ALBERTA GOVERNMENT. View Only OCCUPATIONAL HEALTH AND SAFETY AUDIT DOCUMENT. Ministry Name. Audit Name. Audit Dates

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ALBERTA GOVERNMENT OCCUPATIONAL HEALTH AND SAFETY AUDIT DOCUMENT Ministry Name Audit Name Audit Dates In certification years certificate is mailed to Approved December 3, 2013

PURPOSE OF AUDIT: GOVERNMENT OF ALBERTA PARTNERSHIPS AUDIT COVER PAGE Auditor Qualification Baseline COR COR Maintenance A. EMPLOYER INFORMATION Department or Organization Name: Division or Worksite Name: (as entered on COR) Employer WCB Account Number: Employer WCB Industry Code: Employer Contact Name: Employer Contact Title: Employer Address: (including postal code) Certificate #: Expiry Date: Telephone #: Fax #: E-mail: Note: Audit Scope needs to be approved by the Public Service Commission before the Audit begins. Audit Cover Sheet Page 1 of 2

GOVERNMENT OF ALBERTA PARTNERSHIPS AUDIT COVER PAGE B. LEAD AUDITOR CONTACT INFORMATION Lead Auditor Name: Lead Auditor Department or Organization Name: Lead Auditor Address: Telephone #: Fax #: Lead Auditor Signature C. AUDIT TEAM MEMBERS INFORMATION (excluding Lead Auditor) Name Employee I.D. # Role Documentation Review, Observation Tour, Interviews, Report Writer Note: Audit Scope needs to be approved by the Public Service Commission before the Audit begins. Audit Cover Sheet Page 2 of 2

AUDIT SCOPE Audit Start Date: Audit End Date: Audit Report Completion Date: Is Work at Peak Activities? Yes No 1. 2. 3. 4. 5. 6. 7. 8. 9. ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here ACTIVITIES Type Activities Here List ALL Program Areas, Worksites, Bldg. Name, Address, Floor Number Covered in the Scope of the Audit (Work areas and activities performed in work area) Program Location (enter one location, e.g. Edmonton, etc.) Sites Visited (enter "x", if applicable) TOTALS Audit Scope Sheet Page 1 of 2

FULL-TIME - If you are identified in IMAGIS as a Permanent employee and work at least 36.25 hrs/week PART-TIME - If you are Temporary, Wage Reg, Wage 1450, Wage 2850 and/or work less than 36.25 hrs/week If you have no direct reports you are a WORKER regardless of your classification If work is regularly scheduled to occur at any time other than regular business hours (i.e. Monday to Friday 8:15-4:30) it must be properly identified as Shift Work 1. Number of Shift Number of Workers Number of Number of Number of Workers Full Time Part Time Managers Executive Managers Supervisors Interviewed Interviewed Interviewed Interviewed Interviewed Interviewed 2. 3. 4. 5. 6. 7. 8. 9. 0 0 0 0 0 0 0 0 0 0 0 0 Audit Scope Sheet Page 2 of 2

Documentation Review 1.0 OH&S MANAGEMENT GoA Occupational Health and Safety Policy (1.3) Contractor Selection Criteria (1.9) Samples of Contracts that Identify Health & Safety Responsibilities (1.9) Contract Compliance Reports, Related Inspection Reports, Incident Investigation Reports, Follow-up Correspondence (1.9) A1.0 HEALTH AND SAFETY COMMITTEES Department Occupational Health and Safety Committee Terms of Reference/Minutes (A1.1, A1.3, A1.7) Workplace Health and Safety Committee Terms of Reference/Minutes (A1.2, A1.4, A1.7) Workplace Health and Safety Contact Person Records (A1.2, A1.4, A1.7) 2.0 HAZARD MANAGEMENT Inventory of Jobs/Occupations (2.1) Inventory of Tasks/Activities (2.2) Completed Hazard Assessment Documents (2.3, 2.4, 2.14) Written Safe Work Practices/Job Procedures/Codes of Practice/MSDS (2.7) Lockout/tag out process and reporting forms/tags (2.17) 3.0 OH&S Training Employee Training Records (A1.6, 2.13, 3.2, 3.3, 4.6, 5.8, 6.7) 4.0 INSPECTION Written Policy/Procedure for Conducting Inspections Including Frequency (4.1) Completed Inspection Checklists and Related Correspondence (4.2, 4.3, 4.5) 5.0 EMERGENCY PREPAREDNESS Emergency Preparedness Plans (5.1, 5.2, 5.4) DOCUMENT LIST The documents listed below are required to verify information related to the specific audit questions in brackets. The completed checklist indicates the documents have been reviewed during the audit. Emergency Response Drill Reports/Follow Up Records (5.7) YES NO N/A Document List Page 1 of 2

