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.
Name of EAP plan provider?
Please list the items covered in your EAP.
List health and wellness-related services available through a company plan, such as massage therapist, chiropractor, naturopath.
List any work-life balance initiatives.
How do you promote your wellness program and encourage employee participation?
How does senior management support your wellness strategy?
Please list other initiatives or wellness goals at your organization.
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.
Upload documents (Supporting document types - pdf, doc, docx, ppt, and pptx)
A maximum of 10 uploads will be accepted.
Deadline for submission: June 1