RESPONSIBILITIES

Management’s Responsibilities
1. Consider safety as well as production in all planning.
2. Take every reasonable precaution to prevent personal injury.
3. Provide and maintain a safe, healthy work environment.
4. Ensure any accident or incident occurring in the workplace is thoroughly investigated and that remedial steps are taken to prevent a
recurrence.
5. Ensure compliance with W.H.M.I.S. regulations.
6. Provide competent supervision.
7. Have a completed registration form available (includes Company details, WSIB and MCCR information)
8. General Contractors must be responsible for all sub contractors on site and have a competent Supervisor in charge of the entire site
who will:
-Provide notice to the Ministry of Labour and keep a copy of the Act and regulations availble
-Establish a safety committee where there are more than 20 workers
-Ensure a safety representative is selected by the workers on site for projects that have between 5 and 20 workers
-Establish written emergency procedures and post them where all workers can see them
-Make arrangements for fire protection and ensure that workers who may be required to use them are trained
-Provide a telephone or other system that can be used in an emergency
-Not permit anyone under the age of 16 on the site
-Make arrangements for the provision of toilet and clean up facilities before work begins
-Keep those facilities clean and ensure supplies are available
-Plan the project so that vehicles and equipment are operated as little as possible in reverse
-Not allow dump trucks on site that are not equipped with “back up” alarms
-Where vehicles or equipment that have an obstructed view must backup, a signal person must be used.

Assist and co-operate with Health & Safety Representatives as well as with members of Joint Health and Safety Committees.

RESPONSIBILITIES
Supervisors’ Responsibilities
1. Be responsible for the safety of the entire project under their charge, including accident investigation and reporting.
2. Actively enforce all aspects of the Occupational Health & Safety Act as well as those of the company Safety Policy.
3. Train and explain safety procedures and policies to their workers, particularly to new workers.
4. Advise their workers of potential or actual dangers including hazardous materials specific to the workplace.
5. Ensure personal protective equipment is used by workers as needed to perform their work in a safe manner.
6. Ensure that all equipment, including safety and protective equipment, is in good operating condition and that any defective equipment
is immediately tagged and removed for repair.
7. Co-operate fully with the Safety Co-ordinator, employees’ Health & Safety Representative and project Joint Health & Safety Committee
members, where applicable.
8. Report all accidents and incidents immediately to management.
9. Investigate thoroughly any accident or incident occurring in the workplace and implement the remedial steps necessary to prevent a
recurrence.
10. Promptly submit to management an Accident/Injury Report for every medical aid and/or lost time injury.
11. Be available at all times where there are more than 5 workers and have a competent person available to assume the Supervisors
responsibilities during their absence

RESPONSIBILITIES
Employees’ Responsibilities
1. Perform their work with a safety-first attitude.

2. Comply with the Occupational Health & Safety Act as well as with this company’s Safety Policy.

3. Immediately report any injury or accident, no matter how minor, to their supervisor.

4. Immediately report to their supervisor any condition, practice or hazard that may cause injury to a worker or damage to equipment.

5. Wear, use and properly maintain personal protective equipment wherever required by their supervisor.

6. Be accountable for their own safety and work in a manner so as not to endanger fellow workers.
EMPLOYEES’ HEALTH & SAFETY REPRESENTATIVE

On projects where the number of employees regularly exceeds five but is not more than 20, the constructor shall cause a Health & Safety
Representative to be selected by the workers or appointed by the trade union. The employees’ Health & Safety Representative shall not
hold managerial functions.

The Health and Safety Representative

1. Should have a current first aid certificate.

2. Shall be familiar with the requirements of the Occupational Health & Safety Act and Regulations for Construction Projects as well as
with this company’s Health & Safety Policy.

3. Should follow the published guidelines for Health & Safety Representatives.

4. Shall perform site inspections at least once a month or as required by the Occupational Health & Safety Act.

5. May assist in investigating serious accidents and confer with supervisors, employees and Ministry of Labour inspectors whenever
necessary.