YES NO N/A 6.0 INCIDENT MANAGEMENT Incident Reporting and Investigation Procedure (6.1) Completed Supervisor's Incident Investigation Reports (6.3, 6.4) Incident/Injury Statistical Reports (6.5) 7.0 PROGRAM EVALUATION Occupational Health and Safety Annual Plan (7.1, 7.3) Previous Audit Report for information (7.1) Observation Tour Other documents need to be assessed during the audit observation tour to verify the specific audit questions in brackets. Occupational Health and Safety Legislation, and other legislation as required (1.2) Meeting minutes for the Workplace Health and Safety Committee or Contact (A1.5) Administrative Controls such as Safe Work Practice or Procedures, Codes of Practice (2.8) Document List Page 2 of 2

EXECUTIVE SUMMARY INTRODUCTION Type Info Here. For a hard return remember to use ALT + ENTER. To expand your cell place your cursor below line number and double click left mouse button. SCOPE Type Info Here. For a hard return remember to use ALT + ENTER. To expand your cell place your cursor below line number and double click left mouse button. PROGRAM STRENGTHS Type Info Here. For a hard return remember to use ALT + ENTER. To expand your cell place your cursor below line number and double click left mouse button. IMPROVEMENT OPPORTUNITIES Type Info Here. For a hard return remember to use ALT + ENTER. To expand your cell place your cursor below line number and double click left mouse button. RECOMMENDATIONS Type Info Here. For a hard return remember to use ALT + ENTER. To expand your cell place your cursor below line number and double click left mouse button. CONCLUSIONS Type Info Here. For a hard return remember to use ALT + ENTER. To expand your cell place your cursor below line number and double click left mouse button. Executive Summary Page 1 of 1

1.0 Occupational Health and Safety Management 1.1 Employees are familiar with relevant occupational health and safety (OH&S) legislation. Verified by interviews with Executive Managers, Managers, Supervisors and Workers D/I/O Point Value Score I (all) 0-10 All employees should be able to explain OH&S legislated requirements outlined in the Act, Regulation and Code that apply to the work that they do. Other sources of legislation may also apply to them such as the Alberta Fire Code or Building Codes, Transportation of Dangerous Goods etc. They must be able to also explain how this legislation applies to their work. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 1.2 Health and safety legislation is available to employees at all workplaces. Verified by observation of the workplaces O 5 Current versions of Alberta s Occupational Health and Safety Act, Regulations and Code must be available to all employees. If the legislation is available electronically employees must be able to demonstrate how they access it. A reliable source of internet service must be present in order for the online access to be acceptable. All points are awarded if observations indicate current legislation is available at all workplaces. Provide examples. Element 1.0 OHS Management Page 1 of 6

1.3 Audit Questions / Instructions The health and safety policy for the Government of Alberta is available at all workplaces. D/I/O Point Value Score D 5 The Government of Alberta (GoA) Occupational Health and Safety Policy is signed by the Public Service Commissioner and endorsed by the President of the Alberta Union of Provincial Employees (AUPE). The policy is written in the GoA OH&S Program and must be available in hard copy or online to employees at all workplaces. 1.4 All points are awarded if documentation is in place. Provide examples. Employees are aware of the health and safety policy for the Government of Alberta. Verified by interviews with Executive Managers, Managers, Supervisors and Workers I (all) 0-5 Employee responses should demonstrate an understanding that the GoA OH&S Program is built collaboratively with the AUPE; that everyone has a shared responsibility to follow the GoA OH&S Program at their workplaces; and that health and safety practices are integrated with business operations and individual activities. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element 1.0 OHS Management Page 2 of 6

1.5 Audit Questions / Instructions The Deputy Minister/Assistant Deputy Minister demonstrates the Department's commitment to health and safety with employees. Verified by interviews with Managers, Supervisors and Workers D/I/O Point Value Score I (m,s,w) 0-10 Commitment to health and safety within the department may be demonstrated through communications that outline approval and communication of any department specific OH&S procedures and practices; department OH&S goals and plans; by providing leadership to executive management on health and safety initiatives; and by communicating and recognizing department results and employee accomplishments for health and safety performance. Interview responses should illustrate how the commitment of the Deputy Minister, and Assistant Deputy Minister, to health and safety has been demonstrated. Initiatives by the Department Health and Safety Committee and the policy statement from Question 1.2 are not included in this question. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 1.6 Health and safety responsibilities have been assigned for all employees. Verified by interviews with Executive Managers I (em) 0-5 Specific tasks and activities related to the implementation of the GoA OH&S Program and effective operation of health and safety practices and procedures must be assigned to employees at all levels within a business unit. Senior managers are accountable to ensure employees have assigned health and safety responsibilities and are measured on their performance. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element 1.0 OHS Management Page 3 of 6

