IMPORTANT: The nomination form times out after about two hours. Please save all your answers in a word document on your desktop and then copy and paste them into the form when you are ready to submit. We cannot retrieve lost data.
Psychological Safety Award
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.
About the organization
Brief description of the organization / scope of operations.
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?
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.
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?
Does your organization have a developed return-to-work system for people on STD / LTD due to psychological health and safety issues? Please detail.
Do you have an Employee Assistance Program / Employee and Family Assistance Program? If so list coverage details. Please list name of EAP supplier.
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.
Injury statistics in the last three years
Total number of lost-time claims
Total number of medical aid incidents
Total number of other incidents (with no lost-time and no medical aid)
Total employee hours worked (includes full time, part-time and casual employees)
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.
I understand if my company is a gold winner we need to participate in a phone interview with a journalist as well as an on-site video shoot. I understand I am not able to see the article or the video prior to publication as they are both pieces of journalism, not personalized marketing items.
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Deadline for submission: June 1