2014 Safety Group Audit Report

2014 Safety Group Audit Report

WorkWell Criteria

Firm Information

Name of Firm:
If this audit report covers more than one location findings, please list all locations to whom this audit applies:
Can provide on a separate sheet, with account and firm numbers
WSIB Account Number(s):
WSIB Firm Number(s):
Auditor Name(s):
Did the auditor(s) complete the WSIB Introduction to Auditing Course in 2014?
Date Audit Commenced:
Date Audit Completed:
Date Audit findings were reviewed by the Auditor with Senior Manager:
Senior Manager Name:
Date Senior Manager finished their review of Audit:
Date Senior Manager finished their review of the Action Plan:
Person Responsible for recording resolution of non-conformity action items:
This page is documentation of the required reviews for the WSIB Safety Groups Advantage Program 2014. This is the electronic verification of names and signatures:
Name of Auditor (lead if more than one):
Position in your firm:
Contact Phone Number:
Name of Senior Manager who reviewed the Audit and Action Plan (list all, if more than one):
Title:
Phone Number:

How to use this Form

The 12 sections of WorkWell have been broken out. The Auditor completes all columns in all 12 sections up to the decision of “Conformity”. The Senior Manager completes the review of the audit and the action plan.

Timelines for 2014

The audit must be completed and sent to Dunk & Associates by September 1st 2014.

The Senior Management sign-off, determination of action items and assigned responsibility with timelines must be

completed prior to submission to Dunk by September 1st 2014.