1.7 Audit Questions / Instructions Employees at all levels of the organization are familiar with their assigned health and safety responsibilities. Verified by interviews with Executive Managers, Managers, Supervisors, and Workers D/I/O Point Value Score I (all) 0-10 Employees should be able to discuss their assigned health and safety responsibilities and authorities included in their annual performance plans, job descriptions and responsibilities outlined for them in the GoA OH&S Program. 1.8 Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Workers receive information, and can provide feedback, on health and safety issues. Verified by interviews with Workers I (w) 0-15 Employees must be able to describe methods in which they receive health and safety information and how they can provide feedback on the information they have received. Communication methods may include minutes of staff meetings, incident bulletins, health and safety newsletters, memoranda etc. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element 1.0 OHS Management Page 4 of 6

1.9 Audit Questions / Instructions There is a process in place to ensure contracted employers fulfill their legislated responsibilities under the OH&S Act, Regulation and Code. D/I/O Point Value Score D All employers are required to meet the responsibilities of health and safety legislation. The nature of the contracted work may provide different levels of risk, which may result in not all of the criteria listed being required. A sample of contracts should be reviewed which may be present under various terminology - i.e. Service Agreements, Fee for Service, short form and long form General Services etc.. The process will include: OH&S selection criteria for contracted employers; 5 the contract must identify health and safety responsibilities of contracted employers; a process to monitor health and safety performance for contracted employers during the period of the contracted services and to correct identified deficiencies; a process to evaluate any improvement opportunities for future contracts 5 points are awarded for each criterion if documentation is in place. If specific criteria are not required for low or medium risk operations they may be eliminated through the use of a not applicable and a full explanation must be provided. High risk operations (as defined in the OH&S Code, Schedule 2, Table 2) are evaluated for all four criteria. 5 5 5 Element 1.0 OHS Management Page 5 of 6

1.10 Audit Questions / Instructions Sufficient resources are provided by the employer to implement and improve health and safety. Verified by interviews with Executive Managers D/I/O Point Value Score I (em) 0-10 Department Deputy Ministers/Executive Managers have the responsibility to allocate funds, time and human resources to implement, maintain and evaluate the operation of the GoA OH&S Program, Goal and Plans within the Department. Resources include such things as the provisions of health and safety professionals or expertise, funding made available to implement controls identified in hazard assessment and control reports, or funding to implement corrective measures or correct deficiencies identified in investigation and inspection reports. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 1.11 Health and safety records are retained. D 10 Records must confirm that the standard forms contained within the GoA OH&S Program are being used for documentation of health and safety events at the workplaces. This will include Hazard Management forms, Incident Management forms, and OH&S Management forms. The workplace where the document originated must have a completed version of the document. There must be evidence that forms are being maintained according to proper GoA OH&S Program retention schedules and maintain any applicable levels of confidentiality. Documentation of other events such as site specific workplace inspections checklists, health and safety orientation checklists, and records of emergency response exercises must also be retained. All points are awarded if documentation is in place. Element Total 105 0 Element 1.0 OHS Management Page 6 of 6

A1.0 Health and Safety Committees A1.1 There is a Department Health and Safety Committee operating in accordance with the Government of Alberta OH&S Program. D/I/O Point Score Value D 10 Terms of Reference and meeting minutes must confirm the existence of an operational Department Health and Safety Committee. The Terms of Reference must include an appropriate representation of management/opted out or excluded and bargaining unit representatives; executive sponsorship or participation of an Executive Team member on the committee must also be documented; and outline the frequency at which meetings will be held. All points are awarded if documentation is in place. Element A1.0 Health Safety Committees Page 1 of 6

A1.2 There is a Workplace Health and Safety Committee (or Contact in lieu of a committee) operating at the workplace in accordance with the Government of Alberta OH&S Program. D/I/O Point Score Value D 10 Terms of Reference and meeting minutes must confirm the existence of an operational Workplace Health and Safety Committee. Terms of Reference must identify the workplaces included within the scope of the committee, identify an appropriate representation of management/opted out or excluded and bargaining unit members and outline the frequency at which meetings will be held. The number of non-union representatives cannot exceed the number of union representatives on the committee. Administrative workplaces may have a Workplace Health and Safety Contact person acting in lieu of a committee. Documentation may be present in the form of meeting minutes or email communications between the contact and the Workplace Manager. WHS Contacts are required to complete an activity report annually. All points are awarded if documentation is in place. Element A1.0 Health Safety Committees Page 2 of 6

A1.3 Audit Questions / Instructions The Department Health and Safety Committee performs its responsibilities in accordance with the Government of Alberta OH&S Program D/I/O Point Score Value D 10 Meeting minutes for the Department Health and Safety Committee should confirm: issues addressed by the committee have a department wide impact; the committee reviews annual evaluations of workplaces within their scope; it reviews and supports the implementation of the Department s annual health and safety plan; members attend meetings regularly; minutes are approved by both management/opted out/excluded and bargaining unit co-chairs (copies of the meeting minutes are sent to the Deputy Minister, department Human Resource Services and the AUPE) meetings occur at least three times per year. All points are awarded if documentation is in place. Element A1.0 Health Safety Committees Page 3 of 6

