Safety 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.
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 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 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)
Industry category
To which industry does the company being nominated belong? Please check the box that applies (one answer only).









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 name
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
Please note that each question has a 7,000 character maximum. Please describe both the basics as well as the innovative aspects of your program for each question.
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.
Ergonomics (5)
Explain what processes you have in place to ensure proper ergonomics and prevent musculoskeletal injuries at your workplace.
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.
Training (10)
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 processes.
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?
Communication strategies(10)
Describe how you are communicating safety messages.
Health and wellness (10)
Describe your health and wellness program.
Injury / incident investigation (10)
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)
Lost time injury (LTI) rate
2016:

2017:

2018:
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.
Name
Title
Date

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Deadline for submission: May 24
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