1

WorkWell Section 1
WorkWell Section / Criteria / Step 1: Standard Criteria (Every box must be checked for your standard to meet conformity and must be dated the last 12 months / Step 2: List additional evidence (proof) that your company is implementing what you stated in your written standard. (You must list sufficient additional corroborating evidence (records, observations, and interviews) to select a finding of conformity. If you're unable to verify additional evidence, briefly list what you could not verify, and select finding of non-conformity.) / Decision: Conformity or Non-Conformity (You must be in conformity for both Step 1 & 2 to have conformity) / Action Plan: What action items are required for non-conformities? List what will be done. (All missing criteria from Step One and Step Two must be included in the Action Plan.) / Actions Items assigned to: / Timeframe for completion. (All non-conformities must be at least initiated within 6 months of audit and planned to resolution) / Senior Management Review / Confirmation of Action Plan completed/
Date
1.1 / Health and Safety Policy Containing the following:
(1.1a-g) / Does this Policy Exist?
Yes
Title of Policy
Dated:
1.1a / Employer Commitment / A statement of commitment to preventing occupational illness and injury in the workplace / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.1b / Employer Responsibilities / A statement of commitment to implement and maintain a safe and healthy work environment / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.1c / Supervisor Responsibilities / A statement of responsibility to ensure that safe and healthy work conditions are maintained in his/her assigned work area / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.1d / Worker Responsibilities / A statement of responsibility to work in accordance with legislated standards and employer Safe Work Procedures/Practices / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.1e / Dated / The posted copy is dated within a 12 month period / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.1f / Signed / The posted copy is signed by the most senior management person on site / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.1g / Posted / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
1.2 / Workplace Violence & Harassment Policy
(This may be part of your H&S policy) / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Signed by the most senior management person
Dated in the last 12 months
Posted in a high traffic area / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
Comments:
WorkWell Section 2
WorkWell Section / Criteria / Step 1: Standard Criteria (Every box must be checked for your standard to meet conformity and must be dated the last 12 months / Step 2: List additional evidence (proof) that your company is implementing what you stated in your written standard. (You must list sufficient additional corroborating evidence (records, observations, and interviews) to select a finding of conformity. If you're unable to verify additional evidence, briefly list what you could not verify, and select finding of non-conformity.) / Decision: Conformity or Non-Conformity (You must be in conformity for both Step 1 & 2 to have conformity) / Action Plan: What action items are required for non-conformities? List what will be done. (All missing criteria from Step One and Step Two must be included in the Action Plan.) / Actions Items assigned to: / Timeframe for completion. (All non-conformities must be at least initiated within 6 months of audit and planned to resolution) / Senior Management Review / Confirmation of Action Plan completed/
Date
2.1 / Health and Safety Responsibilities Policy includes the following:
2.1a / Manager Responsibilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Workplace inspections
Information Sessions
Incident Investigations
Worker Training
Correcting substandard acts or conditions
Commending Worker H&S performance
Appoint a competent supervisor
Section 25 & 26 of the OHSA / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable
(N/A only if you do not have managers) / Agree
Disagree
2.1b / Manager Accountabilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Who conducts the evaluation
Measures each responsibility in section 2.1a
Completed at least annually / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable
(N/A only if you do not have managers) / Agree
Disagree
2.1c / Supervisor Responsibilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Workplace inspections
Information Sessions
Incident Investigations
Worker Training
Correcting substandard acts or conditions
Commending Worker H&S performance
Section 27 of the OHSA / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable
(N/A only if you do not have supervisors) / Agree
Disagree
2.1d / Supervisor Accountabilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Who conducts the evaluation
Measures each responsibility in section 2.1c
Performed at least annually / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable
(N/A only if you do not have supervisors) / Agree
Disagree
2.1e / Worker and Supplied Labour Responsibilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
H&S rules for the workplace
Included section 28 of the OHSA / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
2.1f / Worker and Supplied Labour Accountabilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
A formalized performance review
Progressive discipline process
Worker understands the consequences of H&S violations / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
2.1g / Contractor Responsibilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Ensure H&S of workers
Provide qualified workers
Ensure they work within governing legislation/regulations/industry standards
Communication of workplace specific H&S rules and Emergency Procedures / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable
(N/A only if you so not have contractors) / Agree
Disagree
2.1h / Contractor Accountabilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Performance Review
Consequences of unsafe behavior, policy or procedure violation / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable
(N/A only if you so not have contractors) / Agree
Disagree
2.1i / Visitor Responsibilities / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
H&S rules for the workplace to read before entering the workplace
Escorted while in the workplace
Use of PPE
Remain in designated areas
Report injury/illness suffered / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
2.2a / The employer has assigned an individual to coordinate the health and safety activities. / A written description for this individual, outlining specific activities to coordinate the health and safety program
Title of the Document
Dated: / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
2.2b / The individual is experienced and trained. / The individual has industry Experience and knowledge of the following fields:
Applicable safety legislation
Incident investigation
Workplace inspection / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
Comments:
WorkWell Section 3
WorkWell Section / Criteria / Step 1: Standard Criteria (Every box must be checked for your standard to meet conformity and must be dated the last 12 months / Step 2: List additional evidence (proof) that your company is implementing what you stated in your written standard. (You must list sufficient additional corroborating evidence (records, observations, and interviews) to select a finding of conformity. If you're unable to verify additional evidence, briefly list what you could not verify, and select finding of non-conformity.) / Decision: Conformity or Non-Conformity (You must be in conformity for both Step 1 & 2 to have conformity) / Action Plan: What action items are required for non-conformities? List what will be done. (All missing criteria from Step One and Step Two must be included in the Action Plan.) / Actions Items assigned to: / Timeframe for completion. (All non-conformities must be at least initiated within 6 months of audit and planned to resolution) / Senior Management Review / Confirmation of Action Plan completed/