A1.4 Workplace Health and Safety Committees and Contacts perform their responsibilities in accordance with the Government of Alberta OH&S Program. D/I/O Point Score Value D 20 Meeting minutes for WHS Committees should confirm: meetings are occurring at the frequency defined within the Terms of Reference; members, or alternates, are regularly attending the meetings; members are reviewing incident summary reports; members are participating in workplace inspections; the status of identified hazards and concerns discussed; other events planned and activities completed or their status; and are making recommendations to the Workplace Manager that support the operation of the health and safety program within the workplace. minutes are approved by both management/opted out/excluded and bargaining unit co-chairs Administrative workplaces require a Workplace Health and Safety Contact person acting in lieu of a committee. Documentation must show that Contacts are conducting annual inspections of their workplace; accepting employees health and safety concerns and utilizing the Issue Resolution Process as needed; reviewing incident summary reports; and documenting any other health and safety events or activities organized by the Contact. All points are awarded if documentation is in place. Element A1.0 Health Safety Committees Page 4 of 6

A1.5 Audit Questions / Instructions Meeting minutes for Workplace Health and Safety Committees are maintained and are available to employees at all workplaces. Verified by observation of the workplaces D/I/O Point Score Value O 0-10 Meeting minutes of the health and safety committee must be available to employees. Original minutes and records of all committee activities are maintained by the committee secretary. They may be posted in a visible location or available electronically. Points are awarded based on the percentage of locations where meeting minutes were available compared to the total number visited. Provide examples. A1.6 Workplace Health and Safety Committee members or Contacts have taken the required health and safety training. D 5 Training records of all committee members or contacts must show they have taken the required training identified in the GoA OH&S Program within their first year of appointment. All points are awarded if documentation is in place. Element A1.0 Health Safety Committees Page 5 of 6

D/I/O Point Score Value A1.7 D 10 Established timelines within the Issue Resolution Standard Process are met to ensure identified issues are resolved in a timely manner. The issue resolution process begins after the employee has discussed the concern with his/her supervisor and the supervisor has failed to satisfy the employee s concern; and the Workplace Health and Safety Committee or Contact validates the concern as a health and safety issue in accordance with the Issues Chart within the GoA OH&S Program. Specific timelines, outlined within the program, must be met in order to comply with the standard process. Documentation must show timelines have been met. Meeting minutes include the status of validated health and safety issues and recommendations made to supervisors and managers. Points are awarded based on the percentage of issues resolved within the established timelines compared to the total number of issues. Provide examples. A1.8 Employees are familiar with the functions of the Department and Workplace Health and Safety Committees or Contact. Verified by interviews with Executive Managers, Managers, Supervisors and Workers I (all) 0-10 Employees should be able to describe how the Department and WHS Committees or Contact promote a healthy and safe workplace. This should include identification of the members of the committee or Contact who represents them; health and safety activities that are organized by the committees or Contact; and the methods used by the committees or Contact to communicate their operations to the workplaces. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element Total 85 0 Element A1.0 Health Safety Committees Page 6 of 6

2.0 Hazard Management 2.1 Audit Questions / Instructions Workplace specific Occupation Inventory forms have been completed for all jobs and occupations. D/I/O Point Value Score D 0-25 A detailed list of all employee jobs and occupations must be available to compare to the staff listings for the area being audited. The inventories must be specific to the workplace and must have been reviewed within the previous three years. Points are awarded based on the percentage of jobs and occupations inventoried compared to the number required as identified on staff listings or organizational charts. Sampling is not acceptable for scoring this question. 2.2 Task Inventory forms have been completed for all jobs and occupations in question 2.1. D 0-25 A list of job-specific tasks and activities must be available to compare to the Occupation Inventory listings in Question 2.1 If no Occupation Inventory is available, or it is incomplete, the Task Inventories must be compared to the staff listings or organizational charts in order to verify they are complete. The inventories must have been reviewed within the previous three years. Ensure highway motor vehicle operation is considered if driving is a frequent activity. Points are awarded based on the percentage of Task Inventory forms completed compared to the jobs and occupations identified in 2.1 or to the staff listings. Sampling is not acceptable for scoring this question. Element 2.0 Hazard Management Page 1 of 12

D/I/O Point Value Score 2.3 D 0-40 Hazard Assessment and Control Report forms have been completed, and include all identified tasks and activities, for each job and occupation at the workplace. Hazard Assessment and Control Reports must demonstrate that existing and potential health and safety hazards have been identified for the tasks and activities listed in the Task Inventories for each job or occupation. The reports must have been reviewed within the previous three years. Hazard Assessment and Control Reports must be available to employees at all workplaces. If employees at a workplace are unable to access the reports the score will be reduced accordingly. Points are awarded based on the percentage of reports completed compared to the total number required from the inventories. Sampling may be necessary for scoring this question. The maximum score available for this question will be determined by the total score awarded in question 2.2. Element 2.0 Hazard Management Page 2 of 12

