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 Psychological Safety Award

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 psychological safety perception survey provided by the Canada’s Safest Employers organizing committee to your workforce should you be shortlisted? (At least 30 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 or fatalities that resulted in prosecution under occupational health and safety, workers’ compensation and/or the Criminal Code legislation?
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
Street Address
City
Province
Postal Code
Contact Person (Person responsible for this application)
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
Demonstrated management commitment
Describe how your most senior leaders participate in leading the Psychological Health and Safety Management System (PHSMS) in your organization and how they show commitment to your PHSMS. How is PHSMS defined within your organization?
Risk identification
Describe how psychological safety hazards and risks are identified, assessed and controlled. Please name any instruments used for this purpose.
Training and awareness
Describe how you ensure managers are selected and adequately trained to identify and respond to psychological safety issues in the workplace.
Communication strategies
Describe how you are communicating psychological safety messages to managers and employees. Please provide examples.
Reporting and investigations
Describe your organization’s process for reporting and investigating work-related psychological health and safety incidents. How are psychological safety breaches addressed?
Return-to-work
Does your organization have a developed return-to-work system for people on STD/LTD due to psychological health and safety issues? Detail.
Employee Assistance
Do you have an Employee Assistance Program/Employee and Family Assistance Program? If so list coverage details. List name of EAP supplier.
Innovative approaches
Describe, if any, some of the innovative approaches and programs around your psychological health and safety management system (not previously mentioned) that you have implemented and the result of those programs.
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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