Date
3.1 / Policy on Posted Materials / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
A list of posted materials required for your workplace
How frequently the posting need to be updated/replaced
Where to post materials / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1a / Occupational Health & Safety Act (OHSA) / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1b / Appropriate Regulations / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1c / WHMIS Regulations / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1d / Material Safety Data Sheets / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1e / Designated Substance Regulation / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable / Agree
Disagree
3.1f / Health & Safety Explanatory Materials (Gide to the OHSA) / Posted in a high traffic area
Accessible to all workers / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1g / Form 82 – In Case of Injury at Work Poster / Posted in a high traffic area
Available at all First Aid stations / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1h / First Aid Regulation 101 / Posted in a high traffic area
Available at all First Aid stations / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1i / Emergency Services and Phone Numbers / Posted at primary telephones throughout the facility (including offices)
Emergency #'s Include:
911
Fire
Police
Ambulance
Ministry of Labour
Ministry of Environment
Utilities
Internal Contacts / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1j / Reports / Posted in a high traffic area
Accessible to all workers
Reports include:
Monthly Workplace Inspections
JHSC Meeting Minutes
H&S assessments/surveys
Ministry of Labour Orders / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
3.1k / Other / Available as applicable to the worksite activities
May Include:
Traffic Control
Transportation of Dangerous Goods / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable / Agree
Disagree
Comments:
WorkWell Section 4
WorkWell Section / Criteria / Step 1: Standard Criteria (Every box must be checked for your standard to meet conformity and must be dated the last 12 months / Step 2: List additional evidence (proof) that your company is implementing what you stated in your written standard. (You must list sufficient additional corroborating evidence (records, observations, and interviews) to select a finding of conformity. If you're unable to verify additional evidence, briefly list what you could not verify, and select finding of non-conformity.) / Decision: Conformity or Non-Conformity (You must be in conformity for both Step 1 & 2 to have conformity) / Action Plan: What action items are required for non-conformities? List what will be done. (All missing criteria from Step One and Step Two must be included in the Action Plan.) / Actions Items assigned to: / Timeframe for completion. (All non-conformities must be at least initiated within 6 months of audit and planned to resolution) / Senior Management Review / Confirmation of Action Plan completed/
Date
4.1 / Employer has identified H&S Hazards, implemented controls, and developed safe operating procedures where necessary: / Agree
Disagree
4.1a / Identify all health and safety hazards in the workplace / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
A list of activities performed by the workers
Implement a review process / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.1b / Rate each hazard for loss potential and implement health and safety controls / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Rate hazards for loss potential
Identify controls in place for the hazards identified
Consider controls according to the following priority
•Elimination
• Substitution
•Engineering controls
•Administrative controls
•PPE / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.1c / Develop and implement safe operating procedures (SOP's) /safe work instructions for every activity rated as a major hazard / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Developing a step-by-step description for each activity rated as a major hazard
H&S controls at each step
Inform and instruct all workers of the SOP's / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.2 / The employer has developed and implemented standards and procedures for:
4.2a / Injury/Illness Reporting / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Definition of injury/illness
When to report
How to report (form)
Who should be notified
What treatment will be provided
Recording requirements
Follow-up contacts / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.2b / Hazard Reporting / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Definition of hazardous condition/act
When to report
How to report (form)
Who should be notified
Hazards are rated for loss potential
What actions will be taken, by whom and when
Follow-up on any actions/ responses / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.2c / Emergency Response / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Identify potential emergencies and appropriate responses for each:
(i.e.: fire, power failure, gas leak, chemical spill, weather conditions, violence, medical emergencies, fall arrest/high angle rescue, entrapment, motor vehicle incidents)
Floor plan of the workplace
Exit route for all workers
Training requirements
Assign responsibilities for:
•Contacting Emergency
Response
•Accounting for workers
•Authorizing re-entry / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.2d / Emergency Equipment / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Identifies all emergency equipment
(i.e.: fire extinguishers/hoses, fire suppression system, emergency lighting, eye wash station, deluge shower, fire exits)
Review process for correct selection of equipment
Review process for adequate supply of equipment
Review process for appropriate location of equipment
Training required for emergency equipment users
Checks, inspections, replacement and/or calibration required / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.2e / Refusal to Work / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
When a worker has the right to refuse
Who is notified/involved
Explanation of the step-by-step process to be followed / Record
Interview
Observation / Conformity
Non-Conformity / Agree
Disagree
4.2f / Control of Hazardous Energy (Lockout) / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Definition
Specific procedures for equipment/processes
Who can perform
When to perform
How to perform
Includes circumstances for multiple workers, live work or partial lockout)
Reporting (tags)
Audit plan
Procedures posted at applicable locations
Worker training and assessments required
Adequate supply of energy isolating devices / Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable / Agree
Disagree
4.2g / Confined Space / Does this Policy Exist?
Yes
Title of Policy
Dated:
Policy Includes:
Definition of confined space
Method to recognize and assessed confined space
Training
Permit system
Written entry plan including

• Duties & Coordination
• Rescue procedures
• Rescue equipment
• Communication
• Clothing and PPE
• Lock-out & control of materials movement
• Attendants
• Means of entry/exit
• Atmosphere testing
• Procedures for working with/near explosive or flammable substances
• Ventilation and purging

/ Record
Interview
Observation / Conformity
Non-Conformity
Non Applicable / Agree