6. Will receive the full co-operation and respect of both management and the workforce.

JOINT HEALTH & SAFETY COMMITTEES

AND WORKER TRADES COMMITTEES
Where a project lasts three months or more and where 20 or more people are regularly employed, the general constructor or
employer shall cause a Joint Health & Safety Committee to be established and maintained.
For Construction projects that are expected to last three months or longer and employ 50 or more workers the Joint Health & Safety
Committee must establish a Worker Trades Committee.

To further assist in promoting job safety, the management of this company and their employees will provide their full co-operation
to any members of Joint Health & Safety Committees or Worker Trades Committees on projects where they may be established.

Where a project regularly employs 50 or more workers, the health and safety committee on the project must have at least one
member representing workers and one member representing the constructor who are certified by the Workplace Health and Safety
Agency.

ACCIDENT PREVENTION
1. Safety Policy – All employees must be familiar with and understand, to the best of their ability, the contents of this Safety Policy
and Reference Manual.
2. New Employees – A workplace safety orientation must be conducted with all new employees to ensure compliance and
understanding of this Safety Policy and Reference Manual.
3. Hazards – All unsafe conditions or practices must be reported immediately. All reported hazards must be investigated and
corrective action taken to avoid injury, damage or recurrence.
4. Personal Protective Equipment – Approved hard hats and safety boots must be worn on all construction projects. Personal
protective equipment provided by this company must be worn wherever and as directed by the supervisor.
5. Materials Handling – Workers should know their own physical limitations and the approximate weight of materials they are
trying to lift. Use correct lifting techniques and get help to lift or move objects not safely handled alone.
6. Housekeeping – No object shall be placed or left where it is likely to endanger a worker. Waste material and debris should be
disposed of as necessary.
7. Conduct and Behavior – Horseplay or dangerous behaviour will not be permitted. No person under the influence of intoxicating
alcoholic beverages or drugs will be permitted to work.
8. Tools and Equipment – Unsafe tools or equipment are not to be used and must be reported immediately to a supervisor.

9. Maintenance of Equipment – Supervisors are each personally responsible for ensuring that all equipment is in top working
order. Any defective equipment is to be immediately tagged and removed for repair.

GENERAL PERSONAL PROTECTION

For personal protection on the jobsite, workers should avoid wearing loose, greasy or oily clothing, gloves or boots; torn or ragged
clothing; and rings, neck chains and other jewelry that may become entangled with equipment. Shirts and long pants shall be worn
at all times. Gloves, respirators and specially designed protective clothing shall also be worn under certain hazardous conditions.
Butane lighters should not be carried on the jobsite.
Head Protection

Workers shall wear, at all times on the jobsite, a CSA-certified Class B safety hat. Workers shall not paint or drill holes in the safety
hat and shall replace damaged or cracked hats immediately.

Foot Protection

Workers shall wear CSA-certified Grade 1 footwear or CSA-certified footwear with heavy-duty toe and sole protection at all times on
the jobsite. Work boots should be laced to the top and tied. Replace badly worn or deteriorated work boots.

Eye Protection
Eye protection shall be worn by any employee who is exposed to the hazard of eye injury in the performance of his work.

For basic eye protection, wear properly fitted industrial quality glasses with side shields.

Hearing Protection

It is recommended that each worker have hearing protection available at the workplace since continuous exposure to excessive
noise from certain construction activities can lead to hearing loss.
Hearing protection is available in three general types:
- Disposable Ear Plugs
- Reusable Ear Plugs
- Earmuffs

Respiratory Protection

Work areas should be ventilated to reduce hazards from dust, fumes, gases or vapors.
Where ventilation is not practical, workers must be provided with respirators appropriate to the hazard and be trained to use and
maintain the respirators properly.
FALL PROTECTION SYSTEMS AND DEVICES

GUARDRAILS

The provision of guardrails must be the first method of protection considered where workers may be exposed to fall hazards. Where
it is not possible to install guardrails, other methods may be used. (ie: travel restraint, fall arrest or safety nets)
Guardrails, consisting of a top rail, mid-rail and toeboard, must be provided around work platforms on all scaffolds, floor openings,
ramps and open areas where a worker can fall from one level to another.
When guardrails or opening covers are temporarily removed, signs must be posted warning of the hazard and workers in the area
must be protected by a fall protection system. Barricades, guardrails and covers must be replaced in a proper manner immediately
after work is completed.
All barricades, guardrails and covers must be of adequate strength and be properly secured to withstand all potential loads likely to
be applied to them. (Refer to the Regulation for Construction projects section 26.3(5) or the CSAO publication on Guardrails for
information concerning load design.)