2.4 Health and safety hazards have been evaluated to determine their level of risk and prioritized to determine the order of importance to implement controls. D/I/O Point Value Score D 5 Hazard Assessment and Control Reports must demonstrate that a process is in place to identify and prioritize the risk of health and safety hazards for the tasks and activities listed in the inventories. Degree of risk is based on an evaluation of the: Frequency of employee exposure to the hazard; potential consequence of exposure to the hazard; probability of an incident occurring. Frequency x Potential x Probability = Risk The risk analysis on the hazard assessment will assign an overall rating for the degree of risk. The degree of risk must be prioritized as High, Medium, or Low in order to establish the order of importance to implement controls. Hazard Assessment and Control Reports must be available to employees at all workplaces. All points are awarded if documentation shows the degree of risk has been determined and prioritized. Sampling may be necessary for scoring this question. Element 2.0 Hazard Management Page 3 of 12

D/I/O Point Value Score 2.5 I (w) 0-20 All workers have participated in the identification of applicable hazards and the implementation of controls for their work and their workplace(s). Verified by interviews with workers Interview responses must demonstrate that workers have participated in the assessment, elimination and control of hazards for their work and workplace. They should be able to describe the process in which they participated in the development of their hazard assessment(s), and/or that they reviewed the hazard assessment for their job or occupation with the Hazard Assessment Lead or their Supervisor, and it is directly applicable to the work they do, the conditions under which they perform their work, the equipment they use, and the controls in place at their workplace. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 2.6 Engineering controls identified in Hazard Assessment and Control Reports have been implemented. Verified by observation of the workplaces O 0-15 Engineering controls must be available to employees at the workplace for which they have been identified in the Hazard Assessment and Control Reports. Implemented means the controls are in place and functional. Points are awarded based on the percentage of engineering controls that have been implemented at the workplace where it is required compared to the number selected from hazard assessments. Provide examples. Element 2.0 Hazard Management Page 4 of 12

2.7 Administrative controls identified in Hazard Assessment and Control Reports have been written. D/I/O Point Value Score D 0-10 Safe Work Procedures are written step by step instructions required to safely perform a task from beginning to end. Safe Work Practices are written guidelines that help in the safe performance of a task that may not always be done in a specific way. A Code of Practice is required for any respiratory protective equipment in use at the workplace, confined space entry and the use of chemical substances and processes listed in Schedule 1, Table 1 of the OH&S Code. Any NIOSH approved respiratory protective equipment (i.e. N95 masks) in use at the workplace require a Code of Practice. Material Safety Data Sheets (MSDSs)are required for harmful substances that are controlled products and/or may have an adverse effect on employees or occupants of the facility. MSDSs must have preparation or revision dates within the past three years. Correspondence to the supplier requesting new MSDSs must be on file if they are outdated. Correspondence must be dated within the past three months of the audit dates. Points are awarded based on the percentage of administrative controls that have been written compared to the number selected from hazard assessments. Provide examples. Element 2.0 Hazard Management Page 5 of 12

D/I/O Point Value Score 2.8 O 0-15 Administrative controls are available to employees at the workplace(s). Verified by observation of the workplace(s) Written Safe Work Procedures/ Practices/Codes of Practice, MSDSs or any other administrative control in the form of a written document must be available to employees at the workplace for which they have been identified on the Hazard Assessment and Control Reports. Points are awarded based on the percentage of administrative controls that are observed at the workplace(s) where it is required compared to those selected from the hazard assessments. Provide examples. 2.9 Required Personal Protective Equipment (PPE) identified in the Hazard Assessment and Control Reports is available to employees for use. Verified by observation of the workplaces O 0-15 Examples of common PPE are chemical or puncture resistant gloves, respirators that meet NIOSH standards, hard hats that meet CSA or ANSI standards, hearing protection that meets CSA standards, foot protection that meets CSA, ASTM or NFPA standards, eye protection that meets CSA or ANSI standards. Other standards may be identified in the adopted code for that activity. Points are awarded based on the percentage of PPE available to employees for use at the workplace where it is required, compared to those selected from hazard assessments. Provide examples. Element 2.0 Hazard Management Page 6 of 12

D/I/O Point Value Score 2.10 Where Personal Protective Equipment (PPE) is identified on the Hazard Assessment and Control Report as a method of control, employees are trained in the proper selection, use, care and maintenance of the PPE. Verified by interviews with Managers, Supervisors and Workers Employees must be able to describe the method of training they received on the proper selection, use, care, and maintenance of the PPE they are required to use. Points are awarded based on the percentage of positive responses from employees interviewed. I (m,s,w) 0-15 2.11 Employees are using the controls for the identified health and safety hazards on the Hazard Assessment and Control Report. Verified by observation and interviews with Managers, Supervisors and Workers Interview responses must indicate that workers are using engineering and administrative controls and PPE. Points are awarded if observations indicate the controls are in place, in use AND at least 70% of interviews are positive. Provide examples for both techniques. O AND I (m,s,w) 15 Element 2.0 Hazard Management Page 7 of 12

