3.1 Have controls (Engineering, Administrative and Personal Protective Equipment) been identified for health and safety hazards? Attach documentation that shows the recommended hazard control methods for each identified health and safety hazards from 2.1. Hazard controls are indicated for all identified hazards. /1 Notes: Additional Requirements: Copy of the formal hazard assessment (or other similar document) listing recommended hazard controls for each identified health and safety hazard attached – Appendix 3 3.2 Are Health and Safety Hazards controlled using the following methods and are employees using the identified controls? Engineering For each type of control, (engineering, administrative, PPE) give examples of controls that have been implemented and are used by employees at the work site(s). Examples of engineering controls in use provided. /2 Notes: Administration Examples of administrative controls in use provided. /2 Personal Protective Equipment (PPE) Examples of PPE controls in use provided. /2 3.3 Does the owner ensure health and safety policies and control methods are followed? Describe how this is done. describe how the owner ensures health and safety policies and control methods are followed on site. /1 Notes: 3.4 Is a scheduled Preventative Maintenance program for equipment, machinery and vehicles in place? Attach a copy of the preventative maintenance log(s) or records from the past 12 months. Note: select a representative sample from the equipment, machinery and vehicles in use. Notes provide sufficient evidence that a PM program is in place. A sample of preventative maintenance records is attached. Sample should demonstrate that required PM is being completed for the size and type of business. /2 Notes: Additional Requirements: Copy of the maintenance log / records from the past 12 months attached – Appendix 3 3.5 Where personal protective equipment is required, are workers trained in use, care and maintenance of the protective equipment?
Describe types ongoing training, refresher and recertification in job specific skills, such as skills upgrading, WHMIS, first aid, defensive driving, TDG, etc. provided. Attach training records from the past 12 months. This question may not be applicable (n/a) for new operations. Notes identify which types of refresher training are provided. Copies of on-going training records are attached. Notes: Additional Requirements: Copy of on-going training records attached – Appendix 4 AUDIT SCORE – Element 4 Element Score Possible: 10 Points not applicable (N/A): Total points possible: Points scored on this element: Percentage: %
Describe how action is taken as a result of incident investigations and give examples where possible. Completed investigations should show corrective action taken. If no incidents have occurred in previous 12 months, attach documentation that verifies corrective action is required according to company policy. The incident report from 7.4 a) indicates that corrective action was taken OR if no recent investigation available, policy requiring corrective action attached. /2 Notes: Additional Requirements: Documentation to verify Incident Investigations require Corrective Action attached – Appendix 7 AUDIT SCORE – Element 7 Element Score Possible: 9 Points not applicable (N/A): points possible: Points scored on this element: Percentage: %
8.1 Is there a system in place to ensure: a) health and safety issues, including improvements, are communicated to employees? Describe how employees are advised of health and safety issues and improvements. Attach sample documentation from the previous 12 months (e.g. records of safety meetings/toolbox meetings, bulletins, etc.) to demonstrate this is happening. This question is not applicable (n/a) for owner/operators. Notes provide sufficient evidence that communication is happening. Copies of appropriate documents (meeting minutes, bulletins, etc.) attached. /1 Notes: Additional Requirements: Documentation ( ) attached – Appendix 8 b) feedback on health and safety issues is sought from employees? Describe the system used for employees to offer feedback on health and safety issues, AND how employees are made aware of the system. This question is not applicable (n/a) for Notes outline how employees can offer feedback and provide sufficient evidence that 2 way communication is happening. /1 follow-up of significant identified during health and safety meetings? Describe the process used to ensure follow‐up is done, and explain how employees are made of any follow‐up completed. This question is not applicable (n/a) for owner/operators. provide sufficient evidence that follow-up on identified items is done and communicated to employees. /1 Notes: 8.2 Are safety and loss control statistics maintained and analyzed to identify trends and Attach samples of statistics maintained (e.g. first aids, medical aids, claim rates, number of inspections / orientations / safety meetings, etc.). Describe any trends that were identified. Notes provide sufficient evidence that records are maintained, injury frequency monitored, and trends & needs reviewed, if applicable. Copies of records attached. /1 Notes: Additional Requirements: Copies of safety and loss control records attached – Appendix 8 8.3 Have health and safety processes been evaluated through the use of an audit process within the last 12 months?
Provide the date of the last audit/assessment. If this is the employer's first health and safety audit/assessment, this question is not applicable (n/a). Notes correctly identify the date of the last audit/assessment. Notes: 8.4 Was an action plan developed and have previous action items been implemented, or initiated? Attach the action plan from the previous year. The plan should include: Target and actual completion dates Person responsible Note: The action plan must include any additional deficiencies identified as a result of the quality assurance review. If this is the employer's first health and safety audit/assessment, this question is not applicable (n/a). A completed Action Plan from the previous year is attached, and includes a description of the changes that were enacted and actual completion dates. Any additional action items identified by the reviewer in the previous year must be included. /1 Notes: Additional Requirements: Copies of completed action plan from previous year attached – Appendix 8 AUDIT SCORE – Element 8 Element Possible: 6 Points not applicable (N/A): Total points possible: Points scored on this element: Percentage: %