Safety Belts, Harnesses and Lanyards

All safety belts and lanyards, full body harnesses, fall arresting devices and vertical lifelines, self retracting devices, descent control
devices and shock absorbers must be CSA-certified. All should carry a CSA label. Safety harnesses must be snug-fitting and worn
with all hardware and straps intact and properly fastened.
The lanyard of the safety harness should be positioned, preferably higher than waist level, and be kept as short as possible (no more
than 1.5 metres 5 feet) to reduce fall distance. All lanyards must have a shock absorber and be attached to a fixed support or to a
lifeline attached to a fixed support. The system must be arranged so that the worker cannot bottom out in the event of a fall.
Fall arrest systems must be inspected by a competent worker before each use and be removed from service if found to be defective.
All components of a system must be removed from service if used to arrest a fall until certified for re use by the manufacturer
For fall arrest systems, a full body harness is required. Safety belts are only to be used for travel restraint to prevent access to a fall
hazard.
A permanent anchor that meets the Building code should be the primary consideration when selecting a fixed support to tie off fall
protection systems
Temporary fixed supports can be used providing they have been subjected to a dynamic test conducted in accordance with good
engineering practice to ensure it has the capacity to arrest a workers fall or be manufactured or designed for that purpose and be
used according to that design.

(Note: Effective June 12, 2002, Employers must ensure that workers required to use fall protection systems are adequately trained
by a competent person. The training must include both oral and written instruction. A record must be kept that includes dates of
training, workers names and signatures. The Employer must keep a copy available for review by an Inspector)

Lanyards and Lifelines

All lanyards and lifelines must:

1. Be free from any danger of chafing, cutting or abrasion

2. Not be subjected to any hazards that may damage it ie; (flame, corrosives, extreme temperature)
3. Be only used by one person at a time
4. Be kept clear of equipment and machinery
5. Have manufactured connecting ends (protective thimble, swaged fitting or eye splice)
6. Horizontal and vertical lifelines must be free of knots other than those used to connect it to a fixed support.
7. Be long enough to reach the ground and knotted at the end, cable-clipped or otherwise provided with a positive stop to
prevent the lanyard from running off the vertical lifeline.
8. Where it is a horizontal lifeline, be a design approved by a Professional Engineer.

If Safety Nets are used, they must be designed, tested and installed under the direction of a Professional Engineer and in
accordance with ANSI standard 10.11-1989
WORKING BESIDE UNPROTECTED OPENINGS AND EDGES
A worker must wear a safety belt or harness with the lanyard tied off to a fixed support whenever the worker is more than 3 metres
(10 feet) above the next level or above operating machinery, hazardous substances or objects, regardless of the possible fall height.

WORKING FROM SWING STAGES

A worker shall wear a safety harness with the lanyard tied off to:
- an independent lifeline, if the swing stage has only two independent suspension lines,
or
- the swing stage, if it has more than two means of support or suspension lines.

TRENCHES AND EXCAVATIONS

Where personnel are required to enter a trench or excavation, it shall be properly sloped or shored and trench boxes must be used
where required.

LIGHTING
Stairs and work areas should be adequately lit at all times. Dark areas should not be entered without the assistance of portable
lighting or flashlights.

