Canada's Best Health + Safety Culture Award

IMPORTANT: The form does not save your responses during input. Please have all your answers saved in a Word document then copy and paste your answers into the form.
Please note this award is intended to recognize an entire organization with an excellent culture, not local branch plants or individual franchises.

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 perception survey provided by the Canada’s Safest Employers organizing committee to your workforce should you be shortlisted? (See FAQ section for details.)
Are you willing to have an auditor from Workplace Safety and Prevention Services come to you workplace to conduct a one-day audit, which includes focus group with staff, site tour and C-suite interview?
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 Awards.
In the last five years, has your company been charged under occupational health and safety, workers' compensation and/or the Criminal Code legislation? (If yes, please give 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
Street address
Postal code
Contact person (Person responsible for this application)
E-mail address
Telephone number
Alternate contact name
E-mail address
Telephone number
About the organization
Brief description of the organization / scope of operations.
Employee profile
Total number of employees
Please note that each question has a 7,000 character maximum.
Summarize how your organization has inspired transformative behaviours within your areas of influence. What is a positive demonstration of your culture in action? What are the best aspects of your organization’s culture?
Describe how your organization incorporates the values of health and safety culture into the corporate business model, including how health and safety targets are aligned to revenue and performance. (15 points)
Describe the approach used by the organization towards integrating measurable health and safety targets into the performance management and evaluation criteria of organizational leaders. Provide specific examples and discuss how these targets are measured. (20 points)
Provide evidence demonstrating that organization leaders practice the health and safety values promoted by the company and effectively lead by examples or “Walk the talk”. (15 points)
Describe how company leaders instil a culture of respect, understanding, courage and potential anonymity in the event a worker is willing to bring forth a health and safety issue or concern. If a concern is brought forward, how is it rectified? (20 points)
What does “accountability” mean to your company, specifically as it relates to establishing a strong culture of health and safety? Provide examples of initiatives that foster accountability and ensure that all level of staff and contractors are held accountable for nurturing a culture of health and safety. (20 points)
Describe your organization’s “internal responsibility system.” How does it align with corporate values, targets and business goals? What criteria are used to evaluate effective functioning? Please provide a specific example that demonstrates commitment across the organization (senior management to front line staff) towards the internal responsibility system. (20 points)
Describe your organizations recognition program that highlights safety achievements and recognizes the commitment of all staff to a healthy and a safe working environment. (10 points)
Does the organization have a corporate social responsibility (CSR) program? If so, how is it grown within communities and how can employees and contractors get involved? (Provide specific examples) (10 points)
How does management demonstrate corporate social responsibility? Are CSR and health and safety system improvement goals and targets shared publicly? (15 points)
Describe your organization’s change management strategy that ensures effective staff and business risk management in response to industry volatility. For the purpose this evaluation, change management is defined as “the process of managing transformational changes which affect the culture, structure, and performance of an organization.” (15 points)
Demonstrate how industry recognized best practices are used within the organization to create a sustainable culture of health and safety. (10 points)
Describe which health and safety leading indicators are captured by your organization and how that information is used to reinforce and revise current practices. Provide an example of this in practice. (15 points)
What metrics and key performance indicators does the organization currently use to evaluate the health and safety program? How frequently are they captured and how do they align with metric used to evaluate business performance? How are they communicated to staff? (25 points)
Describe the organization strategy for using audits or root-cause-analysis to continually recognize, access, control and evaluate potential health and safety risks. Provide an example of this in practice. (10 points)
As all organizations move forward in their journeys of continuous improvement, they experience both success and challenges; the best organizations learn from these. In this section, describe a challenge faced by your organization, from a description of the issue to a reflection on the improvements seen, including intermediate actions taken and observed results.
Injury statistics in the last three years (25 points)
Lost time injury frequency rate



Please specify your industry:
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.

Upload documents (Supporting document types - pdf, doc, docx, ppt, and pptx)
*You must attach your company's Statement of Corporate Responsibility to be eligible for this award
A maximum of 10 uploads will be accepted.
Deadline for submission: May 24
*Criteria informed in part by the international Robert W. Campbell Award for Business Excellence through EHS Management (
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