training procedures.

QUESTION 4.6 Is there a system for preventing the use of defective /broken tools and equipment until it is repaired or replaced? Is it being followed?

Auditor Guideline • Review documentation (JOHSC minutes, maintenance records, etc) to verify the system

is in place and being followed. • Observe and verify during site tour by looking at condition/ repair of a sample of items. • Interview Supervisors and Workers to ensure a system is in place.

Employer Guideline • This is usually a policy or procedure outlining the steps to take if a piece of equipment

breaks down and needs to be repaired or replaced. The procedure might incorporate some kind of lock-out, removal or flagging system that clearly identifies to everyone items that are not safe to use. During the observation tour, auditors verify that this system is being followed according to the policy. Auditor interviews verify that supervisors and workers are aware of the system and know how to prevent co-workers from using defective or broken equipment.


Element 5: Investigation of Incidents/Accidents

Overview

The objective of any investigation is to learn from the event and reduce the risk of repeating it. Only by performing an effective investigation can root causes be discovered, and only by addressing those root causes can effective changes be made. Investigating properly and effecting change is one of the most respectful ways to treat injured and otherwise affected workers. Management’s failure to investigate properly or, worse, failure to follow up on the recommendations from a proper investigation is one of the surest ways to have workers disengage from the company, fostering lower morale and trust. A good safety culture demands a thorough investigation in a blame-free setting. Investigations must not focus on blaming the worker, but rather on finding where the system allowed the worker to make a poor decision. Investigations of serious incidents are not easy to perform for many companies, so outside assistance is perfectly acceptable in these cases. The audit will measure whether:

• there is a procedure for the immediate investigating and reporting of incidents that identifies:

o what to report to WorkSafeBC o which incidents to investigate o the intent of the investigation o the content, distribution and follow-up of reports

• there is a process to identify and record the actions necessary to prevent recurrence and to implement and follow up on those actions

• designated investigating personnel are adequately trained and knowledgeable of the type of work involved.



• The employer has a comprehensive written investigations policy. • The investigations required in the policy, Regulation and law are actually being done as

required by the appropriate people for: o injuries requiring medical aid, time loss or modified work duties o serious close calls o property damage involving or affecting a worker o first aid cases that did not result in medical aid or time loss.

• When problems are found, they are fixed properly in a reasonable time. • There is a method for workers to report injuries, close calls, hazards and other

problems, and that the workers are using it. • Training is documented.


Not all investigations are required to be full formal investigations. Minor first aid could be investigated entirely in a manager’s notebook if that is standard company procedure.


How to – Accident Investigations

Investigations of Accidents and Diseases (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/investigatn_accdnt_disease.pdf

Accident Investigations Report (WorkSafeBC)

http://www.worksafebc.com/forms/assets/PDF/52E40.pdf

BC Ski Area Investigation Tool (go2)

http://www.go2hr.ca/health-safety/program-tools/sector-specific-resources/ski-areas#ski-investigate

Accident Investigations (CCOHS) http://www.ccohs.ca/oshanswers/hsprograms/investig.html

Incident Investigation (WorkSafe Alberta)

http://www.employment.alberta.ca/elearning/Incident/Incident.htm

Conducting a Workplace Accident Investigation (Safe Manitoba)

http://safemanitoba.com/conducting_a_workplace_incident_investigation.aspx









http://www.ccohs.ca/oshanswers/hsprograms/investig.html

http://www.ccohs.ca/oshanswers/hsprograms/investig.html






What Does an Accident Really Cost? (WorkSafeBC)

http://www2.worksafebc.com/sc/tours/default.htm

TRAINING OPTIONS:

Training - Investigations




CCOHS http://www.ccohs.ca/products/courses/accident_investigations/

BC Forest Safety Council (dates on this form update continually)

http://www.bcforestsafe.org/files/files/training/Enrollment%20Form%20-%20Incident%20Investigation%20Training.pdf




Investigations General

• Sections 3.3 Violence / conduct

• Section 4.26 Air Quality

• Section 4.79 Chemical exposure

• Section 5.59



Investigating injuries Section 173


QUESTION 5.1 Does the employer have an accident / incident investigation procedure?

Auditor Guideline • Review documentation (the accident / incident investigation procedure) to determine if

it identifies what to report to WorkSafeBC, which incidents to investigate, the intent of the investigation and the content, distribution and follow-up of reports.





http://www.ccohs.ca/products/courses/accident_investigations/









Employer Guideline • Ensure that the incident or accident investigation procedure identifies the following: 1. What to report to WorkSafeBC immediately (WCB Act. 10-172): This includes cases that

resulted in serious injury to or death, a major structural failure or collapse of a building, the major release of a hazardous substance or were required by regulation to be reported.

2. Which incidents to investigate (WCB Act. 10-173): An employer must immediately undertake an investigation into the cause of any accident or other incident that:

o is required to be reported by Section 172 of the Act, o resulted in injury that required medical treatment, o did not involve injury to a worker, or involved only minor injury not requiring

medical treatment, but had the potential to cause serious injury to a worker o was an incident required by regulation to be investigated.

3. In addition, an employer needs to investigate all first aid cases, near misses, threats and significant property damage in a manner appropriate to the severity of the incident.

4. The intent of the investigation (WCB Act 10:174): As far as possible, the investigation must:

o determine the cause of the incident o identify any unsafe conditions, acts or procedures that contributed in any

manner to the incident o recommend corrective action to prevent similar incidents.

5. Content: This could include photos, diagrams, witness statements and contact information, events leading up to the incident, description of incident, etc.

6. Distribution: Who is required to get copies of the investigation? This should include the JOHSC and senior management.

7. Follow-up of reports: What are the procedures for following up on the incident, and who is required to receive the updated reports?

Types of Documentation to Review • Accident investigation policy or procedure

QUESTION 5.2 Have Employees been made aware of the accident / incident investigation procedure?

Auditor Guideline • Interview Employees to determine if they have been made aware of the accident /

incident investigation procedure.

Employer Guideline • All employees should know that all incidents will be investigated. This question tests

whether employees are aware of the company procedures for an investigation. Do they know the steps that will be followed, and what are their responsibilities during that process, if any? Their responses are measured against either the regulatory requirements, the company system or this audit, whichever is the higher standard. For example, if the company system does not include investigation of first aid cases to any degree, and employees confirm this, there would be a negative finding.


QUESTION 5.3 Are incidents/ accidents investigated as per the company’s procedures?

Auditor Guideline • Review documentation (incident/accident investigation procedures and reports).

Interview Managers, Supervisors and Workers.

Employer Guideline • A review is done of all investigations performed in the past year. The auditor will want

to verify effective evidence gathering techniques are used and that root causes were found and corrective actions taken and completed. Did management sign off on the investigation, did the JOHSC review the investigation, and was worker privacy protected? Through interviews, the auditor is looking for verification from employees that investigations are happening according to policy. Some workers interviewed may not know the details of an investigation if nothing happened in their work area, but they do need to know that if there was an incident, that it was investigated and that the investigation was done by the appropriate individuals.

Types of Documentation to Review • Incident investigation policy or procedures, incident investigation reports

QUESTION 5.4 Are the persons investigating incidents trained in investigation techniques?

Auditor Guideline • Review documentation (training records). • Interview investigator(s). Formal incident investigation training is required to achieve

points.

Employer Guideline • There needs to be evidence of formal training for the people responsible for

investigations. This could be through the Employers’ Advisers Office or another recognized training institution. Certificates and training spreadsheets are the easiest way to verify this training but are not the only form of verification. Emails from the training institutes can also be used. Those who are competent to do so can also conduct internal training.

QUESTION 5.5 Are investigation findings and recommendations discussed with the joint occupational health and safety committee?

Auditor Guideline • Review documentation (JOHSC meeting minutes) to ensure findings and

recommendations are reviewed with the committee.


Employer Guideline • The JOHSC meeting minutes are reviewed to see that incident investigations are being

discussed; these minutes are often used to track the resulting corrective actions or demonstrate that there has been brainstorming to find solutions to the problems identified. Worker identities need to be protected in this process.

QUESTION 5.6 Are employees aware of their responsibility to report all incidents?

Auditor Guideline • Interview Employees to ensure they are aware of their responsibility to report all

incidents and the procedures to do so.

Employer Guideline • This question aims to determine what kind of incident employees would report, whether

if they would report all incidents or just the serious ones. The same criteria as in 5.2 apply. The interviewees need to report that all incidents are investigated, even if company policy does not demand that degree of thoroughness.


Element 6: Training and Instruction of Employees

Overview

Training and instruction are one aspect of the overall theme of communication. All workers need to know how to perform their jobs safely and understand their role in maintaining a healthy and safe workplace. Employers must ensure that workers are trained, qualified and competent to perform their tasks. Adequate instruction and supervision must also be provided to workers in the safe performance of their work. The audit will measure whether:

• A system to ensure job specific instructions and training (including job-specific hazards and work procedures and practices) has been communicated to workers.

• Training and instruction is current, enforced and followed. • The system assesses and ensures that all employees are qualified and are competently

performing their duties in a safe manner. • For new employees, visitors and contractors, orientation about emergency procedures,

hazard reporting and health and safety policies and procedures is delivered in a timely manner.

The system for tracking this training can vary widely, from electronic databases to simple spreadsheets or wall charts. There needs to be some way to list in an easily searchable way showing who has what training. The records in the system can range from formal certificates issued by external agencies to minutes from meetings or a supervisor’s journal notes and sign-offs on safe work procedures. How each company keeps the records and the system is entirely up to the company, but the policy should fit with the overall company style and culture. Records should be readily available and protected from alteration. The method for tracking safety training should be the same as for tracking non-safety training. (In other words, a course in bookkeeping is no more or less valid than a course in investigation techniques.) Other elements of the audit will look at specific training topics. This element looks at the training system – how it is all linked together and tracked. Training is not just reading a manual or being shown how to do a job. It includes evaluation on an ongoing basis to verify that a worker is actually doing the job the right way every time.


In order to meet the above objectives, the audit checks whether: • The employer has a written training program that covers the items mentioned above. • The training required in the policy, Regulation and law are actually being done as

required by the appropriate people for o employees o supervisors o managers o specialists in the company o contractors o visitors


Evaluations of training competency can range from formal worker assessments to managers’ notebooks. Feedback should be given for both positive and negative observations, leading to continual improvement in the workforce and the company.


How to - Training

Three Steps to Effective Worker Education and Training (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/3-steps.pdf

Training and Orientation for Young and New Workers (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/YW_Orientation.pdf

Training and Orientation (go2) http://www.go2hr.ca/health-safety/ohs-program-tools/young-and-new-workers/orientation-and-training

Young and New Worker Safety Kit (WorkSafeBC)

http://www2.worksafebc.com/PDFs/YoungWorker/tourism_yw_safety_kit.pdf

Supervising for safety (WorkSafeBC)


Young Workers Zone (CCOHS) http://www.ccohs.ca/youngworkers/







http://www.go2hr.ca/health-safety/ohs-program-tools/young-and-new-workers/orientation-and-training






http://www.ccohs.ca/youngworkers/


TRAINING OPTIONS:

Training




CCOHS http://www.ccohs.ca/products/courses/

go2 http://www.go2hr.ca/tourism-education




Training General

• Sections 3.3 New Worker

• Section 3.23 Observation evaluation

• Section 3.24



Training all workers (note – includes workers of any company, not just your company) Section 115 (e)

Note that the regulation links only cover training systems. There are many other references requiring training in specific areas, topics and skills.


QUESTION 6.1 Does the company have a program to ensure employees are trained, qualified, and competent to perform their tasks safely?

Auditor Guideline • Review documentation to verify there is a system to ensure job-specific instructions and

training have been given to workers, training and instruction is current and followed.

Employer Guideline • There needs to be a system in place that tracks employees through the training

process, qualifying that process through to the stage where workers are competent in their jobs. This documentation is crucial. Consistent training techniques need to be seen in order to prove that everyone is receiving the same level of training and attention.

Types of Documentation to Review • A formal documented policy or procedure is required. A collection of forms and

spreadsheets is insufficient to be considered a system without a guidance document showing how it actually works.



http://www.go2hr.ca/tourism-education








QUESTION 6.2 Are Workers trained on safe work practices and job procedures?

Auditor Guideline • Review documentation (training records). Ensure Employees receive job-specific

training including when they are transferred to a new job or perform new tasks. • Interview Workers to verify training is occurring.

Employer Guideline • There needs to be evidence that when workers are transferred to a new job or task,

they receive some kind of training before being allowed to perform the new role. This training can be in the form of an orientation checklist, a training tracking program or some other means of documenting what level or job each worker has been trained for. The auditor’s interview verifies that workers have received this training. It is understood that very long-term employees may have never received formal training because they pre-date the current company system. This is not necessarily a negative finding, provided the company can show that the workers are competent.

Types of Documentation to Review • Question 6.1 should have defined what records the company keeps and where they are

kept. Training records can include certificates, spreadsheet entries, meeting minutes, job description sign-off, supervisor notes, manager’s journal, etc.

QUESTION 6.3 Is there a system to assess and ensure that all Employees are qualified and are competently performing their duties in a safe manner?

Auditor Guideline • Interview Supervisors to verify that worker skills are checked to ensure competency.

Employer Guideline • The question is looking for information from the supervisors about how workers are

evaluated and judged to be competent to do the jobs that they are required to do. Examples are required. While this is an interview question, supervisors should be able to discuss how they document their assessments.

QUESTION 6.4 Does the organization have a health and safety orientation for all new Employees?

Auditor Guideline • Review documentation to ensure all new Employees receive an orientation that covers

critical issues (ERP, hazard reporting, etc) and health and safety procedures in a timely manner.

• Interview Supervisors to determine their knowledge of the procedures for orienting new Employees.


Employer Guideline • The company must ensure all new employees, including those transferring from other

positions or returning after a significant absence, receive an orientation that covers critical issues and health and safety procedures on or before their first day of work. The orientation checklist must include all of the applicable following items:

o supervisor name and contact information o PPE policy o first aid procedures, facilities, equipment and personnel o reporting responsibilities for hazards, close calls and other incidents o Emergency response plans (ERPs) o training, certification, qualifications o acknowledgement of the right to refuse unsafe work o policy on working alone or in isolation o WHMIS orientation o progressive discipline policy o policy on workplace violence o safe work procedures o rights and responsibilities o known hazards and how to deal with them o contact information for JOHSC o any other information required by a change to ‘New and Young Worker

Orientation’ regulation • Orientation topics often include non-safety issues, such as keys, contact information

and medical issues. Companies are encouraged to integrate safety and non-safety orientation as much as practical in order to reduce paperwork.

• The auditor’s interview determines whether supervisors understand how new employees are to be trained.

Types of Documentation to Review • Orientation checklists and records

QUESTION 6.5 Does the organization have a health and safety orientation for all contractors?

Auditor Guideline • Review documentation to ensure all contractors receive an orientation that covers

critical issues (ERP, hazard reporting, etc) and health and safety procedures in a timely manner.

• Interview Contractors (if possible) to verify that they received an orientation. • Interview Supervisors to determine their knowledge of the procedures for contractors

that come to the site.

Employer Guideline • Contractors coming on site need to receive an orientation that includes the key points

that will affect them during their job. These factors include ERPs, hazards, reporting of incidents, PPE, WHMIS and any chemicals they will be bringing on to the property. As


part of the due diligence process the company should require a proof of WorkSafeBC insurance and detailed explanation how all safety aspects of the job will be handled by a contractor. If contractors are present when the auditor is there, a quick question can be asked to see whether they have received orientation on emergency response plans and hazards. If no contractors are reasonably available, the contractor interview portion is to be scored as not applicable and five points deducted from the available total. Supervisors are asked whether they are familiar with how to bring a contractor on board, and what to do if a contractor has not been put through the orientation process.

Types of Documentation to Review • Health and safety orientation for contractors

QUESTION 6.6 Does the organization have a health and safety orientation for all visitors?

Auditor Guideline • Observe during site tour. Look for examples of signage in all areas such as emergency

evacuation plans, wet floor signs, or employee only signs. • Interview Supervisors to determine their knowledge of the procedures for visitors that

come to the site.

Employer Guideline • The auditor’s observation tour includes looking for evidence of safety for visitors. This

could include signage for employee-only areas, directions for evacuations, wet floor signs, no-smoking signs, adequate parking and luggage storage, non-slip strips on stairs, the availability of antibacterial hand soap, cleanliness of bathrooms, etc. The interview will confirm that supervisors know how to manage visitor safety. It is not expected that guests at companies in the hospitality/tourism industry will receive a formal briefing unless undertaking special high-risk activities (heli-skiing, bungee jumping, etc.). High-risk activities should be preceded by formal briefings, supported by documentation when deemed necessary by the risk involved.


Element 7: Program Administration

Overview

The maintenance of health and safety records is necessary in order to determine the effectiveness of a health and safety program. Reports of inspections and incident investigations are required in order to determine incident trends, including their frequency and severity. Effective communication of the program is necessary in order to promote a good safety culture. Performing the COR audit annually is a major review, but the company needs to stay on top of its own system. Think of the audit as your annual physical; as a company you still should look in the mirror daily and step on the scales weekly. The audit will measure the following:

• a health and safety records management system • the analysis of records and statistics that determine incident trends (frequency,

severity, type and nature of worker injury) • effective communication of the program at all levels • a system for program evaluation and a plan to correct deficiencies



• The employer keeps records in a way that they can be retrieved. • The records required by legislation, regulation and the company are maintained. • The records are analyzed on a regular basis, at least annually. • Senior management has formulated a plan based on that analysis. • Everyone in the company knows the major themes that the plan is going to address

(i.e., reducing cuts or improving return-to-work times).


How to – Record keeping

Joint Occupational Health and Safety Committee

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/jointoch.pdf

Managing Safety from Supervisors Perspective (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/managing_safety.pdf








Business Planning Toolkit (WorkSafeBC)

http://www.go2hr.ca/IndustrybrHealthSafety/ResourcesLinks/WorkSafeBCsEnhancedEmployerPortal/tabid/2463/Default.aspx

TRAINING OPTIONS:

Training





Statistics • Sections 3.3 (f)

Records All sections require that a record be kept to prove due diligence


QUESTION 7.1 Is there a health and safety records management system? Are records being maintained as per the policy?

Auditor Guideline • Review a representative sample of documentation from the program to ensure there is

a system to manage health and safety records. For example, which documents are collected and how documents are collected, retained, stored, and protected.

Employer Guideline • The company needs a policy or procedure that outlines specifically which documents are

to be stored, how many years will they be kept, where will they be stored, and what security measures are in place to protect the private information contained within those documents. The second part of the question tests whether the policies are being followed, documents were readily available at the time of the audit, and whether any requested documents were found easily.










QUESTION 7.2 Are records and statistics collected and analyzed to determine incident trends (frequency, severity, type and nature of worker injury)?

Auditor Guideline • Review documentation to ensure records and statistics are being collected and analyzed

to determine incident trends (including frequency, severity, type, and nature of worker injury).

Employer Guideline • Auditors look to see that information and analysis are being gathered from recorded

incidents. Are reports being examined for trend analysis, are corrective actions being put in place to mitigate the risk, and is the information shared with everyone? This analysis can be presented in graphs, through JOHSC meeting minutes, in newsletters or posted on OHS boards, etc.

QUESTION 7.3 Are the outcomes of the analysis of incident trends communicated to all Employees?

Auditor Guideline • Interview Employees to determine their level of awareness of incident trends and plans

to correct deficiencies.

Employer Guideline • The question is looking to verify whether employees have seen or heard any analysis of

incident trends, or where they would find this information if they wanted to. Positive findings would result if employees were aware of overall, “big picture” themes or were aware of detailed plans that directly affect them. It is unreasonable to require employees to be aware of detailed plans that have no direct impact on their work, but it is regarded as highly positive if they are.

QUESTION 7.4 Is there a safety improvement plan based on the analysis of incident trends referred to in Question 7.2?

Auditor Guideline • Review documentation (for example management meeting minutes, JOHSC meeting

minutes) to determine if incident trends are being used to evaluate and correct deficiencies in the health and safety program.

Employer Guideline • This question is looking for evidence that the information gathered is being put to use

to manage the risks identified and to address any issues that can improve the safety culture and safety performance of the company. If there is no information gathered in question 7.2, this question cannot have a positive score. Some companies have a separate plan to deal with incident trends, which can also be tracked in JSHC meeting minutes or other committee minutes.


QUESTION 7.5 Does senior management make sure that previous safety audit recommendations are implemented and deficiencies corrected?

Auditor Guideline • Review documentation to confirm previous safety audit recommendations are

implemented and deficiencies corrected. • Interview a representative number of Managers to determine if recommendations and

deficiencies are dealt with.

Employer Guideline • This question is looking for any other safety audit that might have been performed. This

can be a previous COR external audit or internal audit. For companies that are undergoing their first formal COR audit, results of an internal dry-run or gap analysis would be evaluated. Some companies that are part of large corporations may have undergone corporate safety audits using non-COR tools. These would also be valid. If no safety audit has been performed, no points are awardable. If an audit has been performed, then the auditor will evaluate the percentage of deficiencies that have been addressed to date. While having a plan that is not yet enacted is better than having no plan for a particular item, this question only evaluates the percentage of items that have been completed.


Element 8: Joint Occupational Health and Safety Committee

Overview

A joint occupational health and safety committee (JOHSC) is required at every workplace and is an integral part of an effective occupational health and safety program. A JOHSC is a key facilitator of communication, and its meeting minutes are often excellent documentation of larger-scale safety initiatives. Such a committee often directly interacts with inspections, investigations and system administration. The audit will measure the following:

• a functioning JOHSC, with clearly defined committee membership, function and duties • committee members’ active involvement in health and safety activities • a process that ensures committee minutes are maintained and communicated, with

recommended actions followed up by the employer.



• The employer has written terms of reference for the safety committee. • The committee has been trained appropriate to those terms of reference. • The committee actually performs its duties to according to legislation, regulation and

company policy. • The committee routinely meets and then publishes minutes so that everyone knows

o the importance of safety in the workplace o the names of the committee members o how workers can take safety issues to the committee.