PROPER USE OF LADDERS

1. Ladders should be set up on a firm level surface. If the base is to rest on soft, uncompacted or rough soil, a mud sill should be
used. Portable ladders should be equipped with non-slip bases.
2. Ladders should be tied off or otherwise secured to prevent movement.
3. When a task must be performed with the worker standing on an extension ladder, the length of the ladder should be such that
the worker stands on a rung no higher than the second from the top.
4. When climbing up or down, workers should always face the ladder.
5. Ladders should not be erected on boxes, carts, tables, scaffold platforms, elevated platforms or on vehicles.
6. Ladders shall be set up 1 foot out for every 3 or 4 feet up.
7. Metal ladders, or ladders with wire reinforcements, shall not be used near energized electrical conductors.
8. All ladders erected between levels must be securely fastened, extend 90 centimeters (3 feet) above the top landing and afford
clear access at top and bottom.
9. Ladders with weakened, broken, bent or missing steps, broken or bent side rails, broken, damaged or missing non-slip bases or
otherwise defective parts shall not be used and should be tagged and removed from the site.
10. Ladders should not be used horizontally as substitutes for scaffold planks, runways or any other service for which they have not
been designed.
11. Workers on a ladder should not straddle the space between the ladder and another object.
12. Three points of contact should always be maintained when climbing up or down a ladder (two feet and one hand or one foot
and two hands).

Working from Ladders

A worker must wear a safety belt or safety harness with the lanyard tied off to either a fixed support or a lifeline whenever the
worker is:
- 3 metres (10 feet) or more above the floor; or
- above operating machinery; or
- above hazardous substances or objects.

SCAFFOLDS
1. The erection and dismantling of scaffolds must be carried out by personnel knowledgeable and experienced in such
operations.
2. Scaffolds must be erected with all braces, pins, screw jacks, base plates and other fittings installed as required by the
manufacturer.
3. Scaffolds must be equipped with guardrails consisting of a top rail, mid-rail and toe board.
4. Scaffold platforms must be at least 46 centimeters (18 inches) wide. If they are over 2.5 meters (8 feet) high they must be
planked across their full width.
5. Scaffolds must be tied in to a building at vertical intervals not exceeding three times the least lateral dimension, including
the dimension of any outrigger stabilizing devices.
6. Where scaffolds cannot be tied in to a building, guy lines adequately secured should be used to provide stability.
7. Scaffold planks must be installed in a manner that prevents them from sliding.
 8. Wooden scaffold planks must be of good quality, free of defects such as loose knots, splits or rot, rough sawn, they must
measure 51 mm x 25.4 cm (2 in. x 10 in.) in cross section and be made of No. 1 grade spruce or better when new.
9. Scaffolds must be erected, used and maintained in a reasonably plumb condition.
10. Scaffolds must be equipped with a proper ladder for access. Vertical ladders must be equipped with 15 centimeter (6 inch)
standoff brackets and a ladder-climbing fall protection device or safety cage when they are more than 5 meters (16 feet)
high.
11. Scaffolds over 15 meters (50 feet) in height must be designed by a professional engineer and constructed in accordance
with the design. These design documents must remain on site for the duration of the scaffold work.
12. Remove ice, snow, oil, grease and other slippery material from the platform.
13. Wheels or casters on rolling scaffolds must be equipped with braking devices and they must be securely pinned to the
scaffold frame.

(Note: Effective January 1st 2001, Workers who erect and dismantle scaffolding will be required to use a fall protection system while
doing so)

POWER ELEVATING WORK PLATFORMS

In addition to the specific manufacturer’s requirements for operating power elevating work platforms, such as scissor lifts and
boom-supported platforms and buckets, all operators must inspect such equipment each day and:
1. an operator’s manual must be kept with the elevating work platform while it is on a project.
2. be thoroughly familiar with all operating instructions and safe load limitations;
3. use three-point contact in mounting and dismounting the equipment;
4. keep the equipment free of slippery substances at all times;
5. ensure no obstructions or workers are in the direct path of the equipment’s operation;
6. keep all guardrails and gates secured during operations;
7. maintain proper distance from live electrical conductors or equipment at all times;
8. ensure safety belts or body harnesses are worn as required;
9. ensure the equipment rests on a firm, level surface;
10. the owner must keep a log of all inspections, tests, repairs, modifications and maintenance; and

ACCESS TO WORK AREAS

Ladders, scaffolds, swing stages, ramps and runways should be constructed, erected and secured in accordance with the Regulations
under the Act. When work areas are above or below ground, access to and egress from the work area shall be provided and
maintained in a safe condition. Proper and sufficient warning signs, tags or lockout devices shall be installed wherever hazards exist,
such as moving machinery, open excavations, temporarily removed manhole covers and electrical hazards.