2.12 Audit Questions / Instructions Managers and supervisors ensure the employees use of engineering controls, administrative controls and personal protective equipment. Verified by interviews of workers D/I/O Point Value Score I (w) 0-15 Workers must be able to discuss how supervisors and managers ensure the use of required controls at the workplace. The process may be a formal disciplinary process that includes verbal reminders and written reprimands, as well as recognition of positive behaviors. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 2.13 D 5 Employees assigned as hazard assessment leads have completed the required training. Training records for identified hazard assessment leads must show that they have taken the required training since the implementation of the revised GoA OH&S Program was released in 2009. All points are awarded if documentation is in place. Element 2.0 Hazard Management Page 8 of 12

D/I/O Point Value Score 2.14 The Hazard Assessment and Control Reports have been completed by a hazard assessment lead in consultation with employees who perform the work. and interviews with Executive Managers and Managers Employees trained as hazard assessment leads must have been involved in the process of developing hazard assessments with employees who perform the task or activity to ensure the report is accurate. The involvement by the Lead must be present in the form of a signature on the reports. The training of the Lead identified on the reports must be verified by the audit team through review of their training records. All points are awarded if documentation is in place AND at least 70% of interview responses are positive. D AND I (em,m) 10 Element 2.0 Hazard Management Page 9 of 12

D/I/O Point Value Score 2.15 I (m,s) 0-30 Hazard assessments are reviewed according to Government of Alberta OH&S Program requirements. Verified by interviews with Managers and Supervisors Hazard assessments must be reviewed and revised according to provincial OH&S legislation requirements, GoA OH&S Program requirements and as a result of inspection or investigation findings. The hazard assessment process must be repeated: when a new work process or new equipment is introduced; when a work process or operation change; when or before the construction of significant additions or alterations to the workplace are made; when new hazards are identified, new controls are implemented or controls for hazards are modified as a result of an inspection, incident investigation, emergency exercise or emergency; and at least every three years. Interview responses must demonstrate that managers and supervisors are aware that hazard assessments are reviewed and revised periodically, and give examples of when this has happened at their workplaces due to the listed criteria. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element 2.0 Hazard Management Page 10 of 12

D/I/O Point Value Score 2.16 I (s,w) 0-15 Equipment is maintained according to its manufacturer's specifications. Verified by interviews with Supervisors and Workers Equipment (for example: vehicles, mobile equipment, tools, supplies, machinery, and sanitary facilities) must be maintained in a condition that adheres to the manufacturer s specifications and will not compromise the health or safety of employees using or being transported by them. Schedules should be available for each piece of equipment and based on the manufacturer s specifications for maintenance and servicing. These may be in the form of log books, inspection checklists or databases. Typical office equipment is not included. Supervisors and workers should be able to describe how equipment is maintained within their business unit. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element 2.0 Hazard Management Page 11 of 12

2.17 Audit Questions / Instructions There is a procedure in place to prevent the use of defective equipment by employees. and observation of the workplaces D/I/O Point Value Score D AND O 20 An important part of equipment maintenance is knowing the process to report and record defective equipment that fails during use, and isolating or controlling hazardous energy so that defective equipment is not used by others. If tags, signs, locks or other energy isolating devices are used, training must also be provided to employees who are required to control and isolate the hazardous energy of the defective equipment. Documentation will include the process and may also include reporting forms, new or used warning tags or a computerized program or database. Observation should identify examples of equipment or machinery that has been removed from service. If none are readily available the auditor should inquire regarding the process. All points are awarded if documentation is in place AND the procedure is observed to be in use. Provide examples for both techniques. Element Total 295 0 Element 2.0 Hazard Management Page 12 of 12

3.0 Occupational Health and Safety Training 3.1 Employees receive health and safety orientation that includes: Roles and responsibilities for workers, supervisors and managers; locations of first aid supplies and services; (0-5 points) Health and safety procedures such as: emergency response; imminent danger; and reporting incidents; (0-5 points) And it occurs within the first week of commencement. (0-5 points) Verified by interviews with workers Health and safety orientation must be provided by the supervisor of both new employees, and employees who are assigned a new job or who are relocated. Orientation for employees must provide workplace specific information on health and safety topics that include hazards specific to their assigned duties and workplace, emergency response plans for their location, procedures for emergency response, the location of first aid services and supplies, incident notification procedures and responsibilities for health and safety of the employee, their supervisor or manager and the employer. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples in each category. D/I/O Point Value I (w) 0-15 Score Element 3.0 OHS Training Page 1 of 5