How to – Joint Occupational Health and Safety Committee

Joint Occupational Health and Safety Committee (WorkSafeBC)






TRAINING OPTIONS:

Training – Joint Occupational Health and Safety Committee




CCOHS http://www.ccohs.ca/products/courses/hscommittees/




Committee • Section 3.3 (f)



Committee Section 125-138


QUESTION 8.1 Is there a joint occupational health and safety committee (JOHSC)?

Auditor Guideline • Review documentation (JOHSC meeting minutes) to confirm there is a joint health and

safety committee.

Employer Guideline • There need to be meeting minutes demonstrating that there is a JOHSC committee in

place and that it is functioning. This question deals solely with the existence of a committee. Other questions in this element deal with whether the committee is properly constituted and performing useful safety duties so as to meet company and legal requirements.

Types of Documentation to Review • JOHSC meeting minutes

QUESTION 8.2 Does the joint occupational health and safety committee have written terms of reference?

Auditor Guideline • Review documentation (Terms of Reference) to verify that it sets out the committee

involvement, membership, function, and duties

Employer Guideline • The terms of reference for a safety committee should stipulate:

1. equal representation of management and workers



http://www.ccohs.ca/products/courses/hscommittees/








2. responsibilities of members 3. attendance criteria 4. frequency of inspections 5. frequency of meetings 6. investigation procedures 7. work refusal procedures.

• These are requirements set by the Workers’ Compensation Act and OH&S Regulations.

Types of Documentation to Review • JOHSC terms of reference

QUESTION 8.3 Are committee members aware of the terms of reference and carrying out their roles and responsibilities as identified?

Auditor Guideline • Interview JOHSC members to determine their level of knowledge and understanding of

their roles and responsibilities on the committee and the terms of reference.

Employer Guideline • The interview aims to verify that the committee members are aware of their key

responsibilities, which are a combination of regulatory responsibilities and any additional responsibilities assigned by the company The results of this question are independent of question 8.2. Committee members could be aware of their regulatory duties even if the JOHSC does not have any formal terms of reference.

QUESTION 8.4 Are joint occupational health and safety committee meetings held regularly?

Auditor Guideline • Review documentation (meeting schedules and minutes) to ensure meetings are held as

outlined in the Terms of Reference.

Employer Guideline • The company needs to be able to show that a safety committee met during every

operating month, or more often if company policy requires meetings to be more frequent. For seasonal companies, there does not need to be a formal meeting if there are fewer than 10 people working that month. This is an all-or-nothing question, so all required months must have a recorded meeting.

QUESTION 8.5 Are minutes kept for the meetings and made accessible to all employees?

Auditor Guideline • Review documentation (copies of minutes) from the meetings. • Observe the minutes are made accessible to all employees.


Employer Guideline • This question anticipates that all required meetings are recorded with official, formal

minutes. The documentation portion is looking to verify that the minutes do exist somewhere, and the observation portion is looking to see that the minutes of at least the last three meetings are accessible by all employees. These minutes can be in paper or electronic form, but if the company relies only on electronic means, all workers must have the ability to access them.

QUESTION 8.6 Does the JOHSC have a process for ensuring recommendations are presented to and followed up with management?

Auditor Guideline • Review documentation (Terms of Reference or meeting minutes) to determine if a

process for the committee to submit and follow up on recommendations made to management.

Employer Guideline • Auditors are looking for some kind of tracking system for corrective actions. This can be

done within the JOHSC meeting minutes, which should clearly show that action items are addressed in a timely manner or by the established due date. A separate corrective action log can track all identified deficiencies, including JOHSC meeting items, but it needs to also show the date, item deficiency, person responsible, due date and the actual completion date.

QUESTION 8.7 Do Workers know how to find out who their representative on the JOHSC is?

Auditor Guideline • Interview Workers to determine if they are aware of how to find out who their safety

representative on the JOHSC is.

Employer Guideline • This question is looking to see whether workers know who their representatives are on

the JOHSC, or know how to find out who they are. Many companies have a representative from every department; others have a select number of workers on the committee. It is not a requirement that the workers actually know who their representative is, but they need to know how to find out.


Element 9: Injury Management/Return to Work Programs

Overview

Injury management/return-to-work (IM/RTW) programs are a proactive way for employers to help injured workers stay at work or return to productive and safe employment as soon as physically possible. These programs are based on the understanding that many injured workers can safely perform meaningful and productive work during the process of recovery, and that returning to work can be an effective part of the worker’s therapy and recovery. Effective injury management/return-to-work programs are initiated when the worker first contacts the employer. At this time, an early intervention procedure can be initiated to determine whether the worker is capable of staying at work to perform normal duties or modified duties while the injury heals. In many cases, this prevents any time lost from work. If workers do need time away, the injury management/return-to-work program can reintegrate injured employees into the workforce much earlier and on average with better health outcomes for the worker. While this element is long and has many details, it again covers the three basic themes:

• What are you supposed to do? • Is there training for that? • Are you actually doing it?



• The employer has a written policy and procedure for return-to-work and stay-at-work injury cases.

• Cases are tracked from first injury through rehabilitation and analyzed to improve the program. Tracking includes:

o date and nature of injury and absence with first aid report and link to investigation

o medical details if any o claim contact details if any o contact schedule with worker while absent o return-to-work or stay-at-work plan with estimated end date o involvement of multiple parties (first aid, medical, WorkSafeBC, coordinator,

worker, supervisor, human resources, union if any, etc.) o any modifications to the plan based on worker progress o conclusion of case o analysis of case with suggestions for improvement.

• The program coordinator’s duties have been defined and appropriate training given. • Record-keeping and privacy requirements are being met. • People with responsibilities in the program (managers, supervisors, HR, first aid, etc.)

have been trained appropriately.


• Workers have been trained in how to access the program from their first orientation (or from the start of the program for more experienced workers), so they expect that every injury will result in a return-to-work or stay-at-work plan.

• Meaningful alternate duties have been written down in advance. • The benefits of the program are promoted to workers, instead of simply informing them

of the program’s existence. • There is a prepared package to send with the worker to the doctor. • Training records exist.


How to – Injury Management

Rehabilitation and return to Work (WorkSafeBC)

http://www.worksafebc.com/claims/rehab_and_IM/RTW/default.asp

Return to Work: Good for Business, Good for Workers (WorkSafeBC)

http://www2.worksafebc.com/Publications/Multimedia/Videos.asp?ReportID=36382

Navigating Challenging Slopes – A Modified Work Trail Map (go2)

http://www.go2hr.ca/health-safety/program-tools/sector-specific-resources/ski-areas#ski-modified

Return to Work Is a Good Business

http://www.worksafebc.com/publications/how_to_work_with_the_wcb/Assets/PDF/IM/RTW_goodbiz.pdf

Return to Work and Injury Management programs (WorkSafeBC)

http://www.worksafebc.com/claims/rehab_and_IM/RTW/IM/RTW_employers/default.asp

http://www.worksafebc.com/claims/rehab_and_rtw/default.asp

http://www.worksafebc.com/claims/rehab_and_rtw/default.asp







http://www.worksafebc.com/publications/how_to_work_with_the_wcb/Assets/PDF/rtw_goodbiz.pdf



http://www.worksafebc.com/claims/rehab_and_rtw/rtw_employers/default.asp




Guidelines for Modified Work (WorkSafeBC)

http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/GuidelinesModifiedWorkStrainSprainInjuries.pdf

TRAINING OPTIONS:

Training – Joint Occupational health and safety Committee




CCOHS http://www.ccohs.ca/products/courses/return_to_work/



There is no regulation for Injury Management. It is purely best business practices.



Social Responsibility Section 107 Responsibility to care for workers (even when injured) Section 115 (a) and (e)


QUESTION 9.1 Is there a policy outlining the company’s commitment to the Injury Management / RTW Program that details program objectives?

Auditor Guideline • Review documentation - if they have a written policy and it outlines the objectives of

the program. • Observe if the policy is posted in the workplace.

Employer Guideline • There needs to be a policy that states clearly what the goals of the IM/RTW program

include. This can be done in a bullet-format document or a paragraph. The policy can stand alone or be part of a general safety policy or mission statement. During the observation tour, auditors are looking to see that this policy is posted on an OHS board or otherwise readily available to workers for reference. This can be on a shared computer drive or Intranet that everyone can access.

Types of Documentation to Review • IM/RTW policy







http://www.ccohs.ca/products/courses/return_to_work/





QUESTION 9.2 Is there a written Injury Management / RTW Program?

Auditor Guideline • Review documentation to confirm proof of a written Injury Management / RTW

Program.

Employer Guideline • Auditors are looking for a program in place that shows the steps, and the documents

required, to complete the process. The program needs to include a summarized step-by-step instruction for injury management. For example:

o first response to injury o worker reporting requirements o medical assessment o contact with worker by the employer o employer’s reporting requirement to WSBC o claims management o identification of alternate or modified duties available o process to develop IM/RTW plan. o process to modify IM/RTW plans depending on worker progress.

Types of Documentation to Review • IM/RTW program

QUESTION 9.3 Are outcomes of the Injury Management / RTW Program tracked and analyzed?

Auditor Guideline • Review documentation to determine if outcomes are tracked.

Employer Guideline • The company needs to have a case tracking system; this could be done electronically

with in-house software or on a spreadsheet that is maintained by an outside third party. There needs to be evidence that the results are tracked and that management is looking at them to identify trends. If there are outcomes but no analysis, this is insufficient for the points. If there is non-documentation evidence that there is tracking and analysis, this should be recorded here but is not worth points. If the company has no cases yet and therefore no outcomes to analyze, this question could be scored as “not applicable.”

QUESTION 9.4 Is the analysis of the program outcomes utilized to improve the program?

Auditor Guideline • Interview Managers to determine if actions are implemented to address the

opportunities identified as a result of the analysis.


Employer Guideline • This question flows from 9.3. and seeks to determine whether management is aware of

the results being tracked, and what happens to that information afterward. The tracking and analysis need to exist (but not necessarily be documented for the purposes of this question) before they can be used to improve the system. Random improvements that do not come from analysis are not positive findings. This question could be deemed “not applicable” if there are no relevant cases.

QUESTION 9.5 Have the duties of an Injury Management / RTW Coordinator been assigned and does this outline the authority to establish and implement IM/RTW plans?

Auditor Guideline • Review documentation (roles and responsibilities document) to determine if program

coordination duties have been assigned.

Employer Guideline • The company needs to have a list of responsibilities identified for the IM/RTW

coordinator, and it could be part of IM coordinator’s job description. The responsibilities include the steps needed to put the IM/RTW plans into action. This information needs to be in a policy, procedure or other guidance document rather than solely existing in meeting minutes. For large companies, more than one coordinator may be assigned.

Types of Documentation to Review • Roles and responsibilities of IM/RTW coordinator

QUESTION 9.6 Has education been provided to ensure the coordinator has an understanding of Injury Management / RTW Programs?

Auditor Guideline • Review documentation (training records or credentials of the coordinator) to determine

if training has taken place.

Employer Guideline • IM/RTW coordinators need to have training appropriate to the program they are

administering. If a third party administers most of the program, the company contact still needs training for the part of the system performed in house. Training could range from evidence of an HR certification through to attendance at a briefing by the third-party service provider. Companies that are administering their own program need to have a coordinator with at least the training equivalent of the four hours of the Employer’s Advisors Office Claims Management program, modules 1 and 2. If there is more than one coordinator in large companies, they all need training appropriate to their duties in order to be awarded points.


QUESTION 9.7 Does the individual assigned Injury Management / RTW duty have as awareness of the relevant legislation? (i.e. Human Rights, Workers Compensation Act)

Auditor Guideline • Interview the Injury Management / RTW Program coordinator to determine awareness

of legislation. The coordinator should, as a minimum, know where to access this information. If awareness is apparent award 10 points.

Employer Guideline • This question aims to verify that those in charge of the IM/RTW program are aware of

what legislation applies to their job and in what way. Their level of knowledge should be appropriate for their level of involvement in the program, and the basic awareness should include issues like human rights, and privacy.

QUESTION 9.8 Are policies or procedures in place regarding retention of records?

Auditor Guideline • Review documentation to determine if records are retained for an appropriate amount

of time.

Employer Guideline • The company needs to have as part of its policy or procedures, or as a stand-alone

document, an itemization of the documents that are to be stored, how many years will they be kept, where will they be stored, and what security measures are in place to protect the private information contained within those documents. This outline can be included in the policy related to safety records (question 7.1), or it can be a separate policy for handling IM/RTW cases.

Types of Documentation to Review • IM/RTW policy or program, actual records related IM/RTW cases

QUESTION 9.9 Have relevant groups, such as HR, Injury Management / RTW, or OH&S been educated in privacy issues related to Injury Management / RTW?

Auditor Guideline • Review documentation or training records to determine if education on privacy issues

has been provided.

Employer Guideline • Auditors are looking for a documented policy, procedure, or training that explains how

the privacy of workers is to be maintained, and proof that this information has been shared with supervisors and managers. This could achieved through policy sign offs, or a sign-in sheet for a training session at which privacy issues were reviewed. The session’s topic could be privacy in general or specific to IM/RTW.


Types of Documentation to Review • IM/RTW Policy, training records

QUESTION 9.10 Does the company have a written process (series of steps) for dealing with all Injury Management / RTW cases?

Auditor Guideline • Review documentation to determine if a written process is outlined and communicated

to employees.

Employer Guideline • Auditors are looking for a step-by-step outline that shows what is to be done if

someone gets injured, from the point of the injury through to the worker’s return to full duties. Question 9.2 deals with the company’s need for a step-by-step procedure for injury management. This question deals with the need for correct and workable content for each of those steps. The steps must also be communicated to employees, along with documented proof that the information was disseminated. For this question, bulletin boards would be acceptable documentation. This is an all-or-nothing question; the auditor wants to know that communication was presented in a reasonable form to all employees, while not requiring proof of comprehension.

Types of Documentation to Review • IM/RTW program, meeting minutes, information posted for employees to view

QUESTION 9.11 Does the company have a ‘Stay at Work’ initiative as part of the Injury Management / Return to Work Program?

Auditor Guideline • Review documentation (Injury Management / Return to Work Program procedures) to

determine if a ‘Stay at Work’ process is outlined.

Employer Guideline • This question is asking the company to show that the process applies to cases where

there is no time loss, rather than requiring time loss before a worker can have light, modified or alternate duties. When appropriate for the injury, and usually on the advice of the first aid attendant, this stay-at-work program avoids any time loss and possibly even any claim costs. Meeting this requirement can be as simple as having a single sentence in the program stating that the process applies to both stay-at-work and return-to-work cases.



QUESTION 9.12 Does the company have alternate duties that are meaningful and productive identified in writing? Are Supervisors aware that they can offer modified duties when required?

Auditor Guideline • Review documentation to determine if alternate work is identified. • Interview Supervisors to determine if they have knowledge of the possibility of

providing modified or alternate work to injured workers.

Employer Guideline • The company needs to have a list of alternate duties or modified duties available to

workers should they need them. This list must to be available in advance, since there is usually significant stress on the worker, supervisor and administrator when a worker is injured. Having the list in advance makes it very easy to present and gives time for creative solutions within the company. The auditor’s questions are posed to see whether supervisors know what some of the jobs available are or, if they have nothing in their immediate area, how to access jobs that other areas may have available.

Types of Documentation to Review • List of alternative duties

QUESTION 9.13 Is education on ‘Stay at Work’ procedures provided to contact personnel and are these procedures being followed?

Auditor Guideline • Review documentation to determine if education for contact personnel has taken place.

Interview contact personnel to determine if procedures are being followed.

Employer Guideline • For this question, “contact personnel” refers to people in the organization who would

reasonably be the first to contact an injured worker before that employee leaves the work site. A contact person would typically be a supervisor, human resources person or first aid attendant, although someone from the security, reception or dispatch departments may be included, depending on the company. These people all need to have documented internal training in the company system and be able to recall how they would use stay-at-work scenarios if the situation arose. Documentation can range from certification to a training record to meeting minutes. Interviews are only with the contact personnel, not with all workers.

Types of Documentation to Review • Training records for contact personnel, certifications, meeting minutes


QUESTION 9.14 Is there a procedure in place for maintaining contact with an injured worker? Does the procedure outline when contact is first made with the injured worker?

Auditor Guideline • Review documentation outlining the Injury Management / IM/RTW process to determine

if there is a procedure in place that includes established timelines.

Employer Guideline • This question is looking for a procedure that details when first contact is made with an

injured worker after the injury (on the day of or the day immediately after injury), and how often contact is made after that. (i.e. Daily, weekly, bi-weekly, monthly, etc.) This needs to be specifically outlined to guide the people implementing the program.


QUESTION 9.15 Is there a process to monitor return to work plans and is the process being followed?

Auditor Guideline • Review documentation to determine if monitoring of the plan is occurring.

Employer Guideline • Auditors are looking for a system that tracks the step-by-step progress of the IM/RTW

program (such as initial contact with worker, doctors input, and subsequent contact with worker). This documentation can be done with a spreadsheet, a shared drive or program, the cover page of the injured employee’s file or in material managed by a third-party IM/RTW company. If there are no actually cases to review, the company needs to be able to show the blank templates that they would use, and any policy or procedure that directs how to use them.

QUESTION 9.16 Are end dates established for all Injury Management / RTW plans?

Auditor Guideline • Review documentation to determine if plans have an established end date.

Employer Guideline • This question is looking to see that IM/RTW cases are reviewed and given end dates.

This is not to say that the end date will stay the same, but that the case has been reviewed and an estimated end date has been established. This can help when the case is being reviewed to see if realistic time lines have been provided, and as more data is collected the dates can be adjusted. Everyone heals at different rates as well, so the date may change several times throughout the case. Every case needs to have an estimated end date once medical personnel have set one. If there are no cases, the


company needs to have a procedure stating that all cases will have an end date assigned when medically possible.

QUESTION 9.17 Are Injury Management / RTW plans modified to reflect progression of healing?

Auditor Guideline • Review documentation to determine if plans are being modified or if there is a process

in place to consider modification, based on the worker’s abilities.

Employer Guideline • The company needs to have a program that is flexible and can change as the condition

of the worker changes. Healing times vary from person to person, and the program needs to show that it can bend as needed. This can be done with a spreadsheet, form or chart that tracks the worker’s progress. For example, there can be notes on when and why an end date was changed, according to condition of the employee, or a doctor’s note that updates what the employee is capable of handling in terms of alternate duties after a period of time. If there are no actual cases, then the company policy/procedure and blank templates need to be present and ready for use.

QUESTION 9.18 Are Workers and Supervisors knowledgeable of the reporting process and requirements under the legislation?

Auditor Guideline • Interview Workers and Supervisors to determine their knowledge of the reporting

process.

Employer Guideline • This question helps determine whether workers and supervisors understand the

reporting process ― what needs to be reported to WSBC and why. Workers need to know to report all injuries to supervisors (or other parties as indicated by the company system) and also need to know that if they seek medical treatment advice for a work-related issue while away from work, they must promptly report that to the company. Depending on the company system, supervisors may directly report to WorkSafeBC or may report the information to someone else in the company who will report to WSBC. The auditor will want to interview the person responsible for this.

QUESTION 9.19 Do company policies and / or procedures support a coordinated approach to Injury Management / RTW?

Auditor Guideline • Review documentation to determine if policies and procedures reflect coordination

between the injured worker, RTW coordinator, union (if present), and HR department (if present).


Employer Guideline • Auditors are looking to see whether the program has a system that includes more than

one representative in case reviews. This can be determined by the part of the company policy outlining who is responsible for reviewing cases, including managers, safety coordinators, HR personnel and possibly union representatives. The size of the company will often dictate how this is done to be practical and effective. Completed cases do not need to exist to evaluate the policy.

Types of Documentation to Review • IM/RTW policy, IM/RTW program

QUESTION 9.20 Have Injury Management / RTW policies and procedures been effectively communicated to all Workers, Supervisors, and Managers?

Auditor Guideline • Review documentation (training records, minutes of safety meetings) to determine if

policies and procedures have been communicated to all employees. • Interview various levels within the company to determine awareness of the program.

Employer Guideline • The company must provide proof that the IM/RTW program has been shared with

employees. This can be achieved through worker orientation (provided all workers go through orientation that includes IM/RTW program) or through a safety-related meeting. There could be an annual meeting at which the program is discussed, or a newsletter that goes to all employees, some other form of communication or any combination of these methods. There must be documented proof of this communication, and the auditor’s interview will evaluate if everyone received the information and is aware of the program.

Types of Documentation to Review • Training records, meeting minutes

QUESTION 9.21 Does the Employer actively promote the benefits of the Injury Management / RTW Program?

Auditor Guideline • Observe if promotional information is readily available to Employees. • Interview Workers and Supervisors to determine if the program is actively promoted.

Employer Guideline • The company needs to promote the benefits of the program (i.e., why it is good for

workers) rather than just state that the program exists. Unless exposed to promotional materials, some workers may think that the program is just a way for the company to reduce claims costs, not understanding that the program can be highly beneficial for them. Promotion can be done with posters, pamphlets, educational sessions, etc.


QUESTION 9.22 Are new employees provided with information on the Injury Management / RTW Program at new employee orientation?

Auditor Guideline • Review documentation (training records or orientations) to determine if information

regarding the program is provided in new employee orientations.

Employer Guideline • New employee orientations (question 6.4) need to include IM/RTW as a topic. This can

be seen in the employee files, the completed orientations, or a spreadsheet or program that tracks training. If there are no new employees, blank templates are sufficient.

Types of Documentation to Review • Orientation and training records

QUESTION 9.23 Are medical practitioners advised of the company’s Injury Management / RTW initiatives? (A commonly used method is a written package sent with the injured worker to the physician).

Auditor Guideline • Review documentation to determine if a process is in place to make medical

practitioners aware of the Injury Management / RTW program (the ability of the Employer to provide alternate of modified duties).

