Nomination Form

Nominations are now closed. Thank you to everyone who participated.


Winners will be featured in the November 2014 issue of Canadian Occupational Safety. See FAQ section for more information.



Nomination Process

Canada's Safest Employers recognizes Canadian companies that are making a difference in promoting the health and safety of their workers. If you are operating a safe and successful organization in Canada, we would like to hear from you.


Eligibility

TO BE ELIGIBLE FOR CANADA'S SAFEST EMPLOYERS AWARD, NOMINEES MUST MEET ALL OF THE FOLLOWING ELIGIBILITY CRITERIA:

  • Open to all companies that have been an employer in Canada for the last five years or more.
  • Must have NOT incurred any serious injuries or fatalities in the last five years, which resulted in investigation and subsequent charges under the Occupational Health and Safety Act and/or the Criminal Code.
  • Must have NOT been convicted of any charge under the Occupational Health and Safety Act and/or the Criminal Code, in the last five years.

Screening Process

  1. Completed nomination form.
  2. Completed Employee Safety Perception Survey. Only short-listed companies that pass the eligibility criteria and pre-screening process will be requested to proceed with the Employee Safety Perception Survey, provided by Canada's Safest Employers organizing committee.

Awards

Canada's Safest Employers gold and silver awards are available in the following categories:

  • Building and Construction
  • Health Care
  • Mining and Natural Resources (includes fish and forestry)
  • Transportation (land, sea and air)
  • Hospitality
  • Manufacturing
  • Oil and Gas
  • Public Sector / Non-profit
  • Retail and Services
  • Utilities and Electrical

Gold and silver awards are also available for two additional awards:

  • Wellness
  • Psychological Safety
CANADA’S SAFEST EMPLOYERS 2014 NOMINATION FORM »
Canada’s Safest Employers award – Wellness » Canada’s Safest Employers Psychological Safety Award »

Nomination Process

Canada’s Safest Employers recognizes Canadian companies that are making a difference in promoting the health and safety of their workers. If you are operating a safe and successful organization in Canada, we would like to hear from you. 

ELIGIBILITY


TO BE ELIGIBLE FOR CANADA’S SAFEST EMPLOYERS AWARD, NOMINEES MUST MEET ALL OF THE FOLLOWING ELIGIBILITY CRITERIA:

  • Open to all companies that have been an employer in Canada for the last five years or more.
  • Must have NOT incurred any serious injuries or fatalities in the last five years, which resulted in investigation and subsequent charges under the Occupational Health and Safety Act and/or the Criminal Code.
  • Must have NOT been convicted of any charge under the Occupational Health and Safety Act and/or the Criminal Code, in the last five years.

SCREENING PROCESS

  1. Completed nomination form.
  2. Completed Employee Safety Perception Survey. Only short-listed companies that pass the eligibility criteria and pre-screening process will be requested to proceed with the Employee Safety Perception Survey, provided by Canada’s Safest Employers organizing committee.
***Please note the nomination form times out after 3 hours and your information will not be saved. We encourage you to work in a Word document and then copy and paste your responses.

Canada’s Safest Employers award – Wellness

Eligibility
Have you been an employer in Canada for the last five years or more?
Do you have more than 20 employees?
Are you willing to administer an employee wellness perception survey provided by the Canada’s Safest Employers organizing committee to your workforce should you be shortlisted? (At least 20 per cent of employees must complete the survey within a prescribed time frame for your company to move on in the competition).
Note: If you answered No to any of the questions above, you are not eligible to participate in the selection process for Canada’s Safest Employers Award.
In the last five years, have any of your workers suffered any work-related injuries that resulted in prosecution under occupational health and safety, workers’ compensation and/or the Criminal Code legislation?
In the last five years, have you incurred any workplace fatalities?
In the last five years, has your company been convicted under the occupational health and safety, workers’ compensation and/or the Criminal Code legislation?
NOTE: If you have answered Yes to any of the questions above, you are not eligible to participate in the selection process for Canada’s Safest Employers Award.
Contact Information
Employer Name
Telephone
Website
Mailing Address
City
Province
Postal Code
Contact Person (Person responsible for this application)
Name and title
E-mail address
Telephone Number
Fax number
Alternate contact name and title
E-mail address
Telephone Number
Fax number
About the Organization
Brief description of the organization / scope of operations (please include year founded)
Employee Profile
Total Number of Employees
 
Full-time
Part-time
Contract
Do you have an Employee Assistance Program?
Name of EAP plan provider?
Please list the items covered in your EAP.
Do you offer a smoking cessation plan?
Comments:
Do you offer flu shot clinics?
Comments:
Do you offer diabetes awareness and/or screening programs?
Comments:
Do you offer heart health awareness and/or screening sessions?
Comments:
Do you offer healthy lifestyle sessions/seminars?
Comments:
Do you offer stress reduction initiatives?
Comments:
List health and wellness-­related services available through a company plan, such as massage therapist, chiropractor, naturopath.
Are your workstations ergonomic?
How do you educate staff on ergonomics?
Do employees have access to a nutritionist?
Comments:
Do you have an onsite cafeteria?
Are healthy eating alternatives available?
Comments:
If yes, are healthy alternatives subsidized by the company?
Comments:
Do your vending machines offer healthy food choices?
Comments:
Do you offer a subsidy or personal spending account for gym memberships/sporting equipment/activities?
If yes, how much per employee per year?
Do you do anything to encourage employees to bike to work?
Comments:
Do you have a lunchtime walking club or incentives to encourage employees to take walks during breaks?
Comments:
List any work-­life balance initiatives.
Does your organization or staff participate in community health and wellness events?
Comments:
How do you promote your wellness program and encourage employee participation?
Do you have a strategy for measuring the effectiveness of your wellness programs?
Comments:
How does senior management support your wellness strategy?
Please list other initiatives or wellness goals at your organization.

Statement of Truth
I'm the person named in, and who subscribed in, this application form for Canada's Safest Employers. To the best of my knowledge and belief, the matters and facts in it are true. Where matters specifically stated in it are made upon information and belief, I believe them to be true. I make this declaration conscientiously believing it to be true and knowing that it is of the same force and effects as if made under oath.
Name Title Date

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