3.2 Occupational Health and Safety Training Employees receive job specific health and safety training before they begin a newly assigned task. Managers (0-5 points) Supervisors (0-5 points) Workers (0-5 points) Health and safety training must be provided to all new employees before they begin the task; and all employees before they start working on a newly assigned task. This training must include the review and revision (if needed) of hazard assessments for the task, instruction specific to the employee s tasks and work area, specific requirements identified in and required by the hazard assessments, instruction on safe work procedures, instruction on emergency response procedures, how to use, select and maintain personal protective equipment, how to safely use equipment, and instruction on harmful substances employees will work with or be exposed to. Training records must show that employees receive the training specified on their Hazard Assessment and Control Reports to safely perform their assigned duties. Other methods of identifying training needs may include Safety Training Needs Assessment templates or training matrices. Points are awarded based on the percentage of employees in each category who have received the required training identified in hazard assessments, Safety Training Needs Assessment templates or training matrices, compared to the total selected. Provide examples in each category. D/I/O Point Value D 0-15 Score Element 3.0 OHS Training Page 2 of 5

3.3 Occupational Health and Safety Training Employees receive refresher training to maintain certifications and remain competent to perform their assigned tasks. D/I/O Point Value D 0-20 Score Training records must show that employees who require refresher training to maintain competency in their assigned duties receive the required training. If the hazard assessment for that employee or their tasks requires the training, then it must be maintained. This may include seasonal refresher training, trade and skills upgrading, review of safe work procedures or practices, WHMIS, First Aid (3 years), Transportation of Dangerous Goods (Road 3 years, Air 1 year), control tactics, firearms, emergency vehicle operations, defensive driving, confined space entry, respiratory protective equipment. Departments may establish their own timelines for refresher training in these areas, if there is no legislated requirement, through the use of a training needs assessment or matrix. Points are awarded based on the percentage of employees who have received the required training compared to the number selected. Provide examples. Element 3.0 OHS Training Page 3 of 5

3.4 Occupational Health and Safety Training Visitors and contractors receive health and safety orientation to the workplace. Verified by interviews with Executive Managers, Managers, Supervisors and Workers D/I/O Point Value I (all) 0-10 Score Contractors and visitors require orientation to workplace health and safety requirements. Topics include the location of first aid supplies and services, emergency response procedures for the facility, known hazards at the workplace. External auditors are visitors to the workplace. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element 3.0 OHS Training Page 4 of 5

Occupational Health and Safety Training 3.5 Managers verify that employees have the qualifications, training and experience to perform their assigned tasks safely. Verified by interviews with Executive Managers and Managers D/I/O Point Value I (em,m) 0-20 Score Management is responsible to ensure that employees have the qualifications, training and experience to perform their assigned duties safely with little or no supervision. Qualifications may be earned through a formal educational program, training course or a combination of education and practical experience. Training must be appropriate to the tasks and equipment that will be performed or used and sufficient experience may be evaluated during the length of time that work is performed under supervision. The employer is ultimately responsible to ensure workers are competent. Management must be able to describe the process employees undergo to ensure they are competent prior to performing assigned duties unsupervised. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element Total 80 0 Element 3.0 OHS Training Page 5 of 5

4.0 Inspections 4.1 Management has developed inspection schedules for their operations and workplaces which meet or exceed the requirements outlined in the Government of Alberta OH&S Program Standard Process. Managers must develop inspection schedules for their operations and workplaces based on the frequencies given in this standard process. The schedules should include inspection timeframes, which operations and workplaces will be inspected, and who will carry out each inspection. The GoA OH&S program outlines minimum inspection frequencies for types of workplaces based on continuous use. Workplaces may require more frequent inspections during periods of high activity, if the number of hazards related to equipment used and activities at the workplace changes, or if the frequency or number of incidents increases. A department policy may also outline the frequency of inspections for workplaces other than those in the GoA OH&S Program. All points are awarded if documentation is in place. D/I/O Point Value Score D 15 4.2 D 0-10 Workplace inspections are conducted at the frequency according to the Government of Alberta OH&S Program requirements. Documentation must show that inspections are being carried out at the frequency defined within the inspection schedules in Question 4.1. Points are awarded based on the percentage of inspections that meet the required frequency. Element 4.0 Inspections Page 1 of 4

Inspections 4.3 Inspections are conducted using a workplace specific checklist. D/I/O Point Value Score D 10 Equipment and site-specific checklists for operations and workplaces within the business unit must be utilized. They document observations and the corrective measures implemented, and are the record of inspection. Inspections conducted by Workplace Health and Safety Committees should have the findings of their inspections also recorded in their meeting minutes. All points are awarded if documentation is in place. 4.4 Identified deficiencies on inspection checklists are corrected. and observation of the workplaces Managers are required to prioritize and verify that corrective measures are immediately implemented for substandard conditions and defective equipment identified during the inspection and/or on the inspection report. The manager may delegate the implementation of the corrective measure to the supervisor. Points are awarded based on the percentage of deficiencies selected from checklists that are observed to be corrected. Provide examples D AND O 0-20 Element 4.0 Inspections Page 2 of 4