Employer Guideline • The company needs to communicate with medical professionals involved in any case of

injury. There should be a letter to the doctor explaining the company’s IM/RTW process and the availability of alternate duties, a physical abilities form, and a sign off for the doctor to indicate what the worker is capable of doing. If there are no relevant cases during the auditor’s visit, having the form ready is sufficient.

Types of Documentation to Review • Letter to physician, physical abilities form


Appendices

Appendix 1.1 Health and Safety Policy Statement

Appendix 1.2 Roles and Responsibilities

Appendix 2.1 Hazard Identification and Control Procedure

Appendix 2.2 Hazard / Unsafe Condition Reporting Policy

Appendix 2.3 Hazard Report Form

Appendix 2.4 Corrective Action Log

Appendix 2.5 Discipline Policy

Appendix 2.6 Personal Protective Equipment (PPE) Policy

Appendix 3.1 First Aid Assessment Worksheet

Appendix 3.2 First Aid Supplies Inventory

Appendix 3.3 First Aid Attendants

Appendix 3.4 Guide to Creating an Emergency Response Plan

Appendix 3.5 Emergency Response Planning

Appendix 3.6 Workplace Hazardous Materials Information System (WHMIS)

Appendix 4.1 Safety Inspection Policy and Procedure

Appendix 4.2 Corrective Action Log

Appendix 4.3 Equipment Maintenance Log

Appendix 4.4 Vehicle Inspection Report

Appendix 4.5 Workplace Inspection Checklist

Appendix 5.1 Incident Investigation Policy and Procedure

Appendix 5.2 Incident Investigation Form

Appendix 5.3 Incident Reporting Form

Appendix 6.1 Training Policy

Appendix 6.2 Occupational Health & Safety Orientation Checklist

Appendix 6.3 New Worker Assessment Checklist

Appendix 6.4 Training Records


Appendices (Continued)

Appendix 6.5 Safety Meeting Minutes

Appendix 6.6 Contractor Selection and Safety Checklist

Appendix 7.1 Safety Records and Statistics Policy

Appendix 8.1 Joint Occupational Health and Safety Committee Terms of Reference

Appendix 8.2 Joint Occupational Health & Safety Committee Members

Appendix 9.1 Injury Management Policy

Appendix 9.2 Stay at Work / Return to Work Program

Appendix 1 Version 1.0

Appendix – Element 1

Contents

• Appendix 1.1 Health and Safety Policy Statement

• Appendix 1.2 Roles and Responsibilities

Appendix Disclaimer: Please note that this is not exhaustive list of materials and auditor might require or consider other pieces of documentation. Companies are encouraged to modify provided materials and create policies, procedures, checklists, and forms that will fit their individual needs.

Company Name __________________________________

Appendix 1.1 Health and Safety Policy Statement Version 1.0 Page 1

Health and Safety Policy Statement _____________________ is committed to providing a safe and healthy workplace for all our employees and contractors. _____________________ believes that all injuries are preventable and that excellence in health and safety is the key to our long term success. _____________________ is committed to compliance with any and all governmental agencies, regulations, and industry best practices and will use audits to measure, share and improve our health and safety programs. _____________________ will hold all levels of management accountable for providing a safe work environment and enforcing safe work procedures and practices. Management and supervisors will lead and demonstrate by example their commitment to health and safety, and will ensure that the personnel that they are responsible for have the necessary knowledge to work safely. Supervisors will give health and safety the same priority as productivity, environmental issues or quality control. They must know and comply with applicable occupational health and safety requirements. A supervisor is defined in the Occupational Health and Safety Regulation as “a person who instructs, directs and controls workers in the performance of their duties.” Any person regardless of title who meets this definition even temporarily has the responsibilities of a supervisor for the workers under their control. _____________________ will hold all employees and contractors accountable for following safe work procedures and reporting unsafe acts and safety incidents. We will ensure timely follow-up to safety incidents. Workers have general responsibilities for their own health and safety and that of other persons. In addition, they have the responsibility to refuse unsafe work. Discriminatory action will not be taken against them for refusing to do unsafe work. Employees from every area of the company, regardless of position, will be encouraged to contribute to the company health and safety program. _____________________ encourages the involvement of all workers in the development of the program. We will provide support and promote the program to ensure that safety has the overriding priority. Employee cooperation and compliance with the health and safety program at _____________________ is a condition of employment.

Owner or President:

Signature:

Date:

Company Name __________________________________

Appendix 1.2 Roles and Responsibilities Version 1.0 Page 1

Roles and Responsibilities

Senior Management:

• Maintains overall accountability for ensuring that resources are made available to establish, implement and maintain a suitable, adequate and effective SMS (Safety Management System).

• Leads the planned review of the SMS. • Receives ongoing comments on SMS performance from all staff members. • Schedules management review sessions, develops the meeting agenda and presents

relevant information about the suitability, adequacy and effectiveness of the SMS to other members of senior management.

• Updates the SMS where appropriate based on decisions made in the management review process.

• Facilitates the SMS resource assessment. • Implements the changes identified in the management review process and resource

assessment.

Managers and Supervisors:

• Ensure that all workers are aware of health or safety hazards. • Ensure the health and safety of workers on site. • Ensure that all workers have the training and qualifications for the tasks to which

they are assigned. • Establish occupational health and safety policies and programs. • Provide and maintain all Personal Protective Equipment (PPE) as required by

WorkSafeBC regulations. • Provide all required training to ensure the health and safety of workers. • Post all relevant health and safety information and policies in places accessible to all

workers. • Ensure the general health and safety of all workers under their direct supervision. • Have full understanding of all WorkSafeBC health and safety regulations pertaining to

their supervision duties. • Make all workers under their supervision aware of all known or reasonably

foreseeable health and safety hazards. • Cooperate with all joint health and safety representatives.

Company Name __________________________________

Appendix 1.2 Roles and Responsibilities Version 1.0 Page 2

Workers:

• Take reasonable care to protect the health and safety of themselves and others. • Carry out duties consistent with the company’s established safe work procedures,

and applicable OHS legislation. • Use, wear and inspect Personal Protection Equipment (PPE) as required by

WorkSafeBC regulations. • Report any PPE not in safe working condition. • Do not engage in any on-site behavior or conduct that may endanger themselves or

their co-workers. • Ensure they have the training and qualifications for all tasks they are assigned. • Ensure their ability to work is not impaired by alcohol, drugs or other causes. • Report to their supervisor/employer any contravention of OHS legislation, including

the Workers Compensation Act and WorkSafeBC Regulation. • Cooperate with the Joint Occupational Health and Safety representatives. • Understand the right to refuse unsafe work.

Joint Occupational Health and Safety Committee:

The Company is required by OHS legislation to establish and maintain a Joint Health and Safety Committee (JOHSC). The committee is comprised of management and worker representation.

• The JOHSC will meet monthly. Copies of monthly minutes to be posted on the safety notice board and available on the company’s network.

• JOHSC members are health and safety resources for all company employees.

Contractors:

• Must have their own safety plan. • Comply with the existing safety plan for the office and worksite. • Ensure they have training and qualifications for all assigned tasks. • Identify the company contact before engaging in any work activities.



Contents

• Appendix 2.1 Hazard Identification and Control Procedure

• Appendix 2.2 Hazard / Unsafe Condition Reporting Policy

• Appendix 2.3 Hazard Report Form

• Appendix 2.4 Corrective Action Log

• Appendix 2.5 Discipline Policy

• Appendix 2.6 Personal Protective Equipment (PPE) Policy


Company Name __________________________________

Appendix 2.1 Hazard Identification and Control Procedure Version 1.0 Page 1

Hazard Identification and Control Procedure Purpose A hazard identification and risk assessment are processes used to identify and evaluate both existing and potential hazards on a worksite and the methods used to control or eliminate the hazards identified. The assessment process must be completed prior to the start of all jobs to identify existing or potential hazards to workers and eliminate or control these hazards through the use of engineering or administrative controls, proper training or the use of personal protective equipment. All company staff and contractors are required to take a proactive approach to managing and reporting hazards. When they observe a hazard, they are required to take steps to manage that hazard directly (provided they are adequately knowledgeable / trained to safely do so) – eliminate the hazard or get assistance from appropriate persons to do so whenever reasonably possible. Where hazards cannot be eliminated immediately, take necessary steps to warn others of the hazard. Report hazardous or potentially hazardous conditions and acts to a supervisor or your site contact if a contractor. A “Hazard Report Form” is available as Appendix 2.3 How to complete a Hazard Identification and Risk Assessment Note: The hazard identification and risk assessment must be completed by a supervisor and communicated to all workers before beginning the work. The JOHSC and workers also play an important role in the assessment process. Being the ‘hands-on’ people, they often find the new hazards first and then must stop and report. The JOHSC should review Hazard Assessments as part of their routine business at meetings to help make sure that the assessments fit with each other and cover all the company activities.

Step 1: Identify the Hazards The supervisor is to start the hazard identification process before the job begins by identifying hazards that are known to exist on site and documenting them. By identifying hazards early, the supervisor may be able to implement controls before any workers arrive on site. To ensure the process is thorough the supervisor should:

• look at all aspects of the work, • include non-routine activities such as maintenance, repair, or cleaning, • look at accident / incident / near-miss records, include people who work "off site"

either at home, on other job sites, drivers, teleworkers, with clients, etc., • look at the way the work is organized or "done" (include experience and age of

people doing the work, systems being used, etc), • look at foreseeable unusual conditions (for example: possible impact on hazard

control procedures that may be unavailable in an emergency situation, power outage, etc.),

• examine risks to visitors or the public, • include an assessment of groups that may have a different level of risk such as

young or inexperienced workers, persons with disabilities, or new or expectant mothers.

Company Name __________________________________


To identify potential hazards, the following questions may be asked (this is not a complete list): 1. Can any body part get caught in or between objects? 2. Do tools, machines or equipment present any hazards? 3. Can the worker make harmful contact with objects? 4. Can the worker slip, trip or fall? 5. Can the worker suffer a strain from lifting, pushing or pulling? 6. Is the worker exposed to extreme heat or cold? 7. Is excessive noise or vibration a problem? 8. Is there a danger from falling objects? 9. Is lighting a problem? 10. Can weather conditions affect safety? 11. Is harmful radiation a possibility? 12. Can contact be made with hot, toxic or caustic substances? 13. Are there dusts, fumes, mists or vapours in the air?

Step 2: Assess the Risk Ranking or prioritizing hazards is one way to help determine which hazard is the most serious and thus which hazard to control first. Priority is usually established by taking into account the employee exposure and the potential for accident, injury or illness. By assigning a priority to the hazards, you are creating a ranking or an action list. The following factors play an important role:

• percentage of workforce exposed, • frequency of exposure, • degree of harm likely to result from the exposure, • probability of occurrence.

There is no one simple or single way to determine the level of risk. Ranking hazards requires the knowledge of the workplace activities, urgency of situations, and most importantly, objective judgment. One option is seen in the following two tables:

Risk Severity Index

1

Level 1 Fatality OR Property Damage Exceeding $50,000

Level 2 Employee admitted to hospital or probably permanent disability OR property damage between $10,000 and $50,000

Level 3 Employee not able to perform all of their regular duties OR property damage between $1,000 and $10,000

Level 4 Employee able to perform all their regular duties OR property damage less than $1,000

Probability Index of Occurrence Example

2

A Likely to occur immediately Could happen any day

B Probable in time Likely to happen if conditions are repeated

C Possible in time Under the right conditions, the incident might be repeated

D Remotely possible Even under similar conditions, it is unlikely the incident will be repeated

For the activity being examined, determine the most likely reasonable level of severity (levels 1 through 4 in the above table). Then determine how likely (the probability) the

Company Name __________________________________


injury would be (letters A-D). For example, being hit by a low speed car is most often a level 2 injury but is barely possible for someone who works a kitchen job (level D). However, put that same person wearing all black on a roadside at night replacing the roadside light bulbs and the probability increases to level A and the severity to 1 (fatality reasonably likely). The kitchen worker would have a score of 2D on the following table. The table gives a 2D risk as a level 3. Simple rules such as ensuring that kitchen workers have a path to the dumpster that does not involve vehicle traffic would be an example. The case of the worker all in black at night on the roadside is 1A on the following table – a completely unacceptable level of risk. The worker should do the job in high visibility clothing, in daylight, with traffic control.

Risk Definitions

Risk is the chance or probability that a person will be harmed or experience an adverse health effect if exposed to a hazard. It may also apply to situations with property or equipment loss.

4 - Low

Activities in this category contain minimal risk and are unlikely to occur. Organizations can proceed with these activities as planned.

3 - Medium

Activities in this category contain minor to serious risks that are remotely likely to likely to occur. Application of proactive risk management strategies to reduce the risk is advised. Organizations should consider ways to modify or eliminate unacceptable risks.

2 - High

Activities in this category contain unacceptable levels of risk, including catastrophic and critical injuries that are highly likely to occur. Organizations should consider whether they should eliminate or modify activities that still have a “high” rating after applying all reasonable risk management strategies.

1 - Extreme Activities in this category should not be allowed to proceed without very careful planning. The company needs to evaluate whether the activity is actually necessary in the first place.

Step 3: Develop Safe Practices Once the risk has been assessed, the appropriate controls need to be put into place.

Probability of Occurrence

Pote

ntia

l Sev

erity

A B C D

1 1 1 1 2

2 1 2 2 3

3 2 2 3 3

4 2 3 3 4

Company Name __________________________________


The main ways to control a hazard include:

• Elimination (including substitution): remove the hazard from the workplace. • Engineering Controls: includes designs or modifications to plants, equipment,

ventilation systems, and processes that reduce the source of exposure. • Administrative Controls: controls that alter the way the work is done, including

timing of work, policies and other rules, and work practices such as standards and operating procedures (including training, housekeeping, and equipment maintenance, and personal hygiene practices).

• Personal Protective Equipment: equipment worn by individuals to reduce exposure such as contact with chemicals or exposure to noise.

These methods are also known as the "hierarchy of control" because they should be considered in the order presented (it is always best to try to eliminate the hazard first, etc.). Controls are usually placed: 1. At the source (where the hazard "comes from") 2. Along the path (where the hazard "travels") 3. At the worker Control at the source and control along the path are also known as engineering controls. Administrative controls limit workers' exposure by implementing other "rules", such as training, supervision, shorter shifts in high risk areas etc. These control measures have many limitations because the hazard itself is not actually removed or reduced. Administrative controls are not generally favoured because they can be difficult to implement, maintain and are not a reliable way to reduce exposure Personal protective equipment (PPE) includes items such as respirators, protective clothing such as gloves, face shields, eye protection, and footwear that serve to provide a barrier between the wearer and the chemical or material. It is the final item on the list for a very good reason. Personal protective equipment should never be the only method used to reduce exposure except under very specific circumstances because PPE may "fail" (stop protecting the worker) with little or no warning. For example: "breakthrough" can occur with gloves, clothing, and respirator cartridges. Once it has been decided what the best and most practical control for a particular hazard is, this needs to be documented. The safe work procedure for the job needs to be written based on those risks and controls. Using the examples from earlier with the car striking a worker, the kitchen work procedure for garbage removal should include something about having the dumpster near the back door to the kitchen and not across the parking lot. It could also include instruction to the worker to ensure that they report any burnt-out exterior lights. Some may add requirements to put on a reflective vest when taking out the garbage at night. The groundskeeper changing light bulbs needs to have a safe work procedure that includes only working during the day, in high visibility clothing and with proper traffic control barriers. Parking a service vehicle in the road ahead of the worker to act as a substantial physical barrier would further reduce the risk.

Company Name __________________________________


Step 4: Communicate the Controls and Train the Workers Once the control has been put into place, the workers need to be trained in how to use it. This applies whether it is an engineering control such as a guard or interlock, an administrative control such as a safe work procedure for cold weather or particular PPE when handling a chemical. Training records and/or documented sign-offs are required to show that the workers have been made aware of the hazards and the controls.

Step 5: Review Periodically Repeat the Hazard Assessment process every 2 years or when site conditions change, when new tasks are added or when new workers join the crew, in order to prevent the development of unsafe working conditions

Company Name __________________________________

Appendix 2.2 Hazard / Unsafe Condition Reporting Policy Version 1.0 Page 1

Hazard / Unsafe Condition Reporting Policy

All company staff and contractors are required to take a proactive approach to managing and reporting hazards. When they observe a hazard, they are required to take steps to manage that hazard directly (provided they are adequately knowledgeable / trained to safely do so), eliminate the hazard or get assistance from appropriate people to do so whenever reasonably possible. Where hazards cannot be eliminated immediately, take necessary steps to warn others of the hazard. Report hazardous or potentially hazardous conditions and acts to a supervisor or your site contact, if you are a contractor.

Company staff or contractors attending third-party sites (offices, job locations, vehicles, etc.) will demonstrate core safety values by identifying and reporting hazards to the site supervisor or owner, and providing prompt support for resolution of the hazard.

A “Hazard Report Form” is available as Appendix 2.3

Company Name __________________________________

Appendix 2.3 Hazard Report Form Version 1.0 Page 1

Hazard Report Form

Hazard Report

Date

Identified By

Location Hazard

Location Supervisor

Hazard Description

Hazard Type

Immediate threat to life

Potential threat to life or serious injury

Potential Injury

Ergonomic (MSD) Hazard

Minor Hazard - injury unlikely

Hazard Classification - check all that apply

Electrical

Machine Guard

Slip, Trip or Fall

Temperature

Task or Workstation Design

Fire Hazard

Chemical Hazard

Damaged or Improper PPE

Damaged Equipment

Other - specify:

Hazard Resolution

Description:

Corrective Action Assigned to: Date:

Corrective Action Completed: Date:

Reviewed By: Date:

Company Name __________________________________

Appendix 2.4 Corrective Action Log Version 1.0 Page 1

Corrective Action Log

# Identified Item Required Corrective Action Person Responsible

By When dd/mm/yyyy

Date Completed dd/mm/yyyy

Company Name __________________________________

Appendix 2.5 Discipline Policy Version 1.0 Page 1

Discipline Policy

Purpose To provide a fair and consistent approach to dealing with employees whose conduct, behaviour and/or performance falls below acceptable standards or regulatory requirements.

Policy Employee whose conduct, behaviour and/or performance falls below acceptable standards or regulatory requirements will be subject to corrective action.

Scope All hourly employees.

Procedures

General Employees are expected to conduct themselves in a manner that conforms to generally accepted standards of workplace behaviour and conduct. These standards can be summarized as follows:

• Employees will observe all laws, rules and regulations of Canada, British Columbia and the company.

• Employees will be honest and truthful at all times in dealing with the company and fellow employees.

• Employees will, at all times, respect the personal and property rights of their fellow employees and the company.

• Employees are expected to meet and maintain all company performance and conduct standards.

When a violation of an established standard occurs, each case will be investigated thoroughly, and disciplinary action will be administered on the merits of each case. Generally, if discipline is warranted, a system of progressive discipline will be applied with the expectation that the employee’s performance, behaviour or conduct will change to acceptable standards in the early stages of progressive discipline. However, should there be a serious infraction; the company retains the right to bypass the progressive discipline steps and apply an appropriate disciplinary sanction, up to and including termination. As the approach to dealing with progressive and non-progressive steps will be different, each will be described separately in this policy. In some situations the supervisor may be unclear on an appropriate course of action. In those situations the supervisor should take a consultative approach and seek input from his manager and the Human Resources Advisor. If the matter is of a nature requiring that the employee be removed from the job, the supervisor should do so and have the employee wait in his/her office or other suitable location. If the supervisor is unable to deal with the employee due to other commitments or the supervisor has to arrange relief, the employee should be told what the issue is and then placed on disciplinary report until he/she can be removed from the job.

Company Name __________________________________


Progressive Discipline In progressive discipline the objective is to reverse a non-conformance issue before it becomes a serious matter. This is accomplished through a series of levels of discipline, with the severity of discipline escalating should the non-conformance persist. The following describes the levels in the progressive discipline. Level 1 - Verbal Warning This level will provide an opportunity for the supervisor and the employee to address a violation of standards at an early stage. Specific actions needed to correct the problem and a time frame within which to accomplish them will be defined. While this early intervention is considered a verbal warning, the supervisor should maintain his/her own record of when the discussion took place and any points of significance. Level 2 - Documented Warning Should there be a subsequent violation, this level will once again provide an opportunity for the supervisor and the employee to address the problem. Specific actions needed to correct the problem and a time frame within which to accomplish them will once again be reviewed. At Level 2 the supervisor will document the discussion, providing the employee and the manager with a copy. A copy will also be placed in the employee’s personnel file. Level 3 - Letter of Reprimand Should there be a subsequent violation, or if the incident warrants, it will be necessary to issue a letter of reprimand. At this level the manager or designate will be present at the meeting with the supervisor. If desired the manager may seek input from the Human Resources Advisor. Specific actions needed to correct the problem(s) and a time frame within which to accomplish them will be defined. As well, the consequences of failed compliance will be discussed and documented in a letter to the employee with copies to the supervisor and the employee’s file. Level 4 – Suspension In cases of serious infractions or when an employee has committed a series of infractions and been previously disciplined, a suspension will be issued. The length of the suspension will depend upon the seriousness of the infraction. The suspension will normally range in duration from one day to two weeks. In exceptional circumstances a longer suspension may be issued in consultation with the HR Advisor. Note that if previous discipline was in the form of a suspension, a subsequent suspension must be of greater duration. At this step the manager or designate will be present at the meeting with the supervisor. Prior to holding the meeting the manager and supervisor should consult with the Human Resources Advisor to ensure that appropriate discipline is given. At the meeting the employee will be advised as to the reasons for the suspension and the duration of the suspension. Disciplinary suspensions will be without pay. The suspension will be accompanied by a letter to the employee outlining the circumstances leading up to the suspension, the dates of the suspension, specific actions needed to correct the problem(s) and a time frame within which to accomplish them, as well as consequences for failed compliance. If appropriate the letter may refer the employee to EFAP services with

Company Name __________________________________


relevant contact information. The letter to the employee will be copied to Human Resources Advisor, the supervisor and the employees file. Following the suspension and prior to returning to work the employee will meet with the manager and supervisor, at which time expectations for continued employment with the company will be explained to the employee. Level 5 - Discharge This action will be taken if all previous attempts to help an employee conform to acceptable standards fail, or if the infraction is of such a magnitude that discharge is the required response. The employee will be removed from the workplace in a manner that is respectful of the employee but ensures security of other employees as well as equipment and processes. If necessary, the employee may be suspended indefinitely pending an investigation to determine the appropriate level of discipline. The employee will be advised of termination of employment in a meeting with the supervisor, manager and camp or shop committee representative or union local representative. The information will be documented in a letter that will be copied to the union local. The termination date will be immediate.