HOUSEKEEPING, STORAGE AND TOOL MAINTENANCE

1. Materials and equipment should be stored, moved, piled and transported in a manner that will not endanger workers.
2. All compressed gas cylinders (oxygen and acetylene) must be stored in neat rows. Empty cylinders must be marked M.T. and
stored away from full ones. Cylinders must always be used from a cart or from an upright lashed position.
3. Concrete pipes shall be stored end to end whenever possible and each pipe shall be adequately wedged to prevent movement.
Where this method of storage is not possible and pipes have to be placed side by side, each batch shall be securely wedged. In
no cause shall pipes be stacked on top of one another.
4. Waste material and debris shall not be stored in areas of access and egress. Waste material and debris should not be thrown
from one level to another but be carried down, lowered in containers or deposited in a disposal chute.
5. Material to be lifted by a crane or other hoisting device shall not be stored under overhead power lines.
6. It is the employer’s responsibility to supply and maintain shop tools and other power equipment in good repair. It is the
worker’s responsibility to use such tools properly and to report any defect to the supervisor to ensure repair is initiated and
proper tagging of defective tools is carried out.

MATERIALS HANDLING LIFTING

1. Where practical, heavy lifts should be done with mechanical lifting devices.
2. When manual handling is required, dollies, trucks and similar devices should be used where practical.
3. Workers should know their physical limitations and the approximate weight of materials they are trying to lift. Workers should
be encouraged to get help when a lifting task may be more than they can safely handle.
4. The right way to lift is the easiest and safest. Take a firm grip; secure a good footing; place the feet a comfortable distance
apart; bend the knees; keep the back straight and lift with the leg muscles.
5. Use gloves or hand patches, as required, when handling sharp, rough, heavy or hot materials.
6. Never carry a load so large that it obstructs vision or too heavy that it cannot be safely lifted without assistance.

CHAINSAWS

Chainsaws can be very dangerous and must be only be used by a worker who has received training in it’s safe use.
Workers using chainsaws must wear appropriate personal protective equipment including gloves, eye and face protection and
hearing protection
Always follow the manufacturers recommendations when operating a chainsaw (Ballistic pants are usually recommended as well.)
Chainsaws must be held firmly when starting and held firmly with both hands while in use
Chainsaws must be equipped with safety chains and be provided with a device that stops the saw in the event of kickback.
The chain must be stopped when cutting

EXPLOSIVE ACTUATED FASTENING TOOLS

1. Explosive actuated tools must be used only by workers who have been instructed to operate the tools properly and safely.
2. Workers must carry proof of training with them when using explosive actuated tools
3. Workers using explosive actuated tools must wear impact-resistance eye-protection.
4. Hearing protection should be worn by workers using explosive actuated tools to fire into steel or in a confined space.

TRAFFIC CONTROL

Traffic Controllers and all employees working in traffic shall wear a reflective fluorescent and colored blaze orange or red vest, use
regulation approved signs and be protected by warning signs; flashing lights or flares, as required.
(Note: Effective January 1st 2001, traffic control signs must be high intensity retro reflective grade. Traffic vests must have a side
and front tear away feature and have stripes that are retro reflective and fluorescent)

FUELLING PROCEDURES

Caution must be exercised when refueling equipment. In some cases, regulations insist that internal combustion engines be shut off
during refueling. No smoking signs must be prominently displayed.

EXPLOSIVES

At the end of a shift on any project, the unused portion of both caps and powder must be returned to the magazine for overnight
storage. It is the responsibility of the licensed blaster to ensure this is done. Empty cartons must be disposed of correctly.
Government regulations governing the use of explosives must be followed. No blasting operations will be carried out during the
period of an electrical storm or the periods just before and after. All blasting will be done an employee who holds the proper
certificate.

