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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? (See FAQ section for details.)
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, has your company been prosecuted under occupational health and safety, workers' compensation and/or the Criminal Code legislation? (If yes, please give current status of prosecution and details.)
In the last five years, has your company been convicted under the occupational health and safety, workers' compensation and/or the Criminal Code legislation? (If yes, please explain.)
In the last five years, have you incurred any workplace fatalities? (If yes, please explain.)
Contact information
Employer name
Telephone
Website
Street address
City
Province
Postal code
Contact person (Person responsible for this application)
Title
E-mail address
Telephone number
Alternate contact
Title
E-mail address
Telephone number
About the organization
Brief description of the organization / scope of operations.
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? Please detail.
Employee assistance
Do you have an Employee Assistance Program / Employee and Family Assistance Program? If so list coverage details. Please 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.
Injury statistics in the last three years
Total number of lost-time claims
2016 2015 2014
Total number of medical aid incidents
2016 2015 2014
Total number of other incidents (with no lost-time and no medical aid)
2016 2015 2014

Total employee hours worked (includes full time, part-time and casual employees)

2016 2015 2014



Statement of Truth
  1. 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.
  2. 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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