Non-Progressive Discipline A series of incidents at close intervals or a serious infraction may be grounds for bypassing levels in this guideline. The following will describe those situations: A Series of Incidents Unrelated incidents of poor work performance and attendance may be enough to establish a pattern of performance and behavioural problems that need not be treated independently. In these types of situations the employer may advance to more severe levels of the guideline due to the cumulative effects of the employee’s performance. If the above is being contemplated, a consultative process should occur with the Human Resources Advisor to first ensure that the employee has been made aware of the problems and appropriate documentation of the incidents has been made, and secondly to determine what discipline is appropriate. Serious Infractions Some infractions are of such a serious nature that a single incident may be grounds for immediate discharge. Examples are:

• falsification of employment applications, production reports or other company records

• Possessing, using or being under the influence of intoxicants or narcotics on company property*

• theft • deliberately causing damage to employee, company or contractor property • engaging in conduct that endangers fellow employees • gross insubordination • major safety violations.

Company Name __________________________________


Supervisor Action Plan for Serious Infractions Since the consequences of a serious infraction are a serious matter, the supervisor will not take action alone. Prior to making any decisions, the supervisor will seek advice and input from his/her manager and the Human Resources Advisor. * Employee reporting for work or found working under the influence of intoxicating substances

• Immediately remove the employee from his/her job. • Tell the employee that in the interest of safety he/she is being sent home. (The

employee is not given a choice in this matter.) • Explain to the employee that he/she will be contacted by the company and is not to

return to the workplace until advised otherwise. • If there is a question of a medical issue, have the employee attended by a first aid

attendant to determine if medical care is appropriate. • Arrange for the employee to be escorted safely to his/her place of residence.

If possible, it is recommended that you involve another salaried employee in your discussion with the employee suspected of intoxication. As a minimum you should ensure that the employee has a union representative present. Suggest to the employee that he/she may want to seek the assistance of EFAP and provide contact information.

Disclaimer: This Statement of Policy and Procedure supersedes and replaces any previous policies and/or directives issued or in use covering the same subject. The principles and guidelines outlined in this Statement of Policy and Procedure are not intended to contravene any provisions of applicable legislation of the jurisdictions in which the company operates, or any correct contractual interpretation of collective agreements entered into by the company. If there is any conflict, the said legislation or contract interpretations must prevail.

Company Name __________________________________

Appendix 2.6 Personal Protective Equipment Policy Version 1.0 Page 1

Personal Protective Equipment (PPE) Policy

Policy Management of (company name) assumes responsibility for designing, planning and arranging work processes within the company so that safety hazards are eliminated or minimized. Where hazards cannot be completely eliminated through engineering controls and substitution of materials, management will provide the appropriate personal protection to the workers. Management will ensure that each worker is properly trained in and knowledgeable of the hazards associated with his/her work, the type of PPE required and its proper maintenance, care and use. All PPE must meet regulatory and Canadian Standards Association standards.

Procedures According to the OH&S Regulation Part 8, the worker must use or wear the protective equipment, protective devices and clothing specified by the management of the company. The following safety guidelines should be adhered to, to maximize worker health and safety:

• Always inspect the personal protective equipment prior to use. • Wear only the type of PPE your supervisor specifies as appropriate for the job.

Inappropriate and improperly worn PPE can result in injury, illness and damage to equipment resulting in high costs to both you and the company.

• Be certain your PPE fits properly, especially in the case of hearing or respiratory protection.

• Keep personal protective equipment clean and store in designated container or location when not in use.

• If you are uncertain as to how to wear or operate the required personal protective equipment, or you believe it is not in good working condition, immediately ask your supervisor for assistance.

The following provides a guideline to the requirements and use of PPE. A full listing of requirements can be found in the Occupational Health and Safety Regulation at http://www2.worksafebc.com/publications/OHSRegulation/Part8.asp

http://www2.worksafebc.com/publications/OHSRegulation/Part8.asp

Company Name __________________________________


PPE Requirements Used in these situations

Limb and body protection

• Must be stored in a dry area.

• Must be free of holes and, in the case of hand protection, made of a material that provides a good grip.

• Must be impermeable when used in refueling.

• When the worker is exposed to a substance or condition that is likely to puncture, abrade or affect the skin – or be absorbed through the skin.

Head protection

• High-visibility, side impact hardhat.

• Cleaned regularly and stored away from grease and tools.

• Must be free of cracks, dents or any other damage.

• Chin straps must be used when workers are climbing, working from a height exceeding 3m, or working in high winds.

• Must be worn in any work area where there is a danger of head injury from falling, flying or thrown objects, or other harmful contacts.

Eye and face protection

• Safety eyewear must fit properly and include side shields when necessary for worker safety.

• Safety eyewear must be worn when working in conditions that are likely to injure or irritate the eyes.

• Face protectors must also be used if there is a risk of face injury.

Safety footwear

• Must be of a design, construction and material appropriate to the protection required for the work environment.

• Safety footwear must consider the following factors: slipping, uneven terrain, abrasion, ankle protection and foot support, crushing potential, temperature extremes, corrosive substances, puncture hazards, electrical shock, and any other recognizable hazard.

• Toe and metatarsal protection, puncture resistance, and/or dielectric protection must be used where appropriate.

Company Name __________________________________


PPE Requirements Used in these situations

Hearing protection

• WorkSafeBC’s regulations regarding noise exposure are: o 85dBA Lex daily noise

exposure level o 140 DBC peak sound

level

• If those levels cannot be practicably met, the employer must: o Reduce levels as low as possible o Post warning signs regarding noise

hazard areas o Provide to workers hearing

protection that meets CSA standards, and ensure it is worn effectively in noise hazard areas.

High-visibility clothing

• The apparel must be a colour that contrasts with the environment.

• Must have at least 775 sq cm of fluorescent / retro-reflective trim on both the front and back.

• When worker is outside of a vehicle or machine in a high hazard area.

• When workers need to be located at a distance



Contents

• Appendix 3.1 First Aid Assessment Worksheet

• Appendix 3.2 First Aid Supplies Inventory

• Appendix 3.3 First Aid Attendants

• Appendix 3.4 Guide to Creating an Emergency Response Plan

• Appendix 3.5 Emergency Response Planning

• Appendix 3.6 Workplace Hazardous Materials Information System (WHMIS)


Company Name __________________________________

Appendix 3.1 First Aid Assessment Worksheet Version 1.0 Page 1

First Aid Assessment Worksheet

1. Name of workplace:

Conduct a separate assessment for each identified workplace (see flow chart Step 1).

2. (a) Hazard rating on Assigned Hazard

Rating List L M H

(b) Job functions, work processes and tools: Typical of industry?

Yes No

(c) Types of injuries that can potentially occur:

Typical of industry?

Yes No

(d) Rating adjustment: if hazard rating is adjusted, provide documentation:

Overall workplace hazard rating:

L M H

3. (a) Surface travel time to hospital: greater than 20 minutes

20 minutes or less

4. (b) Total number of workers per shift: (include dispatched workers and workers in lodgings)

5. (f) Barriers to first aid:

Assessment Results (different shifts may require different first aid services)

5. (a) Supplies/equipment/facilities required

5. (c) Number and level of first aid attendants

5. (e) Transportation needs

Date: Change in Business Operations:

Consulted (health and safety committee, worker representative, others):

Name: Signature:

Company Name __________________________________

Appendix 3.2 First Aid Supplies Inventory Version 1.0 Page 1

First Aid Supplies Inventory

For/Applies To:

Completed By:

Date:

Quantity Item Location and/or Description

Company Name __________________________________

Appendix 3.3 First Aid Attendant List Version 1.0 Page 1

First Aid Attendants

Date:

Name Position

and First Aid Level

Photo Contact Number(s)

Company Name __________________________________

Appendix 3.4 Guide to Creating an Emergency Response Plan Version 1.0 Page 1

Guide to Creating an Emergency Response Plan Purpose Emergency procedures ensure that responses to emergencies are prompt, organized and effective. Your company’s Emergency Response Plan must cover off these five key elements:

1. Emergency responsibilities 2. Emergency procedures 3. Communications 4. Investigation 5. Plan verification

Read and answer the questions (where indicated) in each of these five elements to help build your Emergency Response Plan.

1. Emergency Responsibilities During emergencies, emotions can run high. It is crucial that emergency procedures are distributed to all employees and reviewed frequently, so that everyone knows what their role is. Responsibility requirements include defining:

• who is responsible for regular site inspections, including identifying potential hazards and corrective action

• who is responsible for first aid, including making sure trained personnel are on site and first aid kits and equipment are properly maintained

• who is responsible for emergency and evacuation training of all personnel • who is responsible for developing, reviewing and updating emergency and

evacuation procedures • who is responsible for creating and updating the Emergency Contact List (see

Communications below) • who is identified as Emergency Response Team Leader • who is responsible for contacting external emergency responders • who is responsible for initiating the emergency response process (stop-work order,

site containment, search-and-rescue and first aid procedures) • who is responsible for external communications (communities, families, head office,

media, etc.) • who is the internal investigation team leader.

Company Name __________________________________


2. Emergency Procedures The Occupational Health and Safety Regulation requires written rescue and evacuation procedures for a number of different emergency situations, including working in confined/remote spaces, at high angles, near or over water, etc. Based on the work site conditions identified in your site inspection, you must develop the appropriate procedures. These procedures should include but not be limited to: Listing all potential hazards and their possible consequences Preparing an inventory of resources needed for emergency response (medical

supplies, rescue equipment, etc.) Identifying evacuation routes for the work site and surrounding area Contacting on-site first aid providers and the Emergency Response Team Leader Contacting external emergency responders, government and company

representatives On-site fire-fighting, rescue and medical evacuation Containment of the hazard and/or location to protect people and the environment Briefing and training workers on emergency response, and conducting periodic

(annual) drills Shut down and start up Protection of vital records Clean-up, investigation and return to work.

3. Communications Clear procedures and lines of communication must be put in place to enable emergency personnel to notify others on the work site, company management and outside emergency responders. These procedures are also essential in helping the company provide information to families, communities and the media in a timely manner. Communications requirements include: Defining your internal, on-site emergency communications process Ensuring all personnel are trained in that process Identifying who is responsible for contacting external emergency responders Identifying who is responsible for external communications with the community,

company, government, media, etc. Identifying who is responsible for developing and maintaining the emergency contact

list. This list should include at least: o Fire services, including forest fire services o Police and ambulance services o Medivac and hospital services o Municipal and company representatives o Utility providers o WorkSafeBC, and other government agencies o Coroner’s office.

Company Name __________________________________


4. Investigation An internal investigation team leader must be appointed. This person’s job is to act as liaison with police, WorkSafeBC and other government agencies to assist in the full investigation of any incident. This individual is also responsible for the following:

• overall control of the investigation team activities, from inception to completion • reviewing the final report and making a presentation to senior management

personnel on the investigators findings and recommendations • As applicable, meeting with the family of any seriously injured worker(s) to discuss

the incident and convey the company’s sympathy regarding the incident.

5. Plan Verification All work sites must be visited by the site supervisor and at least one member of the safety team. Their job is to make sure the Emergency Response Plan will work on each site. This means adjusting the plan to the site’s logistics as required. Included in the items to be examined are: Communications: Where in the site is there a danger of communication blackout?

How far do workers have to go to get back into communications range? Emergency access: What is the fastest, safest route in for outside emergency

responders? Evacuation procedures: Identify the safest routes out of the work site in the event of

an environmental emergency.

_________________________________ _________________________________ Company Representative Worker Safety Representative

_________________________________ _________________________________ Date Date

Company Name __________________________________

Appendix 3.5 Emergency Response Plan Version 1.0 Page 1

Emergency Response Planning

These procedures address the emergency response for injuries or fatalities on a work site, and forest fires, erosion events and spills.

Emergency Responsibilities

The supervisor on the work site is responsible: • to carry out inspections to identify potential hazards and corrective actions • to ensure there is a trained first aid attendant, as required by regulation, with a maintained

first aid kit • to have documented safety meetings discussing safety, emergency and evacuation procedures

and to update these procedures as required • to post in an accessible location the list of emergency contacts (including updates) • to identify a person to be team leader (usually a first aid attendant) in the event of an

emergency and a person to contact external emergency responders, if required • to initiate the emergency response process (i.e. stop work, site containment, search-and-

rescue and first aid procedures) • to communicate incidents/emergencies to head office (if applicable), families, communities,

etc. • to investigate incidents/emergencies that have occurred.

Emergency Procedures

The on-site supervisor must evaluate every work site to identify conditions and adjust procedures if necessary, ensuring resources are adequate to deal with emergencies. Appropriate procedures will involve the assessment of:

• potential hazards and possible consequences • resources (medical supplies, rescue equipment, etc.) needed for emergency response • evacuation routes

and provide: • name of onsite first aid provider and team leader for emergency response • contact information for emergency responders, government and company representatives • worker briefing and training • shut-down and start-up conditions • investigation and documentation of events • follow-up and final reporting.

Radio Procedures During an Emergency

• Try to be aware of how you communicate and choose your words when using the radio during an emergency; stick to the facts.

• The priority is to get the necessary help to the site as quickly as possible, while trying to ensure information is not worded in a way that can cause individuals listening in on the radio to jump to false assumptions or spread rumors to family members, etc., prior to your being able to get the correct information to them.

• Do not block the radio by having anyone on the crew using the radio for unnecessary communication at this time, as the radio should be clear so that emergency services are able to stay in contact.

Company Name __________________________________


First Aid Procedures for Injury – Serious & Minor

Minor wounds, breaks, strains: • Call the first aid attendant to the scene. • Ensure site is safe, then stabilize patient (provide first aid), transport to hospital, if necessary.

The first aid attendant does not have the authority to overrule a worker’s decision to seek medical attention.

• Advise office and hospital when you are on route. • If accident is the result of a motor vehicle accident, advise the RCMP or local police.

Serious injury: • Ensure site is safe, then stabilize (provide first aid) and/or prepare patient for transport • Call 911 if using a cellular phone, or call 1-XXX- - for alternate emergency

ambulance

Remote Locations: • Provide nature of injuries, location co-ordinates in UTM or longitude and latitude for landing

site, and communication method to use on the way to the accident site. If the first aid attendant thinks that air evacuation is required you must advise the communication centre you’ve reached; if road evacuation is used, advise if you will be meeting the ambulance.

• Radio frequencies:

Procedures for Fatality

Fatality • Ensure site is safe. • Phone 911 or alternate number if using the satellite phone, or RCMP/local police (see phone

numbers in injury section above). • Call WSBC at 1-888-621-7233 Monday – Friday 0830-1630 After Hours 1-866-922-

4357. • Do not disturb the site, cover the body, ribbon off the area, and block access with machinery if

needed. • Note: You do not have to answer any questions; nobody is to make any statements to

anyone except to the supervisor.

In Case of Emergency (e.g. landside, fire, spill)

• Ensure that you and your workers are safe; safety takes precedence over other priorities. • Notify the supervisor of the incident. • Take action to limit the damage; contain the material, fire, etc.

Company Name __________________________________


Emergency Procedures for Spill

Spill • If supervisor is not available, notify the company of any spill to water, or any spill to land of

50 litres (two pails) or more of fuel or other petroleum products (i.e., oil, hydraulic fluid) • All spills greater than 100 litres (22 gallons) must be reported by the company, or by your

supervisor or yourself if the company or the supervisor cannot be contacted, to the following number:

Provincial Emergency Program (PEP) at 1-800-663-3456 • Safety First. Assess the hazards to yourself and others. Turn off ignition sources. No

smoking. Locate and stop the source of the spill if safe to do so; identify the source and type of spill; if needed obtain help when working alone, and get the appropriate protective equipment for dealing with the spill. Contain the spill if possible (if the spill has scattered materials over a large area and it is not feasible to clean it up, then it must simply be reported).

• Spill to land: Mark the perimeter, dig recovery ditches around the perimeter and pits within the spill area for containment, then use sorbent pads to remove free product and excavate contaminated soil.

• Spill to water: in a ditch or a stream contain the spill using a tarp or dirt containment system. Sorbent pads can be wrung out in containment area and reused if necessary.

• Supervisor: If present, must notify company manager and, if reportable, the Provincial Emergency Program. The supervisor must complete the Incident Investigation Report / Spill Report Form (for all non-reportable spills).

Emergency Procedure for Earthquakes

Earthquake • Duck and cover under a solid object. • Do not stand in doorways because the door may swing and hit you or pin your hand. • Wait one minute in case of aftershocks • Go outside to the muster location, helping any mobile people along the way • Leave any trapped people behind if you are the only mobile person. Report their location.

Staying behind to help only traps more people. Getting help is more important.

Emergency Procedures for Fire

Fire • Notify the company if supervisor not available • Notify XXX at ########## • Safety First. If reasonable to do so, take action on all fires

Company Name __________________________________


Emergency Procedures for Flood / Landslide in Outdoor Operations

Flood / Landslide • Notify the company if supervisor not available. • If it is reportable, the company will notify:

Crown Land:

MOF at 1- 250-825-1100

PEP at 1-800-663-3456

• Safety First. If reasonable to do so, prevent further erosion. • Supervisor, if available, must notify company manager. The supervisor or company must

complete the Incident Investigation Report

Emergency Numbers:

Life Threatening Emergency Situations 911 or local emergency number:

Medical Emergencies

Ambulance

Hospital

Helicopters

Forest Fire Reporting

Anywhere in BC 1-800-663-5555

Spill Reporting

Provincial Emergency Program 1-800-663-3456

Other Contacts

RCMP

BC Hydro

FortisBC

Terasen Gas 1-800-663-9911

WorkSafeBC 1-866-922-4357

Company Name __________________________________

Appendix 3.6 Workplace Hazardous Materials Information System Version 1.0 Page 1

Workplace Hazardous Materials Information System (WHMIS) General Protecting workers from injuries associated with the exposure to controlled products.

Application To ensure employees are trained in the use, storage, handling, or manufacture of a controlled product.

Protective Mechanisms Safe Job Procedure

MSDS (Material Safety Data Sheets)

ERP (Emergency Response Plan)

Manufacturers’ Recommendations

OH&S (Occupational Health and Safety) Legislation/codes

Provincial Legislation

Coordinator Responsibility The overall WHMIS Coordinator is (insert name here). This person is in charge of the MSDS library and acts as a technical resource for supervisors and workers.

Supervisor Responsibility 1. Ensure all workers who work with, or near a controlled product are properly trained in

the use, storage, and handling of controlled products.

2. Ensure that the workers are correctly handling the product,, using the right methods and utilizing personal protective equipment as required.

3. Correct the worker when necessary.

Worker Responsibility 1. Must review MSDS before using, storing or handling a controlled product.

2. Must use proper, approved PPE.

3. Ensure all labels stay intact and are readable on all containers. Replace labels as required (damage, painted over, etc.).

4. Must clean up and/or control small spills immediately; large spills will require using the company’s emergency response plan.

5. If you pour a product into a different container (i.e. smaller container for ease of use), the new container must have work site labels.

Company Name __________________________________


WHMIS Classes and Hazard Symbols

Class A Compressed Gas

Class B Flammable and

Combustible Material

Class C Oxidizing Material

Class D Poisonous and Infectious Material

Division 1: Materials

causing immediate and serious toxic effects

Division 2: Materials causing other toxic

effects

Division 3: Biohazardous Infectious

material

Class E

Corrosive Material

Class F

Dangerously Reactive Material

Company Name __________________________________


General Rules A hazard assessment must be completed prior to use of all controlled products.

All uncontained controlled products used, stored and handled at a worksite must be in accordance with Workplace Hazardous Materials Information System (WHMIS).

Hazardous Waste All employees must be trained in how to deal with hazardous waste. Hazardous waste items must be identified using placards, coded labels or work site labels to clearly identify the contents of the product. Reference to the WHMIS sheet and site specific requirements will determine the correct actions to take when dealing with hazardous waste.

Worker Training Worker education will be provided to all workers through the use of a third-party agency or in-house trainer to ensure everyone may work safely with or near controlled products at the workplace. The training will include: information about the requirements for labels, MSDS, site specific requirements, specific products used at the workplace, how to deal with hazardous waste and any other information of importance to the worker’s health and safety.

Labeling All controlled products (including hazardous waste) must be labeled with either the supplier’s label or a worksite label, unless the controlled product is contained or transferred to a contained container such as a piping system or tank. The foreman must ensure that all controlled products received on site are labeled correctly and have the MSDS included.

Those who supply controlled products must affix a supplier label to each container prior to selling it in Canada. These labels provide the basic information needed for a worker to handle a product safely. Supplier labels can be recognized by their distinctive slashing marked borders.

Supplier labels contain seven (7) pieces of information:

1. Product name

2. Name and address of supplier

3. Hazard symbol that applies to the material

4. Precautionary measures

5. Description of the hazards and effects of exposure to the body

6. Reference to the MSDS for additional information

7. First aid measures to treat those exposed to the material.

Situations may occur where the supplier’s label may be a bit different from the basic label. Controlled products in smaller containers (less than 100 ml) may be an example due to the amount of space available, but the most vital information should be provided.

Company Name __________________________________


Workplace labels are prepared and applied at the worksite when controlled products are transferred from the supplier’s container to worksite containers or when the supplier’s label requires replacement due to damage.