WORK ON LIVE APPARATUS

Where it is necessary to work on a live electrical circuit with a potential of more than 300 volts, two or more journeymen must work
together. This does not apply to testing, service or troubleshooting.
Metal ladders, or ladders with wire reinforcing, must never be used by electrical workers working on live apparatus.
All apparatus capable of being electrically energized or dynamically activated must be de-energized or deactivated by locking off,
physically disconnecting or otherwise rendering the apparatus inoperable. Switches, power sources, controls, interlocks and other
such devices must be appropriately tagged and personally locked off by each worker involved in the operation.

ASBESTOS

Asbestos fireproofing and insulation can be found in many buildings. Disturbing this material during renovation, maintenance or
retrofitting can release hazardous dust.
For small scale jobs take the following precautions:
1. Wear disposable coveralls and a NIOSH-approved half-face mask respirator with high efficiency dust filters.
2. Use 4 or 6 mil. polyethylene as a drop sheet under, or as a tent around, the work area.
3. Wet asbestos before disturbing it. Do not remove more materials than necessary.
4. Put removed asbestos in plastic bags for disposal.
5. Clean up any fallen material by wet sweeping, damp wiping or using a High Efficiency Particulate Aerosol (HEPA) filtered
vacuum.
6. Wipe off the coveralls with a damp cloth before removing and disposing of them.

For further information, refer to the Regulation respecting Asbestos on Construction Projects… from the Ontario Ministry of Labor
and Asbestos in Construction, Volumes 1 and 2, from the Construction Safety Association of Ontario.

PROPANE/WINTER HEATING

Workers using Propane equipment must be trained in the safe procedures. This includes proper use and the correct storage,
handling of propane cylinders and equipment.

FIRE PROTECTION

Precautions shall be taken at all times to prevent the outbreak of fire in the workplace.
Fire extinguishers must be readily accessible, properly maintained, regularly inspected and promptly refilled after use.

Workers who may be required to use fire protection equipment must be trained.

In addition to being familiar with the operation and location of all firefighting equipment, all employees should be aware of the
various categories of fire extinguishing equipment according to their capacity for handling specific types of fires.

The following are the three main classes of fire extinguishers, with their applications and symbols:

WORKPLACE HAZARDOUS MATERIALS

INFORMATION SYSTEMS

LABELS

All hazardous materials will be identified in accordance with the Workplace Hazardous Materials Information System (W.H.M.I.S.)
requirements of the Occupational Health & Safety Act.
MATERIAL SAFETY DATA SHEETS

Material Safety Data Sheets (M.S.D.S.’s) provide more in depth information than is given on supplier labels. M.S.D.S.’s are available
from your foreman or project superintendent.

EMPLOYEE TRAINING

All employees must be trained in, and know how to, recognize hazardous materials; read and understand labels and M.S.D.S.’s; and
know how to work with hazardous materials in a safe manner.
Workplace specific training will be provided to new employees by their foreman.
Employers to conduct annual update and review of program.

W.H.M.I.S. HAZARD SYMBOLS

PROCEDURES IN CASE OF INJURY

MANAGEMENT’S RESPONSIBILITIES
First Aid Only:
- Ensure first aid will be administered immediately by a certified person.
- The first aid treatment will be recorded on the Injury Treatment Record, form RF1.

Medical Attention Required:

- Provide treatment memorandum and transportation to medical attention.
- Submit report to Ministry of Labour in case of serious injury.
- Submit Employer’s Report of Accident (Form 7) to the Workers’ Compensation Board within three days (with a copy to the union
office, where applicable).

Modified Work:
- Often an injured worker will be capable of performing duties that will not aggravate the injury. Wherever possible, this company
will endeavour to provide immediate, suitable modified work in order to avoid a possible loss in wages for injured employees.

