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.
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.
OHS management system (10 points)
Describe your company’s occupational health and safety management system.
Demonstrated management commitment (10)
Describe how your most senior leaders participate in leading the OHS Management
System in your organization and how they show commitment to OHS.
Joint health and safety committee (5)
Explain how participation in the JHSC works at your organization, as well as how
often it meets, how meetings are documented and any training participants receive.
Hazard / risk assessment (5)
Describe any hazard / risk assessments that have been done for specific role / jobs
in the organization, or within the overall work environment.
Describe how you ensure that employees are adequately trained to perform their work
effectively and safely.
Workplace inspections (10)
Describe how often inspections are conducted, the inspection process, and follow-up
Emergency response / organizational continuity plan (5)
Describe your organization’s emergency response / continuity plans and procedures,
including the types of emergencies / threats it covers, the steps employees should
take in response, and training.
Employee engagement (10)
What initiatives and activities do you do to keep your workers engaged in safety?
Describe how you are communicating safety messages.
Health and wellness (10)
Describe your health and wellness program.
Innovative approach (10)
Describe, if any, some of the innovative approaches and programs around health and safety (not previously mentioned) that you have implemented and the result of those programs.
Injury / incident investigation (5)
Please describe the steps taken when an injury or “near miss” incidents occur. How do you ensure that recommended corrective actions are implemented?
Injury statistics in the last three years (5)
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)
If you wish, you can use the space below to provide more information or elaborate
on your injury statistics.
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.
Upload documents (Supporting document types - pdf, doc, docx, ppt, and pptx)
A maximum of 10 uploads will be accepted.
Deadline for submission: June 1