These labels contain less information than the supplier label. When prepared, these labels need to only contain three of the seven kinds of information:

a) Name of the material

b) How to handle it safely

c) Reference to the MSDS for additional information.

Material Safety Data Sheets (MSDS) The MSDS will provide more detailed product information than can be found on a product label. WHMIS MSDS’s have nine categories of information about a product’s properties, its hazards, handling emergencies or clean ups and how to keep from being overexposed to it.

Copies of current (within last three years) Material Safety Data Sheets (MSDS) used for controlled products on the worksite will be sent to all worksites with every controlled product and made available to workers.

Storage Hazardous substances must be stored in accordance with the documented MSDS section 7 Preventative Measures.

Spills When a spill of any chemical substance occurs in the work area, the MSDS shall be accessed to determine the actions to be taken to clean up and dispose of the spill. Appropriate PPE as detailed on the MSDS must be worn.

Disposal Any disposal of unwanted hazardous substances shall be carried out by a licensed disposal company and shall be in accordance with applicable legislation for hazardous waste procedure as well as the MSDS.

All hazardous waste must be identified by using placards, coded labels or worksite labels that clearly identify the contents of the product containers.



Contents

• Appendix 4.1 Safety Inspection Policy and Procedure

• Appendix 4.2 Corrective Action Log

• Appendix 4.3 Equipment Maintenance Log

• Appendix 4.4 Vehicle Inspection Report

• Appendix 4.5 Workplace Inspection Checklist


Company Name __________________________________

Appendix 4.1 Safety Inspection Policy and Procedure Version 1.0 Page 1

Safety Inspection Policy and Procedure Purpose The purpose of this policy is to control losses of human and material resources by identifying and correcting unsafe acts and conditions.

Policy The company will maintain a comprehensive program of safety inspections at all facilities and job sites. Observations will be documented and problems corrected. Follow-up inspections will be conducted to ensure problems have been corrected.

Responsibilities Company managers are responsible for the overall operation of the program. The Health and Safety Coordinator under the direction of management will conduct site inspections weekly.

Supervisors are responsible for conducting ongoing informal inspections of areas where their staff is working.

Workers are responsible for participating in and contributing to the inspection program.

All completed inspections should be sent to the Safety Coordinator for review and follow-up of any required items.

Inspection Programs The purpose of the safety inspection program is to detect and address safety-related hazards and risks before the issues cause injury, property damage or environmental impact.

Safety inspections at (company name) should consist of six separate programs;

• Senior management safety walks

• Supervisors’ formal weekly inspections of their own work area

• Supervisors’ ongoing observations of their work area

• Supervisors’ and charge hands’ weekly formal mini-audits

• Safety committee’s formal monthly inspections

• Equipment-specific inspections at frequencies specified by legal, insurance or manufacturer’s requirements or as indicated by best practices.

A related program of contractor safety inspections co-exists with the main safety inspection program. For each contract, the safety inspection frequency by the contractor is defined in writing and communicated to the supervisors of the areas where the contract work is occurring. The contractor-performed inspection report is copied to the applicable supervisor who forwards it to the safety committee for inclusion in monthly meeting business tracking.

Company Name __________________________________


Where there is an incident investigation, a specific inspection of the equipment in question will be performed. That inspection protocol is covered in the “Investigations” section.

Any employee may request that a safety committee member examine an issue of interest. This is not considered an inspection for the purposes of this protocol.

The safety committee participates in all of the programs either directly or by data review, meeting WorkSafeBC requirements.

Senior management walks Senior management each performs at least three safety walks of different areas of the site per month. Observations include safety and non-safety items. Safety-related deficiencies are forwarded to appropriate corrective individuals and copied to the safety committee. The safety committee tracks the number of senior management tours as a business item in its meetings.

Supervisor informal and formal inspections In addition to the ongoing observations provided by the practice of spending the majority of their time on the floor area, supervisors also perform formal weekly safety inspections of their work area and forward deficiencies to appropriate individuals for corrective action. If there are contractors in the work area, the supervisor includes an overview of their work in his inspection. For each contractor in the supervisor’s area, the contractor orientation will have defined the contractor’s safety inspection frequency. The supervisor is to review the contractor’s records to ensure that the agreed frequency is being met, and as an audit of the type and quality of safety items compared to the supervisor’s observations. The supervisor’s review of the contractor inspections occurs at the same frequency as the contractor inspections, not necessarily weekly. The supervisor’s inspection report form is sent to his or her superintendent for review on the day of inspection, as well as to the safety committee within three working days. The safety committee tracks completion and timeliness of weekly inspection by area as a business item in its meetings. Where contractor inspection information in included in supervisor reports, it is tracked separately in safety committee business. Mini-audits Formal mini-audits to review the working practices and procedures of workers in their area are performed by supervisors and charge hands on a weekly basis. A key focus of this component of the inspection protocol is ergonomics. Deficiencies are forwarded to the appropriate individuals for corrective action. The report form is reviewed within a working day by the applicable supervisor and superintendent and forwarded to the safety committee within three working days. See ‘Mini-audit’ section of Safety Committee Terms of Reference for full details. Mini-audits are also performed by all employees, generating at least one employee-performed mini-audit per week per supervisor. The safety committee tracks completion and timeliness of mini audits by area and type (supervisor/charge hand vs. hourly) as a business item in its meetings.

Company Name __________________________________


Monthly Safety Committee Inspections Inspectors and Inspection Areas

The safety committee performs formal monthly safety tours. Each tour is performed by a pair of committee members, one worker and one manager. The manager committee member may be replaced by a supervisor. The facility is divided into six inspection areas on a marked site map (this is illustrative example only – companies should modify this based on individual circumstances;

• Area 1

• Area 2

• Area 3

• Area 4

• Area 5

• Area 6

Note that the above names are titles of the areas, not necessarily complete descriptions. Each area is inspected monthly. Each of those areas has a detailed equipment (fixed and mobile) inventory provided for inspection.

Each member of the committee performs two consecutive inspections in each area, with the hourly members changing areas downwards on the list on even numbered months and the salaried members changing areas upwards on the list on odd numbered months. This rotation is intended to allow continuity of inspectors and to help bring fresh eyes into each area. For further continuity, a printed copy of the previous inspection is carried by the inspection team. Relief due to absences of hourly members is arranged by Human Resources. Relief due to absences of salaried members is arranged by senior management. Wherever practical, a supervisor should not be inspecting his or her own work area as part of the safety committee tour, as they are performing this function elsewhere and are not providing fresh eyes. The inspection schedule is set annually, at least six months in advance. For maximum efficiency of labour, the safety committee tours are scheduled on the same day as the monthly safety committee meeting, occurring before that meeting.

Tour Contents

The tour uses an inspection checklist. See ‘Safety Inspection’ section of ‘Safety Committee Terms of Reference’ for full details. The checklist focuses on high risk safety items in each specific area. Where formal risk assessments have been performed, that data is used to define high risk. When formal assessments have not yet been completed, the best guesses of the inspection team are used. Inspection items include observation of safe working procedures, work practices, safe working conditions of the premises, buildings, equipment and tools as well as worker interviews.

An objective of the tour is to observe and talk with every worker encountered in the tour area to gain their safety input on issues, both positive and negative. For each area, one safe work procedure and associated risk assessment are audited, with the inspection team comparing the documented practice to the observed practice with the goal of improving the documentation and the actual practice.

Company Name __________________________________


The safety committee also selects a key item of interest for the month, such as ladder safety, housekeeping, or safety policy knowledge to promote topical safety to employees. This topic may or may not be communicated to employees in advance.

Actionable Items

Items found on the safety tour are prioritized by risk for assignment of corrective action time frames. While items with a low risk score may be considered trivial (”fix-it” or “nuisance” items), they should still be included in safety reports with a corresponding low priority assigned to their correction, because they are still deficiencies. When the monthly tour is being performed many of these lower priority items should be addressed immediately by the persons performing the inspection. In addition, any high priority item that posed an immediate threat to worker safety must be addressed immediately.

Data Flow

The inspection team takes notes while on the tour and then personally transcribes them into an expanded final version immediately after the tour. The tour report form is forwarded to the applicable supervisor or manager within one working day. The supervisor posts a copy of the inspection report for viewing by all workers and keeps at least the last three inspection reports posted People responsible for correcting deficiencies are informed of their assignments within one working day. For worker-generated issues, the hourly safety committee member will inform the worker of the applicable corrective action plan and time frame for completion within one working day of the plan’s being created. The completed reports are attached to the next safety committee meeting agenda for review at that meeting. Completion by area is tracked as a business item in the meetings, as are the volume of non-trivial items found, the number and fraction of overdue items and the average time to close an item by area.

Equipment-specific Inspections Equipment-specific inspections are performed by authorized and trained workers and/or contractors. Examples of equipment-specific inspections include mobile equipment use inspections, weekly fire extinguisher inspections, annual fire safety equipment inspections, monthly emergency light checks, annual life safety equipment inspections, annual boiler inspections and weekly first aid equipment inventories. The completed report forms are forwarded to applicable supervisors for deficiency correction and kept on file for at least one year or five inspections, whichever is greater (unless a greater time frame is required by regulation or insurance). Safety committee tours include a documentation spot check of at least two random inspectable pieces of equipment per tour. The results of that spot check are included as a written observation on the safety committee tour and included in its monthly meeting business items.

Company Name __________________________________


Corrective Action Tracking

Data from all types of safety inspection programs is input into the Corrective Action Log for tracking. A risk score is assigned if not already done during the inspection process.

By including all inspection data, including worker issues, into the safety committee minutes, feedback is given to the workers that their issues are being addressed.

Training

Inspections should be done by employees who are familiar with the work process and the areas they are inspecting. They must be given instruction/training in the inspection system and be made aware of the standards that have been established in the areas they are inspecting. This training must be documented and kept on file.

Company Name __________________________________

Appendix 4.2 Corrective Action Log Version 1.0 Page 1

Corrective Action Log

# Identified Item Required Corrective Action Person Responsible

By When dd/mm/yyyy

Date Completed dd/mm/yyyy

Company Name __________________________________

Appendix 4.3 Equipment Maintenance Log Version 1.0 Page 1

Equipment Maintenance Log

Complete a maintenance log for all pieces of equipment (machines, vehicles, and tools) that you use.

Equipment (make, model, serial number, year):

Manufacturer’s required service interval (hrs or mileage):

Date (dd/mm/yyyy) Mileage or hours Work completed By whom?

Company Name __________________________________

Appendix 4.4 Vehicle Inspection Report Version 1.0 Page 1

Vehicle Inspection Report (OH&S Regulation 17.01 to 17.14) Vehicle operators are to inspect and document daily and submit this report weekly to their supervisor.

PLEASE PRINT CLEARLY

Vehicle and Operator Information Operator name: Vehicle description:

Licence number: Mileage (km’s): Date of inspection (D/M/Y)

Day 1

Day 2

Day 3

Day 4

Day 5

Vehicle Condition Check

Item Day 1 Day 2 Day 3 Day 4 Day 5

Status Good Comments Good Comments Good Comments Good Comments Good Comments

Motor oil

Coolant / Anti-freeze

Brakes (foot/hand)

Exhaust/mufflers

General (body)

General (mechanical)

Mirrors

Seatbelts

Steering

Tires (incl. spare)

Windshield, wipers condition

Washer fluid level

Lights OK Replace OK Replace OK Replace OK Replace OK Replace

Brake

Head

Signal

Company Name __________________________________

Appendix 4.4 Vehicle Inspection Report Version 1.0 Page 2

Vehicle Equipment Check

Item Day 1 Day 2 Day 3 Day 4 Day 5 Comments (from all sections)

Emergency response numbers posted

Radio, cell or satellite phone

Tools, equipment secured

Axe, shovel, water can

Fire extinguisher

First aid, survival kits

Flares/triangles/cones

Flashlight

Tire jack/wrench

Jumper cables

Cargo netting/restraint

Environmental spill kit

Tow rope, chains

Operator/Inspector Supervisor

Name: Signature:

Date: Name: Signature:

Date:

Company Name __________________________________

Appendix 4.5 Workplace Inspection Checklist Version 1.0 Page 1

Workplace Inspection Checklist Department Date Item Y/N Comment Action Who / due Done

date Floors Floors are even and clean

Pits and drains are covered

Floor is free of obstructions

Mats are in good condition

Work areas are clean

Aisles Clear are adequately marked

Clear of obstructions

Work areas Bench tops are clear of debris

Trash and scraps are cleaned up

Sufficient number of trash/recycle bins

No damaged utensils

No damaged power tools

Stairs and landings Treads or rails show no damage

Landings are clear

Company Name __________________________________


Item Y/N Comment Action Who / due Done date

Windows and doors Clean with no broken panes

Ledges are free of dust

Electrical No more than one extension cord or power bar between the wall socket and a device or tool

All electrical items are tagged

Electric cables are clear of water

Electrical panels have 1-metre clearance

All lights work properly

Tools and equipment Good condition Appropriate to task

Storage is adequate

Substances MSDS available PPE where needed

Manual handling Equipment is available

Supplies are stored properly

Bench heights are suitable

Company Name __________________________________


Item Y/N Comment Action Who / due Done date

Emergency Fire exits are clear

Exit signs work properly

Extinguishers are clearly accessible

Extinguishers are charged

First aid First aid kit is complete

First aid people are trained

Emergency numbers are displayed

Other Gas cylinders are stored properly



Contents

• Appendix 5.1 Incident Investigation Policy and Procedure

• Appendix 5.2 Incident Investigation Form

• Appendix 5.3 Incident Reporting Form


Company Name __________________________________

Appendix 5.1 Incident Investigation Policy and Procedure Version 1.0 Page 1

Incident Investigation Policy and Procedure Purpose The purpose of the Incident Reporting and Investigation Policy is to make certain that incidents are investigated according to the injury, or injury potential of an event, in accordance with company policy and OH&S legislation. This will help to control further losses of human and material resources by identifying and correcting unsafe acts and conditions that lead to an incident.

This policy applies to any and all work-related incidents and close calls that affect company employees and others who are performing work for the company.

Policy All staff and others working with the company are required to report all incidents and close calls, including ergonomic issues, soft tissue damage and any signs or symptoms of musculoskeletal (MSI) injury to their supervisor or company contact. All incidents will be reported and investigated following company and regulatory requirements.

Some incidents are immediately reportable to WorkSafeBC. Incident sites should not be disturbed unless the safety of workers is at risk.

The company uses the word “incident” rather than “accident” because there is an inherent belief by many people that accidents just happen and cannot be prevented. We use the word incident because we believe that all incidents can be prevented. Belief that all incidents can be prevented will drive the level of investigation to determine causes that could otherwise be missed.

Incident reports will be reviewed by a supervisor and other management as appropriate to the severity or potential severity of the incident.

Action items from incidents will be documented and tracked for completion and follow-up using our Corrective Action Log. Implementation of action items will be monitored and reviewed by the JOHSC. Safe work procedures will be reviewed by the JOHSC after an incident to ensure that changes required by the investigation findings are implemented and that they meet or exceed jurisdictional requirements.

Injuries or incidents resulting from ergonomic hazards must be investigated.

Responsibilities

Management A manager will investigate an incident reported by a direct report. A manager will participate in an investigation of an incident if the severity or potential severity requires action appropriate to the manager’s authority. All investigations requiring immediate notification to WSBC will be attended by the appropriate management personnel. Copies of investigations required by the WSBC will be provided by the appropriate management personnel.

Company Name __________________________________


Supervisor A supervisor must advise new and returning workers of the requirement to report all incidents including close calls. An annual reminder to all employees to report incidents is recommended. A supervisor must investigate incidents in a manner that is timely and appropriate to the circumstances and severity of the incident. A supervisor’s incident review and signoff are a requirement.

Worker A worker will report to the supervisor all incidents including close calls. A worker will attend the incident investigation unless unable to do so as a result of injury. Workers may choose to report a close call using the company’s form Incident Close Call Reporting, or verbally to their supervisor, who will be responsible for completing the document.

Joint Occupational Health and Safety Committee (JOHSC) Member A JOHSC member should be included in an incident investigation. If not available, another employee knowledgeable in the investigation process may be included in the investigation.

Procedure

Incident Reporting and Investigations (Company name) has an obligation to make certain that all our employees, staff, contractors, volunteers and visitors are aware of the importance of and requirements for reporting and investigating close calls, near misses and other incidents. Investigations of close calls and near misses provide a learning and improvement opportunity to help prevent someone from being injured.

An investigation is held to prevent recurrence, not to place blame. Definitions

Incident: An incident is any event that has resulted in or has the potential to result in an injury.

Incidents may include property damage, personal injury, death, close calls or near misses.

The Workers Compensation Act (Section 172 (1) requires the following regarding immediate notification of incidents:

An employer must immediately notify the Workers’ Compensation Board of the occurrence of any accident that:

• resulted in serious injury to or the death of a worker

• involved a major structural failure or collapse of a building, bridge, tower, crane, hoist, temporary construction support system or excavation

• involved the major release of a hazardous substance

• was an incident required by regulation to be reported.

Incidents that are required to be investigated by the Workers Compensation Act:

Company Name __________________________________


• An employer must immediately undertake an investigation into the cause of any incident that:

o is required to be reported by Section 172

o resulted in injury to a worker requiring medical treatment

o did not involve injury to a worker, or involved only minor injury not requiring medical treatment, but had a potential for causing serious injury to a worker

o was an incident required by regulation to be investigated.

Subsection (1) does not apply in the case of a vehicle incident occurring on a public street or highway.

Responsibilities of Managers, Supervisors, Workers and JOHSC Incident Reporting and Investigation Procedure:

• The incident is reported by a person to the company. (An incident involving an employee may be reported by others to the company.) The incident may be reported verbally or in writing.

• The incident site must be visited if possible and the site preserved until the investigation is complete, if safe to do so. Photographs, sketches and other evidence collection should be undertaken promptly. Note: Incidents requiring immediate notification to WSBC will require communication with WSBC board officers with regard to site access and preservation of evidence.

• The direct supervisor of the employee involved or the person who reported the incident will organize and lead the investigation. The investigation must be carried out by those knowledgeable about the type of work involved and, if reasonably available, with the participation of a JOHSC member.

• The investigation team will include those appropriate to the severity or potential severity and type of incident. (Refer to the Risk Assessment matrix on the Incident Investigation Form ).The team may include people not under the scope of this policy (for example a prime contractor representative if the incident occurred on a worksite).

• The investigation will follow the Incident Investigation Template format, which includes root cause analysis.

• The investigation must be held in a timely manner. A preliminary investigation may be necessary if required attendees are not able to attend due to injury or other reasons.

• Action required as the result of an investigation will be recorded using a Corrective Action Log (CAL) format and tracked for completion by the JOHSC.

• JOHSC will evaluate any future risks that recommendations or corrective actions could create.

• JOHSC will monitor the effectiveness of any changes or implementations.

• JOSHC will communicate the recommendations and corrective actions to all relevant parties.

Company Name __________________________________


• All investigation reports will be forwarded to the JOHSC. The JOHSC will review the reports for completeness and determine if additional investigation or distribution is required. Note: All investigations that require notification to the WorkSafeBC will be forwarded after review by the JOHSC and approved by company management or as directed by the WorkSafeBC.

• An industry safety alert will be issued through the company if findings from the investigation could help others prevent injury.

Training Managers, supervisors and JOHSC members must be familiar with this policy and associated forms. Training in the investigation process and the company’s specific policy and forms will be determined by company management and communicated to the JOHSC. The requirement to report and investigate close calls and other incidents will be covered during new employee orientation. Review This policy should be reviewed at least annually, or when revision is required. Incident investigation historical records should be reviewed annually by the JOHSC in order to:

• confirm that action required was implemented

• determine if the action was effective in prevention of recurrence

• identify trends

• determine areas for improvement.

Records Copies of incident investigations will be electronically filed on a company Intranet or kept in a secure filing area.

Corrective Action Log A Corrective Action Log (CAL) is used to record deficiencies and is included with the JOHSC monthly minutes. The CAL is updated and posted every month. It identifies an issue, determines the appropriate action, assigns the action to a person, assigns a date for completion of the action, and has an actual completion date. CALs are reviewed monthly by the JOHSC for completion and determination as to the whether the deficiency was addressed to prevent recurrence. CAL’s are reviewed monthly by the JOHSC for completion and determination as to the whether the deficiency was addressed to prevent recurrence.

Company Name __________________________________

Appendix 5.2 Incident Investigation Form Version 1.0 Page 1

Incident Investigation Form

Please refer to reference material at the end of this form to assist in filling out required fields.