Inspections 4.5 Managers have signed completed checklists verifying all identified corrective measures have been implemented. D/I/O Point Value Score D 0-10 Managers must review inspection checklists. They are signed off by managers at a higher level than those conducting the inspection. Points are awarded based on the percentage of inspection checklists signed by management compared to the total number selected. 4.6 Employees assigned by management as inspection leads have completed the required training. D 5 Inspection checklists must identify employees conducting the inspection. Comparison to training records must show that the employee assigned as the inspection lead has completed the required training since the GoA OH&S Program was revised in 2009. All points are awarded if documentation is in place. Element 4.0 Inspections Page 3 of 4

4.7 Inspections Audit Questions / Instructions D/I/O Point Value Score I (all) 0-20 Employees are familiar with the process to report unsafe or unhealthy conditions and practices. Verified by interviews with Executive Managers, Managers, Supervisors, and Workers Employees must be able to describe a process in which they can bring forward concerns regarding unsafe or unhealthy conditions at their workplaces. All employees are encouraged to identify concerns that may affect their own or their co-workers health and safety. An employee who becomes aware of a health and safety concern at the workplace shall immediately notify the supervisor. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. Element Total 90 0 Element 4.0 Inspections Page 4 of 4

5.0 Emergency Preparedness 5.1 There is a written emergency response plan for each type of potential emergency at each workplace. D/I/O Point Value Score D 0-20 Management is responsible to identify potential emergencies in relation to the operations of the workplace, and to maintain current written emergency response plans for each type of potential emergency. The plans are developed and maintained in consultation with employees. Plans must be reviewed and updated annually or when changes at the workplace occur. Workplaces must be assessed for their need for plans specific to the following potential emergencies: Fire; severe weather; medical emergencies; hazardous materials release; workplace violence; suspicious persons; suspicious letters or packages; and other situations appropriate for the nature of the work being performed (for example, working alone). All workplaces within the scope of the audit must have site specific procedures or a plan available to employees. Points are awarded based on the percentage of documented procedures in place in relation to the number required from the list above. (0-20 points) Provide examples. Element 5.0 Emergency Preparedness Page 1 of 6

5.2 Emergency Preparedness The emergency response plan includes: The name and address of the workplace The type of potential emergency Alarm and Communication procedures (two-way radios, personal trackers, cellular phones etc.) Emergency Phone numbers for emergency services (police, fire, ambulance, utilities etc.) List of assigned emergency response personnel trained to respond to the type of emergency to be contacted Appropriate response procedures for employees, visitors and contractors The Facility Emergency Response Plan is a manual that provides templates and guidance. Unless it is modified to be specific to the workplace and the potential emergencies of the location and work performed it will not be considered for the purposes of this question. Points are awarded in each category if documentation is in place. (3 points each to a maximum of 18 points) D/I/O Point Value Score D 0-18 Element 5.0 Emergency Preparedness Page 2 of 6

5.3 Emergency Preparedness D/I/O I (all) 0-20 Point Value Score Employees understand their responsibilities for each emergency procedure under the plans. Verified by interviews with Executive Managers, Managers, Supervisors and Workers Employees should be able to discuss the procedures for potential emergencies at their workplace and their responsibilities related to them. This should correspond with identified responsibilities within the plans. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 5.4 Workers have designated responsibilities for emergency response procedures at their workplace. D 5 Workers may be assigned by the manager as emergency response personnel for a variety of potential emergencies at their workplace. They may be involved in the annual review and update of the emergency response plan; assigned to maintain first aid equipment and supplies, and personal protective equipment, in safe operating condition; assigned to complete emergency response reports for each exercise and emergency; and must complete assigned training, maintain the appropriate certifications and participate in emergency response exercises. Documentation should demonstrate worker participation, in a leadership role, in the emergency preparedness processes and procedures at the workplace. All points are awarded if documentation is in place. Provide examples. Element 5.0 Emergency Preparedness Page 3 of 6

Emergency Preparedness 5.5 Employees are trained on their individual responsibilities for each potential emergency identified in the plan. Verified by interviews with Executive Managers, Managers, Supervisors and Workers D/I/O I (all) 0-20 Point Value Score Employees must be able to describe the methods of training they have had on the workplace specific emergency response plans in order to maintain their competency to respond to emergencies. Employees with designated responsibilities as emergency response personnel (i.e. designated first aiders, rescue and evacuation personnel) may have also received additional training provided by outside service providers such as the fire department, police department or independent resources for confined space rescue or H2S events. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. 5.6 Emergency exercises are held at least annually, for each response procedure identified in the plans to verify its effectiveness. Verified by interviews with Managers, Supervisors and Workers Emergency exercises are required at all workplaces to maintain the competency of the workplace occupants and emergency response personnel to respond. Exercises could be documented in Emergency Reports, staff meeting minutes where a plan was reviewed, or specific meetings designed to review responsibilities under the plans. Examples given by employees during the interviews should be verified by the audit team as part of documentation review. Points are awarded based on the percentage of positive responses from employees interviewed. Provide examples. I (m,s,w) 0-20 Element 5.0 Emergency Preparedness Page 4 of 6