Incident #: (office use only) Operating Area Date of Incident (dd/mm/yyyy) Time of Incident

AM PM

Primary Type of Incident (select one) Recordability of Injury (select one)

Injury Property Damage / Fire Close Call First Aid Medical Aid Fatality

Close Call Process Loss Medical

Treatment Restricted Work Lost Time

Injured/Involved Person(s) Name(s) Department (if applicable) Supervisor

N/A Employee Witness(es)

Visitor Contractor Operation Condition at Time of Occurrence (select one only) Normal Scheduled

Maintenance Upset

Contractor Business Name

Exact Location of Incident

Date Reported (D/M/Y)

Date Investigated (D/M/Y)

Date of Last Revision (D/M/Y) Time in Position

Years: Months/Days:

Cost Estimate: Property / Equipment Damage $

Risk Level (use reference material located on the last page of this form) High Low

1 What was the risk level of this incident? (please choose one) 1 2 3 4

2 What could have been the potential severity level? (please choose one) 1 2 3 4

Cause Analysis

Primary Type of Incident (select one)

Struck against (running, bumping i t )

Contact with (electricity, heat, cold, radiation, caustics, toxics, bi l i l i )

Overstress, overpressure, overexertion, ergonomic

Struck by (hit by moving object) Caught in (pinch & nip points) Violence

Fall from elevation to lower level Caught between / under (crushed

or amputated) Non-specific

Fall from same level (slips & fall, trip over) Environmental release Other

Company Name __________________________________


Incident Description (describe events leading up to, during and post-incident)

Immediate Causes (select and describe all that apply)

1 Failure to follow safe work practices or rules 9 Inadequate awareness of

surroundings 17 Poor housekeeping / disorder

2 Improper use of equipment / tools 10 Improper placement, storage or

securement 18 Worksite conditions / congestion / visibility

3 Inadequate grip or hold 11 Repetitive motion 19 Inadequate warning systems

4 Improper lifting / pushing / pulling 12 Inadequate use of safety devices 20 Inadequate / improper protective

equipment

5 Failure to obtain assistance 13 Under influence of alcohol and / or drugs 21 Inadequate labeling

6 Failure to warn or instruct 14 Weather conditions 22 Other – please specify:

7 Failure to lockout 15 Fire / explosion

8 Failing to use PPE properly 16 Absence of guards and / or barriers

Description of Immediate Causes (for each item selected above, please describe here):

Company Name __________________________________


Root Causes (select and describe all that apply)

1 Inadequate work planning or programming 7 Inadequate assessment of

needs, risks and / or hazards 13 Inadequate change management

2 Inadequate communication standards 8 Inadequate maintenance system 14 Inadequate employee skill

3 Inadequate policy, procedures, practices or guidelines

9 Inadequate engineering and / or design 15 Fatigue due to lack of rest

4 Improper performance is rewarded (tolerated) 10 Inadequate or lack of

inspections 16 Mental / physical stress

5 Inadequate performance feedback 11

Inadequate purchasing standards: tools / equipment / materials

17 Inadequate physical capability

6 Supervision / leadership 12 Inadequate training standards 18 Other – please specify:

Description of Root Causes (for each item selected above, please describe here):

Site Corrective Actions (immediate, short term, long term)

By Whom By When (D/M/Y)

Date Completed (D/M/Y)

Verified by (initial)

System Corrective Actions (immediate, short term, long term)

By Whom By When (D/M/Y)

Date Completed (D/M/Y)

Verified by (initial)

Company Name __________________________________


Injury Information (select all that apply)

Nature of Injury

Allergies / sensitivities Cut / puncture / open wound Hernia / rupture

Amputation Dislocation Infection

Asphyxiation Electric shock Respiratory conditions

Bruise / contusion Foreign body Scratch / abrasion

Burn Fracture Sprains / strains – joints, muscles

Concussion Hearing loss Other occupational injuries

Body Part

Abdomen L R Face L R Neck L R

Ankle L R Hand L R Shoulder L R

Arm L R Wrist L R Foot L R

Back L R Groin L R Mouth / teeth L R

Chest L R Head L R Multiple part L R

Ear L R Hip L R Other L R

Elbow L R Knee L R

Eye L R Leg L R

Source of Injury

Chemicals Human Petroleum products

Conveyor Ladders Power tools

Debris / scrap Logs Slivers

Electrical equipment Lumber Steam

Fasteners Machine parts Work area

Fire / smoke Mobile equipment Working surface

Hand tools Noise Other (provide details below):

Heat Office equipment

Hoisting equipment Pallets

Other

Company Name __________________________________


Approvals Print name Signature Date (D/M/Y)

Investigation leader

Investigation team members

Safety committee

Corrective action assignee(s)

Immediate supervisor

Approved by manager

Company Name __________________________________


Reference Material:

Incident # (i.e. 2009-Apr-30-A) Year

Month (3

letters) Day “A” for first incident of day, “B” for second incident of day etc.

YYYY MMM DD A/B/C or D etc.

Operation Condition at Time of Occurrence

Normal: Normal operating process

Scheduled Maintenance: Planned and scheduled maintenance

Upset: An interruption and / or non-routine break in normal operating process. Includes unscheduled maintenance

Date of last SWP: Indicates the most recent date the Safe Work Procedures (also known as JSB, JSA) for the job was reviewed and signed off with a supervisor

Security Level Questions – Risk Assessment

Risk Level Index

1

Level 1 Fatality OR Property Damage Exceeding $500,000

Level 2 Employee admitted to hospital or probably permanent disability OR property damage between $100,000 and $500,000

Level 3 Employee not able to perform all regular duties OR property damage between $10,000 and $100,000

Level 4 Employee able to perform all regular duties OR property damage less than $10,000

Probability Index of Occurrence Example

2

A Likely to occur immediately Could happen any day

B Probable in time Likely to happen if conditions are repeated

C Possible in time Under the right conditions, the incident might be repeated

D Remotely possible Even under similar conditions, it is unlikely the incident will be repeated

Probability of Occurrence

Pote

ntia

l Sev

erity

A B C D

1 1 1 1 2

2 1 2 2 3

3 2 2 3 3

4 2 2 3 4

For page 1, Question 2, mark the number that is indicated on the Risk Assessment Grid above Site Corrective Actions will be implemented to prevent future occurrence at the site System Corrective Actions will be implemented to prevent future occurrences across the company and, if required, throughout industry.

Company Name __________________________________

Appendix 5.3 Incident Reporting Form Version 1.0 Page 1

Incident Reporting Form Date of incident: Company:

Date reported: Location:

Reported by: Type of job:

Describe incident / close call (draw diagram on other side if helpful)

Category

Notes: close call

bodily injury/illness

Notes: lost time

dangerous goods spill

Notes: fire

vehicle incident / damage

Notes: ATV incident / damage

other equipment damage

Notes: other (describe)

other (describe)

Names/contact info of any individual or witnesses involved in incident / close call:

If first aid was rendered, name of attendant:

Company Name __________________________________


Describe immediate and root cause of incident / close call: This is appropriate for minor incidents or as a preliminary summary for major events. This does NOT replace a full investigation for serious incidents. Immediate cause(s) Root cause(s)

Notes:

failure to follow safe work procedures

inadequate work planning, engineering, design

Notes:

improper use of equipment/tools/lockout

inadequate polices, procedures

Notes:

failure to warn or instruct inadequate communications

Notes:

body motions – pushing, pulling repetition

inadequate supervision

Notes:

improper use of PPE inadequate risk/hazard assessment

Notes:

inadequate awareness of surroundings

mental, physical stress/fatigue

Notes:

poor housekeeping inadequate maintenance/inspections

Notes:

worksite conditions – weather congestion, layout, (circle)

inadequate physical abilities

Notes:

other other

Describe corrective action(s) to be undertaken or already done:

Person responsible for corrective action:

Date action to be completed by:

Person responsible to sign here when completed:

Date when action was completed:

Company Name __________________________________


Report and actions reviewed by

Notes: Date:

Name:

Signature:

Position:

SEND A COPY OF THIS REPORT TO THE PERSON YOU REPORT TO.

Reported to WorkSafeBC Yes No N/A



Contents

• Appendix 6.1 Training Policy • Appendix 6.2 Occupational Health & Safety Orientation Checklist • Appendix 6.3 New Worker Assessment Checklist • Appendix 6.4 Training Records • Appendix 6.5 Safety Meeting Minutes • Appendix 6.6 Contractor Selection and Safety Checklist


Company Name __________________________________

Appendix 6.1 Training Policy Version 1.0 Page 1

Training Policy Purpose (Company name) commits to ensuring that individuals are appropriately trained for the functions that they are assigned and the tasks that they are asked to perform.

This policy applies to all full-time and part-time positions in the (company) up to and including executive level

Policy All new workers and all young workers must receive an orientation prior to the start of normal job activities. In addition, workers who are returning to work after an absence must receive an orientation if hazards in that workplace have changed during the worker's absence.

The orientation must meet the requirements of: WorkSafeBC Regulation and be appropriate to:

• the work activity

• the workers knowledge and skill

• length of absence.

Returning workers may also require assistance from the injury management coordinator.

The supervisor of a new or returning worker must observe and assess the worker to ensure competence prior to performing the task required. This assessment must be documented by the supervisor.

Responsibilities Any person in the company who has other people, including temporary employees or workers from other areas, working under their supervision is directly responsible for ensuring that the individuals under their direct supervision have the appropriate training, and is indirectly responsible for ensuring that this training extends to workers more than one level below them in the organization.

The JOHSC is responsible for reviewing this procedure:

• at least annually

• when the operating structure of the company changes

• when risk assessments indicate a new type of training is required

• when the company offers new types of training to clients that might be applicable to company personnel.

The JOHSC, in consultation with each affected party, annually develops and reviews the training matrix. Training topics are matched against job groups (collections of similar tasks) and marked as ‘Required’. These topics are ones that the target job group needs to be

Company Name __________________________________

Appendix 6.1 Training Policy Version 1.0 Page 2

progressing toward. Not having a mark in the training topic in no way prohibits a person from having that training. Training received prior to company employment may qualify as sufficient training on this matrix.

Procedure Individuals must be appropriately trained for the functions that they are assigned and the tasks that they are asked to perform. The job function training needs assessment provides a training matrix and mechanisms for using and maintaining the matrix in compliance with legal, regulatory and company requirements

Company manager will track and monitor training and such certification for those reporting to them, in order to maintain legal, regulatory and company requirements.

Supervisors must assess the competency of their workers before they are permitted to perform their assigned tasks. Records such as Monthly Operational Reports (MOR’s) and Performance Goals and Measures (PGM’s) will be maintained by supervisors.

All employees must carry their certification documentation with them where required. For example, first aid attendants must carry proof of their qualification; servers in licensed establishments should have Serving It Right certificates, and anyone driving on company business must carry a driver’s license with them.

Records Training records are personnel records and as such must be kept at least as long as the employee is with the company. Master records need to be kept secure from damage but accessible to those who need them. Keeping original documents in personnel files with copies accessible to supervisors and others needing to verify training is recommended. Spreadsheets can be used to track certifications, and can make it easy for supervisors to look up information.

Company Name __________________________________

Appendix 6.2 Occupational Health & Safety Orientation Checklist Version 1.0 Page 1

Occupational Health & Safety Orientation Checklist DEPARTMENT: NAME: _____________________________ POSITION: ______________________________ HIRE DATE: _________________________ DATE OF ORIENTATION: __________________ TRAINER: _____________________________ Initials

Trainer Initials Worker Comments

Supervisor Name: Contact number: Rights and Responsibilities

General duties of employers, workers and supervisors Workers’ right to refuse unsafe work and procedure for doing

so Workers’ responsibility to report hazards and procedures for

doing so

Hazardous Materials and WHMIS Hazardous materials in your work area Location, purpose and significance of material safety

data sheets (MSDS)

Purpose and significance of hazard information on product labels.

How to handle, use, store and dispose of hazardous materials safely.

Procedures for an emergency involving hazardous materials, including clean-up of spills.

Fire Emergency Response Team Fire Extinguishers

o Use & locations Fire exits

o Locations and evacuation meeting point o Alternate routes o Free and clear of obstructions o Location of sprinklers, smoke detectors and

fire alarms

Fire Procedures o Departmental

First Aid Location of nearest first aid kit and main first aid room How to report an illness, injury or other accident

(including near misses)

Certified individuals, listing locations and contact information

Personal Protective Equipment (PPE) – what to use, when to use it and where to find it.

a) b) c) d)

Company Name __________________________________

Appendix 6.2 Occupational Health & Safety Orientation Checklist Version 1.0 Page 2

Known Hazards and how to deal with them 1. Equipment

o Proper storage o Safety precautions o Common malfunctions o Proper use and cleaning

2. Guestroom Floors o Cots o Pictures secured o Fire exits clear and well lit

3. Electrical o Overloading of circuits o Main shut-off switches o Frayed cords

4. Floors o Common water accumulation areas o Signage o Unobstructed walkways o Non-slip surface o Lifted carpets and carpet air pockets

5. Storage Areas o Cleanliness o Heavy items on the bottom

Safe Work Procedures - Physical Lifting techniques Bending techniques Proper carrying techniques Safety wear/proper footwear Reaching Stocking of cart Mattress rotation Pushing vs. pulling

General Basic content of the occupational health & safety

program

Using hand rails Blood-borne pathogens/waste disposal of sharp

objects

Measures to reduce the risk of violence in the workplace and procedures for dealing with violent situations

Preventative maintenance Procedure for working alone or in isolation Emergency telephone numbers Injury Management, Return to Work Program Health & Safety Committee and representative Health & Safety Manual location Location of departmental H&S communication board Following work procedures Using PPE Operating equipment safely

Colleague signature: ________________________________ Trainer signature: ________________________________ Department Head signature: ________________________________ Date completed: ________________________________

Company Name __________________________________

Appendix 6.3 New Worker Assessment Checklist Version 1.0 Page 1

New Worker Assessment Checklist

Worker Name (first & last) Worker Occupation Date of Assessment

New / Returning Worker

Monthly Assessment

Worker Observation

Worker assessment to be completed once per worker per month. This checklist should also be used to assess a new hire or a returning worker that has been away from the job for more than 6 weeks. Check appropriate boxes if “safe” or mark N/A. If “unsafe”, provide corrective action comments for worker.

Company Policies & Procedures Check if Safe Comments

Emergency Response Plan (ERP)

Can locate ERP

Knows relevant emergency plan details

Can identify first aid attendant(s) and how to contact them

Safe Work Procedures for task

Can identify worksite hazards

Is alert and focused on job

Demonstrates safe use of tools & equipment

Consistently uses safe work procedures

Has required certificate(s)

Personal Protective Equipment (PPE)

Wears appropriate PPE identified for the task

Wears appropriate footwear for job

Other:

Additional Comments: New worker is competent to perform assigned duties under normal supervision

Signature of Employee / Contractor Signature of Supervisor / Trainer

Company Name __________________________________

Appendix 6.4 Training Records Version 1.0 Page 1

Training Records

List all personnel in the company; owners, management, supervisor, workers (include field and office) and workers of dependent contractors. Create more rows as necessary

NAME

POSITION BCDL

# / expiry 1st Aid

# / level / exp

FOODSAFE#

Internal Auditor

Other Other Other Tick if contractor

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

“Other” training could include orientation, incident investigation, supervisory skills, injury management, hire date etc.

Company Name __________________________________

Appendix 6.5 Health & Safety Meeting Records Version 1.0 Page 1

Safety Meeting Minutes Safety meeting conducted by:

Date of meeting: Time:

Attendees:

CC:

Item Description of Discussion Person Responsible

Completion Due Date

Completed On

1 Safety/Environment Items

2 Other Topics Discussed

Inspections

Assessments

Industry Alerts

Close Calls and Near Misses

Incidents and Investigations

3 Follow up on Old Business

4 New Business

Company Name __________________________________

Appendix 6.5 Health & Safety Meeting Records Version 1.0 Page 2

Employee Sign-In

Name Signature

Company Name __________________________________

Appendix 6.6 Contractor Selection and Safety Checklist Version 1.0 Page 1

Contractor Selection and Safety Checklist Contract/Job:

Name of Contractor:

Address:

Phone: ( ) Fax:

WCB Registration Number:

WCB current standing (attach clearance letter):

WCB assessment rate (industry average or lower):

Description of written WorkSafeBC orders in past 24 months:

References:

Previous work history:

Using the previous year’s experience, complete the following:

Number of first aid cases: _________________ Number of recordable incidents: ____________

Number of lost time cases: _________________ Number of lost days: _____________________

Severity Rate (# of days lost X 200,000): Total hours worked Exposure Hours

Medical Incident Rate (MIR= # of recordable incidents X 200,000): Total hours worked Exposure Hours

Number of fatalities in the last five years:

How often are safety meetings held with employees:

Are worksite inspections held: if yes, How often:

Attach a copy of written health and safety program. Included within the program should be a list of key personnel and supervisors (including qualifications). Other procedures you need to be aware of if you are awarded this contract include:

• periodic audits by the company.

• contractors and any sub-contractors must review the incident investigation & reporting requirements, policies and procedures with all of their employees at least annually.

• contractors must comply with all applicable government regulations and legislation.

• contractors must be certified for any job tasks that require regulatory certification.

• contractors must have a process for investigating incidents.

• contractors must provide training to all their employees on the hazards associated with the job they are being directed to do.

• contractor safety performance will be monitored for continual improvement.

Contractor Signature: Date:

Company Name __________________________________


Contractor Safety Checklist To be completed at the commencement of activities at the start of the year and then on a quarterly basis thereafter.

Contractor: Contractor Contact:

Location: Date:

Item Yes No Comments

Will a qualified supervisor who meets the criteria below be onsite at all times? Qualified Supervision means a person who instructs, directs and controls workers in the performance of their duties and who is knowledgeable of the work, the hazards involved and the means to control the hazards, by reason of education, training, experience or a combination thereof.

How is your organization identifying and communicating hazards in the workplace - documentation required

What does your organization pre-work planning process look like and what does your ongoing block hazard assessment process look like – documentation required

When do you intend to start operations in the following blocks?

What does your prework meeting look like does it include all subs – are potential hazards identified prior to activities occurring. - occupation

What does the firm’s orientation process look like for new workers/ contractors / sub-contractors including service providers arriving at the worksite.

Defined Area Safety Orientation reviewed with all contractors / sub contractors at the Defined Workplace prior to commencing work activities.

Do all contractors / sub contractors, in the workplace provide a list of their designated supervisors? Documentation

How does the operation coordinate the activities of all permitted persons including contractors / sub-contractors at the Workplace to ensure the Health and Safety of all workers is maintained.

What are your procedures in the workplace to

Company Name __________________________________


Item Yes No Comments

ensure safe access? documentation

What is the process for assessing the workplace first aid needs? documentation

How are you conducting regular inspections of the Workplace, work methods & practices, including worker inspections?

OHS site safety plan is in place and available to all persons. contractors and sub contractors at the worksite.

What is your safety meeting process? Do all persons / contractors / sub contractors at the workplace included in the your OHS program and safety meetings.

Are all safety incidents reported and investigated.

What does your hazard reporting and follow up process look like?

What does your ERP look like and how communicated when was last tested? For

Do you have safe work procedures for all activities being carried out ?

Signed off on behalf of Company:

Signed off by the Contractor:

Dated:



Contents

• Appendix 7.1 Safety Records and Statistics Policy


Company Name __________________________________

Appendix 7.1 Safety Records and Statistics Policy Version 1.0 Page 1

Safety Records and Statistics Policy Policy (Company name) will collect and maintain records and use the records to generate safety statistics that will guide continual improvement.

Responsibilities Human Resources Human resources is responsible for maintaining master employee files. These are maintained in a secure (locked) location in HR and protected from damage for at least as long as the employee is working for the company.

Supervisors Supervisors are responsible for maintaining records other than personnel records. These include but are not limited to:

• Incident investigation reports

• Hazard assessments

• Toolbox meeting minutes

• OH&S reports

• Inspections

• Internal and external audits

These records are to be kept for seven years. The records will be kept in secure filing cabinets for paper copies and secure directories for electronic information. Copies of documents that do not contain confidential information may be released or posted, but the master must remain secure.

Procedures Both leading and lagging indicators are used to assess the effectiveness of the safety management system. Leading indicators provide advanced warning of developing weaknesses before losses occur. Lagging indicators are used to measure the final outcome of the work activities.

The following leading indicators are used to track ongoing activities by month.

• Leading indicator

• Site actions per month

• Office actions per month

• Total actions per month

• Formal inspections

• Specific safety trainings delivered

• Management safety walk

Company Name __________________________________


• Near miss report

• Safety committee meeting

• Toolbox meeting

• Hazard report

• Open safety action items from meetings, inspections, investigations, etc.

The following types of incidents are to be reported and tracked (for both our company and our subcontractors):

• All injuries

• All incidents that cause property damage or interrupt operations

• Incidents, called "near misses," that had the potential to result in the above

• All incidents that, by regulation, must be reported to OH&S, WCB, or other regulatory agencies.

Incidents are tracked in the following categories:

1. Near-miss incidents

2. Injuries

a. First aid

b. Medical Aid

c. Modified duties

d. Lost Time

e. Fatality

3. Incident

a. Property damage

b. Vehicle damage

Monthly and yearly statistics will be kept in accordance with industry practice. Along with the incidents that are tracked, the company also tracks the amount of person-hours that the company works (including subcontractors) and the total kilometers driven by company employees (or subcontractors) while on company business.

Company Name __________________________________


TOTAL RECORDABLE INCIDENT FREQUENCY SEVERITY (TRIFS) In order to track and communicate the frequency of incidents occurring with our employees and subcontractors, a TRIFS report is completed monthly.

The TRIFS report includes all incidents that have occurred year to date separated by category (as listed above). The number of incidents in each category is multiplied by 200,000 and divided by the number of person-hours to come up with our TRIFS rate.

This report is for internal tracking purposes only and is reviewed by all managers on a monthly basis.



Contents

• Appendix 8.1 Joint Occupational Health and Safety Committee Terms of Reference

• Appendix 8.2 Joint Occupational Health & Safety Committee Members


Company Name __________________________________

Appendix 8.1 Joint Occupational Health & Safety Committee Terms of Reference Version 1.0 Page 1

Joint Occupational Health and Safety Committee (JOHSC)

TERMS OF REFERENCE Members as of (date) Co-Chairs: Management representative: Worker representative: Members: (List names and departments here) 1. PURPOSE To provide a consultative forum that can effectively address the health and safety matters arising within (company name) with particular reference to the requirements of the Workers Compensation Act (WCA). 2. FUNCTIONS 2.1 Functions of the Health and Safety Committee

1. The functions of the committee are: a. to facilitate co-operation between an employer and the employees of the

employer in initiating, developing, carrying out and monitoring measures designed to ensure the health, safety and welfare at work of the employees

b. to identify situations that may be unhealthy or unsafe for workers and advise on effective systems for responding to those situations

c. to assist in the resolution of issues relating to occupational health, safety or welfare that arise at any relevant workplace, including considering and expeditiously dealing with complaints related to the health and safety of workers

d. to assist in the development, review and distribution of occupational health, safety and welfare practices, procedures and policies to employees within the workplace

e. to consult with workers and the employer on any issues or proposed changes to occupational health, safety, occupational environment or welfare legislation, regulation, practices, procedures or policies

f. to keep under review: i. developments in the field of rehabilitation of employees who suffer

work-related injuries ii. the employment of employees who suffer from any form of disability;

g. To assist in: i. the return to work of employees who have suffered work-related

injuries ii. the employment of employees who suffer from any form of disability

Company Name __________________________________


h. such other functions as are prescribed or agreed upon by the employer and the health and safety committee

i. to ensure that incident investigations and regular inspections are carried out as required by the Act and the regulations

j. to participate in inspections, investigations and inquiries as provided in the Act and the regulations

k. to complete an annual review of the safety program l. to work with the Ability Manager to monitor and review return to work plans m. to complete or review all incidents and investigations.

3. MEMBERSHIP 3.1 The committee will consist of at least four members. Employees must have equal or

greater representation than the employer. Management and first aid attendant representatives will be appointed by the employer. Member constituencies will include each company office, contractors and first aid attendants.

3.2 Employee representatives shall be appointed and/or elected in accordance with the

WCA. 3.3 A quorum of members must be present before a meeting can proceed. At least two

employee representatives and one management representative must be present for the meeting to proceed.

3.4 Committee members will cease to be members if they:

• resign from the committee • fail to attend three consecutive meetings without providing apologies to the

chairperson • resign from their employment • breach confidentiality

4. Co-CHAIRPERSONS The Co-Chairpersons shall be elected by the committee for a period of 12 months. 5. ROLES AND RESPONSIBILITIES 5.1 Members’ roles:

• to provide input as related to the Committee’s Purpose and Functions • to attend meetings prepared and informed • to attend regularly. If unable to attend a meeting, the member should prepare for

the • following meeting by reviewing the previous meeting summary or liaising with

members of the committee. • To agree to work toward a consensus. If a member is unable to agree, he or she

will articulate this concern and suggest a potential solution. • to be part of reaching consensus recommendations and decisions • to recommend invitation of specific advisors as needed

Company Name __________________________________


• to accept the meeting minutes as a true and accurate record at the commencement of the next meeting

• to participate in inspections, investigations and inquiries at the workplace, whether internally or externally initiated.

5.2 Worker Members’ Role In addition to the above, a worker member has the role and responsibility to

participate in: • refusal-to-work situations • inspections, investigations and inquiries at the workplace, whether internally or

externally initiated. 5.3 The employer’s roles

• To provide support, meeting room, facilitation and expense reimbursement for committee members (if travel is required)

• To review committee recommendations, provide feedback within 21 days and act on those recommendations if appropriate.

On request of the joint committee, the employer must provide the committee with

information regarding: 1. the identification of known or reasonably foreseeable health or safety hazards to

which workers at the workplace are likely to be exposed 2. health and safety experience and work practices and standards in similar or other

industries of which the employer has knowledge 3. orders, penalties and prosecutions under this Part or the regulations relating to

health and safety at the workplace 4. any other matter prescribed by regulation.

5.4 The Co-Chairperson’s Roles The two co-chairs alternate the following duties, or if one co-chair is absent, the other

assumes the duties: • The chairperson checks the minutes, which are accepted by committee members

as a true and accurate record at the commencement of the next meeting. • Invites specialists to attend meetings when required by the Committee. • Guides the meeting according to the agenda and time available. • Ensures that all discussion items end with a decision, action or definite outcome. • Reviews and approves the draft minutes before distribution.

Company Name __________________________________


6. MEETINGS Meetings shall be held the first Wednesday of each month for a target period of two hours. Meetings may be a combination of in-person and teleconference. A special or extraordinary meeting may be called by either co-chair if required. 7. OPERATING RULES The committee members agree to work by the following ground rules:

• All members will maintain professionalism. • All members will be given the opportunity to voice their perspectives. • All members will listen to the range of perspectives. • Meetings will be well structured and facilitated to enable efficient progress. • Meeting format will be round-table discussion.

The following "Code of Conduct" will be posted at each meeting:

• Treat others with respect. • If unclear, ask for clarification. • Everyone is to have an equal opportunity to speak. • Listen actively; think about what others are saying. • All participants accept that the concerns and goals of others are legitimate. • Participants agree to act in good faith in all aspects of the process. • Support the decisions of the committee, even if you don’t agree with the final

result. 8. EDUCATIONAL LEAVE

1. Each member of a joint committee is entitled to an annual educational leave totaling eight hours, or a longer period if prescribed by regulation, for the purposes of attending occupational health and safety training courses conducted by or with the approval of the Board.

2. The employer will provide the educational leave under this section without loss of pay or other benefits and must pay for, or reimburse the worker for, the costs of the training course and the reasonable costs of attending the course.

The company will provide training to safety committee members upon the joint recommendation of the committee and the senior management. 9. AMENDMENTS The terms of reference shall be reviewed annually from the date of approval. They may be altered (within legislative and regulatory boundaries) to meet the current needs of all committee members, by agreement of the majority of employer and employee representatives.

Company Name __________________________________


10. RECORD KEEPING Minutes and other committee documentation will be stored (insert how). The electronic storage will contain all historical committee records. Minutes will be e-mailed to all company staff. Three months of minutes will be posted in each company office in a location that is accessible to all employees.

Company Name __________________________________

Appendix 8.2 Joint Occupational Health & Safety Committee Member List Version 1.0 Page 1

Joint Occupational Health & Safety Committee Members

Date:

Name Position Photo Contact Number(s)



Contents

• Appendix 9.1 Injury Management Policy

• Appendix 9.2 Stay at Work / Return to Work Program


Company Name __________________________________

Appendix 9.1 Injury Management Policy Version 1.0 Page 1

Injury Management Policy Policy Statement The organization is committed to the health, safety and wellness of its employees, clients and the public. We recognize and accept the responsibility to provide our employees with a safe, healthy and productive work environment.

Reason for Policy The purpose of this policy is to establish our Injury Management expectations.

Policy Standards

Incident investigation In the event of a safety incident/accident, we are committed to conducting an immediate, non-biased investigation to determine the root cause and will notify all required internal and external clients/agencies of our findings to rectify current conditions and further promote a safe work environment in future. Our investigation’s findings will be forwarded to clients and colleagues within the industry so that we may all learn and promote a “Courage to Care” attitude within our industry.

We are committed to treating an injured employee and their family with respect and will file all appropriate documentation expediently to ensure the employee receives the medical attention and proper medical coverage they require during this difficult time.

Stay at work or return to work We will support the employee in an effort to stay at work or return to work through light and casual office and modified field work, and by ensuring time is made available to attend rehabilitation programs.

Injury/Claims Management Classification and reporting of injury Minor injury

This is any injury of a minor nature that can be treated with materials available in the first aid kit or by the local first aid attendant? Details of the injury must be recorded in the Treatment Record Book.

Medical aid injury

This is any injury that requires treatment by a doctor but does not prevent the worker from returning to regular duties within the next scheduled shift.

Lost time injury

This is any injury that prevents the employee from performing regular duties during the period of medical care. The period of absence from work is prescribed by the physician.

Company Name __________________________________


All medical aid and lost time injuries must be reported immediately to the employee’s supervisor. The supervisor must complete a WCB Form 7 (Employer’s Report of Injury) and send it to the WorkSafeBC claims centre in that area within three working days.

In all cases an accident investigation must be completed and recorded using the Injury/Accident Report form. The form and copies are distributed to client groups as required.

Treatment of Injuries

Minor injuries These shall be treated using supplies from the first aid kit. (First aid kits shall be located in each vehicle or at each work site.)

More serious injury These shall be treated at the nearest doctor’s office or medical centre. In the case of emergency, the injured person shall be taken immediately to the nearest doctor or hospital for attention. The supervisor must be informed immediately.

Except in the case of ambulance transport, the injured person shall be accompanied by another employee.

First aid kits Responsibility for the maintenance of the kits in vehicles shall rest with the vehicle operator. The supervisor or first aid attendant shall be responsible for the office first aid kits and/or first aid room. Periodic inspections shall be made to ensure that kits and first aid rooms are adequately stocked.

All employees will be required to carry a WorkSafeBC-approved personal first aid kit in the field at all times. Employees shall be responsible to obtain and refresh first aid training and to ensure that at least one other co-worker (whether from the company, the prime contractor or otherwise) with first aid training is present in the field at all times.

The level of first aid care and training of the on-call first aid attendant must meet requirements put forth by WorkSafeBC regulations. Company trucks transporting more than one person to a field location work site shall include Level 1 First Aid Kits.

WCB Requirements for a Level 1 First Aid Kit

• three blankets

• 24 - 14 cm x 19 cm wound cleaning towelettes, individually packaged

• 60 hand cleansing towelettes, individually packaged

• 100 sterile adhesive dressings, assorted sizes, individually packaged

• 12 - 10 cm x 10 cm sterile gauze dressings, individually packaged

• four 10 cm x 16.5 cm sterile pressure dressings with crepe ties

• two 7.5 cm x 4.5 m crepe roller bandages

Company Name __________________________________


• one 2.5 cm x 4.5 m adhesive tape

• four 20 cm x 25 cm sterile abdominal dressings, individually packaged

• six cotton triangular bandages, minimum length of base 1.25 m

• four safety pins

• one 14 cm stainless steel bandage scissors or universal scissors

• one 11.5 cm stainless steel sliver forceps

• 12 cotton tip applicators

• a pocket mask with a one-way valve and oxygen inlet

• six pairs of medical gloves (preferably non-latex)

• first aid records and pen

These items must be kept clean and dry and must be ready to take to the scene of an accident. A weatherproof container is recommended for all items except the blankets. Blankets should be readily available to the first aid attendant.

Major accidents and fatalities In all cases where there are major accidents or fatalities involving company personnel or property, it is imperative that management be immediately informed, in order to permit full investigation and reporting of the circumstances.

Employees involved in a serious accident or fatality will not discuss with or make any statement to anyone either at the scene or later, other than the police, company management, WorkSafeBC officials or the coroner.

Record-keeping requirements Definitions

First aid (WCB classification – RPO – Reported Only) – In the event a worker suffers, or claims to have suffered, a work related personal injury, illness, or industrial disease and is able to return to regular duties after treatment by the First Aid Attendant (if applicable).

Medical aid (WCB classification – HCO – Health Care Only) – In the event a worker suffers, or claims to have suffered, a work related personal injury, illness, or industrial disease and must seek additional medical services as rendered by a registered physician.

Lost time (WCB classification – STD – Short Term Disability) – In the event a worker suffers, or claims to have suffered, a work related personal injury, illness, or industrial disease and is unable to return for the next scheduled shift.

Company Name __________________________________


First Aid Book requirements

• Full name of employee

• Date and time of injury or illness

• Date and time reported to employer

• Names of any witnesses

• Description of how injury or illness occurred

• Description of nature of injury

• Description of first aid treatment received

• Description of any subsequent treatment

• Signature of first aid attendant

Duties – Employee

In a first aid case:

• Immediately report the incident to the first aid attendant or supervisor.

• Complete a Form 6A (Employee’s Report of Injury or Occupational Disease).

• Sign and date the bottom of Form 6A.

• Forward Form 6A to supervisor.

• Record all details in the First Aid Book.

In a medical aid case, all of above, plus:

• Immediately seek attention and assistance of the first aid attendant.

• Seek prompt medical attention upon the advice of the first aid attendant.

• As soon as possible after treatment (no later than the start of the next shift), advise supervisor of the nature of treatment and the name and telephone number of the physician and Teleclaim (Employee’s Application for Compensation).

In a lost time case, all of the above, plus:

• Advise supervisor of estimate of the expected time loss.

Duties – First Aid Attendant

In a first aid case:

• Provide immediate, appropriate treatment.

• Record all the first aid treatment administered in the First Aid Book and sign the book in the correct location.

In a medical aid or lost time case, all of the above, plus:

• Refer employee to immediate and appropriate medical attention.

Company Name __________________________________


Duties – Supervisors

In a first aid or medical aid case:

• Ensure an adequate supply of all types of forms are available at all locations (forms are available from the nearest WCB office or on-line at http://www.worksafebc.ca).

• For MA’s, complete a Form 7 (Employer’s Report of Injury or Occupational Disease).

• Ensure that the employer’s signature, title and date are complete. Submit the form to the WorkSafeBC within 72 hours.

• Review all WorkSafeBC forms (6, 7) to ensure proper completion.

• Ensure that all details of the incident have been recorded in the First Aid Book and initial the book in the proper location.

• Continue to monitor the employee’s condition.

In a lost time case, all of the above, plus:

• Stay in continuous contact with injured worker from the onset to provide company support and to assist in the immediate adaptation of the Injury Management and Return to Work Program.

• Seek sources of alternate stay at work duties for the employee (light duty) if possible.

• Assist in facilitating a graduated return to work schedule. This may require communication with the employee’s physician and possibly the WorkSafeBC physician.

• Upon return to work, complete a Form 9 (Employer’s Statement of Return to Work). Continue to monitor the employee’s condition.

Duties - Supervision

Review all copies of Form 7’s received and acquire any additional information from the supervisor, employee, or first aid attendant as required.

• Liaise with the WorkSafeBC and provide subsequent information as required.

• Assist the company or employees with problems or appeals regarding their claim.

• Assist with investigations and recommendations if required.

• Compile and report accident/injury information to clients as required.

• Compile and report accident/injury information to BCFSC if required.

Important Note:

WorkSafeBC requires all employers to provide them with a copy of the completed Form 7 within 72 hours of the occurrence of the illness or injury.

Failure to report information in a timely manner is a violation of the Workers Compensation Act, and may result in a claim being delayed, or disallowed, or leave the company open for sanctions and fines at the discretion of WorkSafeBC.

http://www.wcb.bc.ca/

Company Name __________________________________


Stay at Work or Return to Work Program Purpose The organization recognizes that our most valuable asset is our employees. It is their work ethic, commitment to service excellence and strong sense of loyalty that allows our organization to excel in a competitive market place.

We realize that work is, in many instances, not only an economic necessity but also a major element in defining personal self-worth. Self-esteem, as well as the satisfaction of basic needs, is met through the process of work. Often a work-related injury will result in feelings of depression, lowered self-esteem, isolation from co-workers and a sense of being a burden on families or society.

It is for these reasons that the organization is concerned about the impact of workplace injuries on our employees. It is our goal to play an active role in minimizing the impact and disruption to the lives of our injured employees and to assist them back to work in as timely a fashion as possible.

Policy The organization is committed to developing and maintaining a safe and healthy work environment. Our goal is to keep workers in the workplace or to assist in returning injured employees to the workplace, allowing them to maximize their full potential. As a by-product of the goal, the high cost of claims from injuries will be reduced.

In keeping with this goal, it is our policy to implement a formal Stay at Work or Return to Work (SW/RTW) Program. We will facilitate the rehabilitation process by making every reasonable effort to provide the following:

• suitable stay at work and/or light modified employment to all employees unable to perform their duties because of a work-related injury

• timely medical intervention resulting in better care and faster recovery, with fewer recurrences of injuries

• daily communication with the injured employee and regular communication with medical service providers and WorkSafeBC personnel.

It is through our commitment to provide, support and facilitate compassionate rehabilitation of our injured workers through our Modified Work Program.

Objectives The objectives of the SW/RTW Program are:

• to provide temporary stay at work employment to the injured employee through a progressive reintegration into the workplace until the regular position is resumed. If

Company Name __________________________________


permanent light modified work is required, the organization will do everything possible to accommodate the employee

• to provide productive, valuable work for injured employees

• to give injured employees an opportunity to develop skills within the organization

• to reduce absenteeism

• to help maintain the injured employee’s identity and self-respect

• to control accident costs and claims.

Benefits By implementing a formal SW/RTW Program the organization provides the following benefits to its employees:

• improved rehabilitation through timely medical intervention

• reduced feelings of alienation or isolation from the work environment

• reduced risk of re-injury on return to work

• minimized loss of employment fitness

• minimized risk of employment loss

• gradual re-adaptation to the physical demands of the workplace

• maintained dignity and self-respect by having the employee remain productive.

Responsibilities In the effective implementation of this policy, it is necessary that responsibilities be understood and properly executed, namely:

Employee’s responsibilities • Report all incidents and accidents immediately, both major and minor, to the

supervisor.

• Assist the supervisor in completing accident reports.

• Accept transportation to a medical facility as provided by the organization.

• Obtain medical attention as soon as possible after the injury occurs.

• Report to the supervisor with all necessary documentation after consulting with the treating physician.

• Participate in the SW/RTW Program. • Communicate any concerns to the supervisor so those potential problems can be

resolved.

• Report to the supervisor on a daily basis if absent for a prolonged period and attend meetings, as required, to assess progress.

Co-worker’s responsibilities • Provide moral support for the injured employee during SW/RTW Program. • Assist with tasks that may be beyond injured employee’s physical restrictions.

• Communicate any difficulties that the injured employee may be having with modified work.

Company Name __________________________________


• Where necessary, complete witness form.

• Cooperate with the principles of the SW/RTW Program.

Supervisor’s responsibilities • Evaluate the situation immediately.

• Provide first aid when required.

• Provide transportation for the employee when required.

• Provide all applicable documentation to the employee for his or her physician.

• Inform the program coordinator that the worker was injured.

• Help the injured worker feel comfortable in the modified work position.

• Uphold the philosophy and policy of the SW/RTW Program to help the injured worker feel like an integral part of the work team.

• Report on a regular basis to the program coordinator on the progress of the worker while on the SW/RTW Program.

o Complete all necessary documents relating to the incident and forward to the appropriate personnel immediately.

o Assist with appeals of questionable WorkSafeBC claims.

• Maintain regular contact with the employee during his or her absence from work.

• Develop action plans for the employee’s return to work.

• Ensure that meetings are held regularly with the injured employee and the required personnel during the work program to discuss progress.

• Work with supervisors and management in order to develop SW/RTW Program opportunities.

• Conduct an evaluation of the Stay at Work or modified Return to Work program on a quarterly basis, presenting the report and recommendations to management.

Injury Management Coordinator’s responsibilities • Maintain regular contact with the employee during his or her absence from work.

• Coordinate administration with WorkSafeBC.

• Develop action plans for the employee’s return to work.

• Ensure that meetings are held regularly with the injured employee and the required personnel during the work program to discuss progress.

• Work with supervisors and management in order to develop Modified Work Program opportunities.

• Conduct an evaluation of the Stay at Work or modified Return to Work program on a quarterly basis, presenting the report and recommendations to management.

Company Name __________________________________

Appendix 9.2 Injury Management Return to Work Program Template Version 1.0 Page 1

Stay at Work or Return to Work Program Template

Sample Return to Work Forms

Appendix Title

A1 Sample Injury Management Policy - Large Employer A2 Sample Injury Management Policy - Small Employer

B1 Sample Stay at Work or Return-to-Work Brochure

C1 Sample Stay at Work or Return-to-Work - Large Employer C2 Sample Stay at Work or Return-to-Work - Small Employer C3 Sample Stay at Work or Return-to-Work - Large Employer C4 Sample Stay at Work or Return-to-Work - Small Employer

D1 Sample Physical Demand Analysis D2 Sample Potential Light Duties

E1 Sample letter to Employee E2 Sample Letter to Physician E3 Sample Physician/Physical Demands Letter 2 E4 Sample Physician Letter 3 E5 Sample Physician Fit For Duty

F1 Sample Light or Modified Work Offer

G1 Sample Stay at Work or Return-to-Work Plan/Offer G2 H1 H2 H3

Sample Stay at Work or Return-to-Work Plan/Offer Sample Transitional Work Plan Sample Short Term Work Plan Sample Functional Abilities Assessment Form

Company Name __________________________________


A1 – Sample Injury Management Policy – Large Employer

Injury Management Policy

Between

Company name

And

Union/Labour representatives

Name of Company is committed to the well-being and rehabilitation of all employees unable to perform their normal duties as a result of being injured on or off the job or recuperating from an illness. Labour and management representatives in cooperation have developed a Injury Management Program, incorporating modified/alternate return to work duties, to meet this objective.

Stay at Work or Return to Work is individualized for each employee and is supported by medical documentation. This program provides for a timely job modification/placement to a temporary or permanent disabled employee who cannot perform regular duties as a consequence of an occupational or non-occupational injury/illness. The alternative job will be productive and valued work that can be performed safely and without risk of re-injury or aggravation to the disability, or risk to other employees.

It is (name of company)’s intent that this program will be compatible with current statutory laws and collective agreements with any exceptions being mutually agreed to by both labour and management representatives.

All employees who become injured/disabled, regardless of cause, will be eligible and encouraged to participate in the program.

The intent of this Injury Management Program is to provide us with a guideline. It should be recognized that this program does not cover all circumstances.

It is also our intent to maintain and expand the cooperative efforts of management, labour and the occupational health and safety committee towards the awareness of accident and injury prevention.

Date:

Signatures: Management Representative Union/Labour Representative

Company Name __________________________________


A2 – Sample Injury Management Policy – Small Employer

Injury Management Policy

Company name

Name of Company is committed to the well-being and rehabilitation of all employees unable to perform their normal duties as a result of being injured on or off the job or recuperating from an illness.

Stay at Work or Return to Work is individualized for each employee and is supported by medical documentation. This program provides for a timely job modification/placement to a temporarily or permanently disabled employee who cannot perform regular duties as a consequence of an occupational or non-occupational injury/illness.

The alternative job will be productive and valued work which can be performed safely and without risk of re-injury or aggravation to the disability, or risk to other employees.

It is Name of Company’s intent that this program will be compatible with current statutory laws.

All employees who become injured/disabled, regardless of cause, will be eligible and encouraged to participate in the program.

It is also our intent to maintain and expand our cooperative toward the awareness of accident and injury prevention.

Date:

Signatures:

Owner Worker Safety Representative

Company Name __________________________________


B1 - Sample Stay at Work or Return-To-Work Brochure

An Exciting New Program!

What’s Involved? Benefits? Special Terms

The company is starting a new rehabilitation initiative for employees recovering from illnesses and injuries. A component of the company General Safety Program, the Stay at Work or Return to Work Program helps convalescing employees ease back into the workplace by adapting schedules and duties to their level of ability.

The Stay at Work or Return to Work Program is designed to help convalescing employees regain both their health and their place in society – this is achieved by restoring their social, vocational and economic capacities through and early and safe return to work. The premise of the program is that employees are our most vital and valuable resource.

Our Approach

The Disability Management Committee developed a Stay at Work or Return to Work Program policy framework for the organization to use. The Stay at Work or Return to Work Program will work very closely with various rehabilitation programs. The program will involve new responsibilities, tasks and work for managers, union reps, supervisors and of course, the injured or ill employee themselves.

Getting back to work after a serious illness or injury is an important stage of rehabilitation. In our culture, work is a big part of life and a major source of self-esteem. To be able to Stay at work or a prompt return to work helps prevent the loss of friends, professional contacts and occupational skills that re essential to our well being, not only on the job, but in every aspect of our lives.

One of the main goals of the Stay at Work or Return to Work Program is to help sick and injured employees maintain their identity as valued members of the company and keep them from thinking of themselves as patients. Recovery not only seems to go faster, it is faster – and more effective – when sick and injured employees keep in touch with their job and their colleagues while under medical care, and plan to go back to work as quickly as possible.

Return to Work:

The reintegration of convalescent employees to the jobs they did before their illness or injury.

Convalescent employees can return to work very quickly if they can be assigned duties that are modified to accommodate their level of ability. The return to work is easier and more successful if it begins as soon as possible in a sick or injured employee’s convalescence, with activities that fit within their restrictions while still challenging them.

Stay at Work or Modified Duties:

Changes in a job’s tasks, work schedules, or both. Modifications are typically made to work areas, equipment, production quotas, schedules and organization of tasks. Convalescing employees using the Stay at Work Program will preferably be assigned modified duties in their own section.

to RTW Program

Company Name __________________________________


C1 – Sample Stay at Work or Return to Work Policy – Large Employer

In fulfilling this workplace’s commitment to providing a safe and healthy working environment, a Return to Work program has been established for workers who sustain workplace injuries.

Name of Company/Organization undertakes to accommodate injured workers through early assistance, rehabilitation and placement, where possible, to the benefit of the entire workplace. This program provides gradual and consistent rehabilitation to all injured workers.

Name of Company/Organization will work toward facilitating injured workers to an appropriate and timely Stay at Work or Return to Work in pre-injury positions. If this is not possible, the original department will make every effort to place workers in suitable, alternative positions. In the event that alternative positions are not available within the original department, every reasonable attempt will be made to find appropriate positions in other departments. All attempts to place the worker in other area must be done, in an appropriate manner, in cooperation with manager, health care providers, Workers’ Compensation Board representatives, union representatives and the worker.

Any personal information received from or about the worker will be held in the strictest confidence. Information of a personal nature will be released only if required by law or with the approval of the worker, who will specify the nature of any information that may be released and to whom it can be released.

Signed: Date:

Signed: Date:

Company Name __________________________________


C2 – Sample Stay at Work or Return to Work Policy – Small Employer

In fulfilling our commitment to providing a safe and healthy workplace, Stay at Work or Return to Work programs have been established for all workers who sustain a workplace injury.

Name of Company will undertake to accommodate injured workers through early assistance and appropriate accommodation. This will include gradual and consistent modification for all workers required.

Name of Company will assist workers in a timely and appropriate return to their pre-injury jobs. If this is not possible, temporary alternate or modified duties will be arranged whenever possible.

All personal information about the injured worker will be held in the strictest confidence and only returned with the permission of the worker or by statutory requirement.

Signed: Date:

Company Name __________________________________


C3 – Sample Stay at Work or Return to Work Policy – Large Employer

Statement of Commitment

Between

Company name

And

Union/Labour representatives

Name of Company and its Employees/Union(s) Name are committed to the prevention of workplace injury and/or illness. In the event of injury or illness, Company name and its employees/union(s) name is committed to minimizing the impact of the injury and ensuring a safe, timely return to the workplace.

Name of Company and its Employees/Union(s) Name are committed to a workplace program that is designed to assist employees to Stay at Work or Return to Work safely and in a timely manner, to assist with treatment and recovery and reduce time away from the workplace.

The program is:

• voluntary • respectful of all employees • flexible • specifically designed for each employee’s abilities • within the scope of the collective agreement(s) • individualized, with programs planned and documented with time lines • communicated and promoted though the company.

Safe and timely Return to Work recognizes that while an employee cannot perform the full range of regular duties, meaningful, productive work can be performed.

We are committed to the principles of the program, and will work cooperatively towards the successful, safe return to work for all employees of the company.

Signed at This Day of 20

CEO Chief Steward On behalf of the employer On behalf of employees

Company Name __________________________________


C4 – Sample Stay at Work or Return to Work Policy – Small Employer

Statement of Commitment

Return To work Name of Company is committed to the prevention of workplace injury and/or illness. In the event of injury or illness, Name of Company is committed to minimizing the impact of the injury and ensuring a safe, timely return to the workplace. Name of Company is committed to a workplace program that is designed to assist employees to Stay at Work or Return to Work safely and in a timely manner, to assist with treatment and recovery and reduce time away from the workplace.

The program is:

• voluntary • respectful of all employees • flexible • specifically designed for each employee’s abilities • individualized, with programs planned and documented with time lines.

Safe and timely Return to Work recognizes that while an employee cannot perform the full range of regular duties, meaningful, productive work can be performed.

We are committed to the principles of the program, and will work cooperatively towards the successful, safe Return to Work for all employees of the company.

Signed at This Day of , 20

Owner

Company Name __________________________________


D1 – Sample Physical Demand Analysis A Physical Demand Analysis describes the physical requirements of the job or position. It focuses on the strength, flexibility, sensory and environmental requirements or conditions of specific tasks. It should be completed for the employee’s present position and modified duty positions available so that it may be used by the health care provider to determine if an employee is physically able to return to work on regular duties or modified duties.

Job or Position: Date form completed:

Regular hours of work/day: Completed by:

During a regular work day, the employee must circle number of hours and indicate if intermittent [I] or constant [C] for each activity. Lifting Requirements Never Occasionally Frequently Continuous Sit 0 1 2 3 4 5 6 7 8 hours I / C Up to 10lbs Stand 0 1 2 3 4 5 6 7 8 hours I / C 11 to 24lbs Walk 0 1 2 3 4 5 6 7 8 hours I / C 25 to 34lbs Drive 0 1 2 3 4 5 6 7 8 hours I / C 35 to 50lbs Bend 0 1 2 3 4 5 6 7 8 hours I / C 51 to 74lbs 0 1 2 3 4 5 6 7 8 hours I / C 75 to 100lbs Above 100lbs Job Requirements

Squatting Carrying Requirements Kneeling Never Occasionally Frequently Continuous Bending Up to 10lbs Twisting 11 to 24lbs Reaching 25 to 34lbs Crawling 35 to 50lbs Ladder Work 51 to 74lbs Stair Climbing 75 to 100lbs Walking on rough ground Above 100lbs Working at heights Exposure to heat or cold (circle) Exposure to dust, fumes or gases Pushing Requirements Exposure to high humidity Never Occasionally Frequently Continuous Exposure to noise Up to 10lbs Repetitive movements 11 to 24lbs Work above shoulder 25 to 34lbs Work below shoulder 35 to 50lbs 51 to 74lbs 75 to 100lbs

Above 100lbs

Company Name __________________________________


D2 – Sample Potential Light Duties

Food and Beverage

Polish Cutlery and Glassware Pre-set Room Service tables & trays

Confirm reservations

Fold Napkins Service audits, silent guest audits Market analysis, e.g. get menus from other restaurants

Answer telephones / fold menus / change menu covers

Health and Safety checklists Update log books

Light cleaning such as dusting and cleaning equipment

Sort guest comments Reservation statistics

Housekeeping

Quality Checks Clock times Fold laundry bags

Collect dirty robes and tie robes

Fold guest comment cards Safety inspections

Clean outside of guest doors Dust hallways Polish brass door handles

Overnight assistance – light cleaning

Deficiency lists Stock employee change rooms

Human Resources

Surveys Photocopy and build Orientation Binders

Build Hiring Packages

Labels for birthday cards Update Material Safety Data Sheets Binder

Assist with Communication boards (recruitment and benefits)

Golf Course

Mail outs for specific events Gift certificate tracking and filing

Make up bag tags for groups

Stuff brochures Inventory of scorecards and pocket pros

Marshalling – requires additional training

Front Office

Re-program telephones

Assist Royal Service agents, if there is front-of-the-house experience

File keys

General filing for Front Office & Reservations

Combine guest history accounts

Put stickers on tour key envelopes

Company Name __________________________________


E1 – Sample Letter to Employee

Date

Dear Employee's Name,

We are concerned to hear of your recent injury. We wish to assist you in your recovery and have you return to your regular duties when appropriate.

We have provided you with the following information package that includes,

1. Letter to Physician: This form explains the light duty program to the physician and authorizes the physician to disclose information pertaining to this injury.

2. Physician; Fit for Duty: Details what the employee is physically fit to do during recovery.

3. Other:

Kindly forward this package to your physician and ask him/her to return the completed forms to ______________________________ as requested in the attached documentation. Please be assured that all information provided will be kept confidential. If your physician has any questions regarding our program or related matters, we have provided the following contact numbers. Calls should be directed to __________________________________________ at phone number (_____) __________.

After you have seen your physician, please contact your supervisor, __________________________, at phone number (_____) __________ to let us know your condition. If you are capable of performing light or modified duty, you will be expected to report to work.

If you have any questions or concerns, do not hesitate to call. With your participation and cooperation we may work together toward your return to your regular duties.

Sincerely,

_______________________________ Supervisor

_______________________________ Phone Number

Company Name __________________________________


E2 – Sample Letter to Physician To the Attending Physician,

Modified work programs assist in the rehabilitation of injured workers. Stay at Work and Return to Work programs for employees with work-related injuries enable companies to reduce the cost of injury and illness. The employee suffers no loss in remuneration and is assigned productive work, which takes into consideration any physical restrictions, identified by you, the medical practitioner. The modified work may consist of modifying the employee’s existing job by removing those tasks the employee is currently unable to do or providing transitional/part-time work until the employee is able to return to full time duty; by providing an alternate productive job; by providing a training opportunity; or by a combination of the above. It is a mutually beneficial situation for both the company and the employee. Thank you for your valuable time and cooperation. If there are any questions in regard to this program, please contact ___________________________ at (_____) ________________.

In order that we, the employer, may help in rehabilitation following this injury, we would like you to be aware that we may be able to offer the employee, _______________________, Stay at Work light duties subject to your instructions. This is done to enable the injured employee to remain on the job. This does not in any way negatively affect the employee’s WCB claim.

As appropriate, the injured employee or the Physician must return the accompanying form to _______________________________________.

Please Fax to: (_____) ________________

Mailing Address:

Company Name __________________________________


E3 – Sample Physician/Physical Demands Letter 2

I authorize Dr. _____________________ to release medical information to my employer, but only that which is related to the “Nature of Injury” as agreed to by me. Nature of Injury:

Employee Name: Employee Number:

Employee Signature: Date:

Physicians, please complete the following:

Is the employee able to return to work on modified work/modified duty assignment:

Yes No

Please circle restrictions:

Standing Lifting/Carrying Climbing Repetitive Motion

Walk/flat Lifting < 25lbs Driving Keyboarding

Walk/uneven Lifting <50lbs Heights Dust/wet

Specific restrictions/comments:

Duration of restrictions: 1 2 3 4 Shifts 1 2 3 4 5+ Weeks

Return to work effective date:

Physician’s name (print) Address

Signature of attending Physician Phone

Company Name __________________________________


E4 – Sample Physician Letter 3

Dear Doctor:

We at Company Name/Organization, in conjunction with the Workers' Compensation Board, are committed to a Modified Work Program for employees who are recovering from illness/injury. Our aim is to provide Stay at Work duties to help rehabilitate the employee to his/her pre-injury occupation in the shortest possible time.

The following are an example of the light duty jobs that we have available:

Job Description Physical Requirements

Stock Count Walking and writing

Office Assistant Sitting and writing

Order Dispatch and Retrieval Walking

Remote Control Crane Operation Walking and operation of lever controls

Cab Crane Operation Operation of lever controls

General Plant Clean-up Operation of sweeping machine, light lifting, light sweeping

In order to accomplish this program effectively, we would ask you to complete the attached Work Capacity Form so that we can give the employee modified work within these restrictions. We require reassessment every two weeks.

Please invoice Company Name/Organization for costs related to completing this form. We will pay as per the BCMA fee code.

Please note that WCB Physician’s First Report and Physician’s Progress Report forms also inquire if the patient is capable of modified duties.

Thank you in advance for your cooperation in assisting us to rehabilitate our employees.

Yours truly,

Company Name/Organization Company Name/Organization

Name, General Manager Name, Supervisor

Company Name __________________________________


E5 Sample Physician Fit for Duty

Employee Name

Sickness Non-Occupational Injury

Work Related Injury Pre-existing Condition

Date of Visit / / Next Visit / /

Nature of injury:

If modified duty is required, please complete the following:

Lifting from waist (weight/frequency) Sitting (duration/frequency)

Lifting from shoulder (weight/frequency) Walking (distance/frequency)

Prolonged standing (duration/frequency) Climbing stairs (distance/frequency)

Work in damp areas (duration/frequency) Ladders (number/frequency)

Work in cold areas (duration/frequency) Work at heights

Work in hot areas (duration/frequency) Bending

Work outdoors (duration/frequency) Operate/repair equipment

Repetition hand/arm (duration/frequency) Typing (typing)

Other/comment:

Employee may commence Stay at Work duties on / / (date)

Employee may return to modified duties on / / (date)

Employee may resume regular duties on / / (date)

Temporary restricted hours or gradually increasing hours is available. Please indicate any restrictions of this type: _________________________________________________.

Name of Medical Authority Telephone

Signature Date

Company Name __________________________________


F1 – Sample Modified Work Offer

Employee Name __________________________ Date _________________________

In keeping with our commitment to provide suitable employment for workers injured in the course of their employment, we are offering you the following work:

Job task(s) or Position:

Specific duties (details):

Physical requirements:

Hours of work per day: ________________ Number of days per week: ______________

Start date: __________________________ Finish date: __________________________

Supervisor’s name: ________________________________

Project: __________________________________________________________________

Your progress will be monitored and the length of this placement will be modified if required based on consultation with your physician, supervisor and the _______________________. If you have any concerns, questions or difficulties with the work you have been assigned, please discuss it with your supervisor immediately. Remember that you are only to do the tasks that are allowed within the limits of your physical ability. You are also asked to meet with your supervisor once per week to review your progress.

Offer accepted: ____________________________________ Date: __________________

Offer rejected: _____________________________________ Date: __________________

If rejected, provide reason:

Company Name __________________________________


G1 – Sample Stay at Work or Return to Work Plan/Offer Employee: Job Title: Supervisor: Claim #:

Home Phone Number: RTW Start Date: Anticipated Length of RTW Program: Doctor:

Phone:

WEEK 1 WEEK 2 WEEK 3 WEEK 4 Hours:

hours/day

days/week

Hours:

hours/day

days/week

Hours:

hours/day

days/week

Hours:

hours/day

days/week

Start time: Start time: Start time: Start time:

Goals: (duties, amount, weight, frequency, duration, etc.)




Comments:

Date: Employee Signature:

Date: Management Signature:

Company Name __________________________________


G2 – Sample Stay at Work or Return to Work Plan/Offer Employee Name: Department:

Supervisor: Regular Job Title:

Physical Capacities/Limitations (per physician)

Date Limitations Began: Next Review Date:

Plan Specifications

Start Date: End Date:

Describe job and/or specific tasks:

Describe hours/day and days/week, including progression schedule:

Special considerations:

This Stay at Work or Return to Work Plan has been reviewed and discussed with me to clarify any questions I may have. I have been provided with a copy of this plan. Any difficulties experienced while performing transitional work will be reported to the Return to Work team.

Employee Signature Date

Supervisor Signature Date

I have reviewed and discussed this Stay at Work or Return to Work Plan with the employee. In addition, I have provided a copy of the plan to the employee.

Return to Work Team Member Date

Return to Work Team Member Date

Company Name __________________________________


H1 Sample Transitional Work Plan

Employee’s Surname

First Name

Occupational

Non Occupational

Date of Injury/Illness (mm/dd/yyyy)

Unit

Employee’s Job Title

RTW Coordinator

Phone

( ) -

Today’s Date

Supervisor:

Department:

Describe Job and/or Specific Tasks:

Describe Hours per Day and Days per Week, Including Progression Schedule:

Anticipated Duration:

Special Consideration (i.e. special equipment, etc.):

Date: / / (mm/dd/yyyy) Supervisor Signature

Date: / / (mm/dd/yyyy) Employee’s Signature

Date: / / (mm/dd/yyyy) Physician’s Signature

Company Name __________________________________


H2 – Sample Short Term Work Form

Doctor-approved Short-term Alternate Duty Program

Employee Name: Date:

Company name is a company dedicated to minimizing the human and financial cost of injury and disability by developing an individualized, safe and timely process for an employee’s return to work.

We offer upon medical opinion suitable alternate work for work- and non-work-related incidents.

Please have your doctor fill out the attached forms and return them immediately to your supervisor or bring them into the office. Please discuss the alternate job list with your doctor and identify any areas that require further modification.

The following individuals are available to answer any questions you may have concerning this process:

Management representatives are:

Manager Phone

Supervisor Phone

Company Name __________________________________


Note to Physician

Physician:

To assist us in facilitating a safe and timely return to work for our employee, your assistance in completing the attached form would be greatly appreciated. Please return the completed form to:

Contact:

Company:

Address:

Phone:

Cellular:

Company Name __________________________________


Physician’s Assessment of Employee’s Return to Work

Worker’s Name: Date of Injury/Illness:

It is recommended for the employee to access additional treatment

Physiotherapy

Chiropractic

Massage Therapy

Athletic Therapy

Other

The employee can return to work with consideration that symptoms may limit certain work tasks.

The employee can return to work with the following restrictions:

Walking

Restricted to less than 1 hour

Restricted, other – please specify:

As Tolerated

Standing



As Tolerated

Sitting



As Tolerated

Bending and Twisting

No bending or twisting


As Tolerated

Lifting floor to waist

No lifting

No lifting over 20 lbs.



As Tolerated

Lifting waist to head

No lifting




As Tolerated

Carrying

No carrying

No carrying over 20 lbs.

No carrying over 40 lbs.

As Tolerated

Company Name __________________________________


Gripping / Pulling

No gripping/pulling

No gripping/pulling > 2 hrs/day

No gripping/pulling > 4 hrs/day

As Tolerated

Climbing Stairs / Equipment

Restricted, please specify:

As Tolerated

Equipment Operation

Prescription medication prohibits driving

No night time driving / equipment operation

Other Comments / Recommendations (Please specify, i.e. medication side effects.)

The following is a list of jobs that may be included in a person’s Return to Work program, understanding that these can be altered further based on medical opinion on the needs of the injured worker to accomplish a successful Return to Work accommodation:

•

•

•

•

•

•

•

• The employee may be an extra person while on the program. Depending on the employee’s qualifications, other tasks may be incorporated into the program. The program could consist of short periods of time on a variety of tasks that will aim at getting the employee back to their regular job.

Company Name __________________________________


H3 – Sample Functional Abilities Assessment Form A Worker’s Information (completed by RTW Coordinator or employee)

Employee’s Surname

First Name

� Occupational � Non-Occupational

Date of Injury / Illness

Unit

Employee’s Job Title

RTW Coordinator Name: Tel. No. ( ) - Fax. No. ( ) -

Today's Date

It is the intention to assist our employees to safely return to their regular duties as soon as medically practical. In doing so, we are able to offer the employee modified duties as a means to transition to their regular duties. The following will assist in this process. B Assessment (Part B, C and D to be completed by attending physician)

Due to injury or illness this employee has: � Normal functional Abilities (Fit for Regular Duties) � Reduced Functional Abilities (No additional information needed. Please sign section E) (Please complete Section C , D & sign section E)

C Functional Abilities: (If unable to test, please estimate)

Step 1 Please circle the appropriate letter(s) & Body area(s) to indicate the affected area(s)

Step 2 Please indicate Reduced abilities

Step 3 Please indicate extent of abilities

Comments

A Systemic or Non-Physical B Head (incl. Vision, hearing, speech) C Neck D Upper back, chest, upper abdomen E Lower Back F Lower abdomen G Shoulder or upper arm H Elbow or lower arm I Wrist or hand J Hip or upper leg K Knee or lower leg L Ankle or foot M Respiratory/Aerobic

Walk Maximum Duration (hours): 1 2 4 5+ Other � Short distances only � No walking

Stand Maximum Duration (hours): 1 2 4 5+ Other

Sit Maximum Duration (hours): 1 2 4 5+ Other

Lift/Carry Floor – waist Waist – shoulder Above shoulder

Occasionally Weight (kg) 21 16 9

< 9kg - Specify

21 16 9 21 16 9

Bend/Twist Neck Back

Occasionally Not at all Specify

Push/pull Moderate load Light load


Climb Flight of stairs Few steps


Reach Above shoulder Below shoulder


Use Hands For: Writing Typing Fine manipulation Grasping

Occasionally L R L R L R L R

Not at all L R L R L R L R

Specify

Sensory Specify:

To See

To Hear To Speak To Maintain Balance

Operate Equipment Specify:

Hours of Work Specify: Normal hours or graduated RTW?

Prescription medication Will it affect ability to work/drive: Other Comments/Instructions (NO DIAGNOSIS OR TREATMENT):

D Normal functional abilities may resume in: 1-3 days 4-7 days 8-14 days Specify: *Other: Employee is not medically fit for regular duties, will require periodic reassessments for effective rehabilitation.

Scheduled reassessment date for:

This authorizes my attending physician to provide the information requested above to COMPANY NAME

Employee's Signature:

Date:

E Physician's name & address:

Physician's Signature:

Physician's Telephone No:

Date:

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http://www.go2hr.ca/

COR Toolkit - Welcome to go2HR: BC’s Tourism and ... · Auditors are experienced in the industry...

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