Lost Time From Work Required:

- Pay wages for the day of injury.
- Monitor the employee’s recovery.
EMPLOYEE’S RESPONSIBILITIES
- Obtain first aid promptly.
- Report injury immediately to your supervisor.
- Ensure you are accompanied by management to a hospital or medical clinic.
- Obtain a Treatment Memorandum form from the supervisor when medical attention is required. Ensure this form is completed by
the first doctor to treat you and return it to your supervisor without delay.
SAMPLE
TREATMENT MEMORANDUM FORM

Practitioner/Hospital: This worker claims to have been injured in our employ and requests treatment. We, the employer, are
sending a report to the Workers’ Compensation Board.
EMPLOYEE
LAST NAME:_____FIRST NAME:________S.I.N.___/___/___
ADDRESS:_________CITY:________ POSTAL CODE______
EMPLOYER:
FIRM NAME: _______________________________________
ADDRESS:__________CITY:_______POSTAL CODE______
DATE OF INJURY HOUR OF INJURY
D /M /Y M

DATE REPORTED HOUR REPORTED

D /M /Y M

NAME OF COMPANY OFFICER: DATE:________

DESCRIPTION OF NORMAL JOB ACTIONS & REQUIREMENTS: ___________________________________

Dear Doctor:
Our employee appears to have been injured. We do not wish to see him/her lose any income. If he/she is able to return to lighter
duties which would not aggravate the injury, please indicate all physical restrictions below. We assure that all restrictions will be
accommodated and we will continue his/her employment without any reduction in wages.
DIAGNOSIS:________________________________________
MECHANISM OF INJURY:____________________________
SPECIFIC RESTRICTIONS:____________________________
TREATMENT:_______________________________________
Doctor’s advice to company supervisor:
1. Yes__, No __, employee may return at once to normal work, with no restrictions.
2. Yes__, No__, employee may return to modified work with the following restrictions:
3. __Lifting,__Climbing,__Sitting,__Walking,__Driving,__
*Other
4. Duration of restrictions:_______Days,_______Weeks

OR:
Employee will probably be absent: _____Days,____Weeks
Doctor’s Signature __________________Date____________
Employee’s Authorization ______________Date__________
 FIRST AID
SHOULD AN ACCIDENT OCCUR, IT IS ESSENTIAL THAT FIRST AID BE ADMINISTERED IMMEDIATELY, FOLLOWED BY PROPER
MEDICAL TREATMENT IF NECESSARY.
Basic First Aid
1. A first aid kit with required contents will be available at each workplace.
2. There will be a certified first aider on each shift.
3. All new employees will be advised of the location of the first aid kit, and the person holding a first aid certificate.
4. Each first aid kit will contain an Injury Treatment Record, form RF1. Any use of the first aid kit will be recorded, including details of
the injury, the injured person’s name, the date and time of first aid treatment, the nature of the treatment and the name of the
person rendering treatment.
5. This record is required legally and compliance will be strictly enforced

INJURY TREATMENT RECORD (RF1)

 EMERGENCY PROCEDURES

Emergency Procedures

BRIEFING NEW EMPLOYEES

All new employees will be assigned to a supervisor or foreman for their initial job orientation.
Prior to beginning work, a new employee will be briefed on the following:
1. The contents of, and the need to be familiar with, the contents of this manual.
2. This company’s commitment to safety and emphasis on working with a safety-first attitude.
3. Location of workplace facilities such as the first aid station, fire extinguishers, emergency exits and toilets.
4. Workplace specific hazardous materials or substances and proper handling procedures (see W.H.M.I.S.).
5. The name of the health and safety representative on the project.
6. Special emphasis on accident prevention, procedures in case of accident and this company’s modified work policy.

The Workplace Safety Orientation Checklist must be completed by the supervisor after each new employee orientation. This
checklist must be signed and returned to head office.
 EMPLOYEE’S CONFIRMATION OF RECEIPT AND UNDERSTANDING
I, _______________________ understand and
Agree to work in compliance with this company’s Health & Safety Policy and Reference Manual as well as the requirements of the
Occupational Health & Safety Act.
Date: ___________________________

Employee’s Signature: _____________________

Date: ____________________________

Supervisor’s Signature: _____________________

SUPERVISOR’S ACKNOWLEDGEMENT
I acknowledge that I have reviewed the Safety Policy and Reference Manual of this company with
__________________________and in my opinion this employee has an understanding thereof.

Supervisor’s Signature
Date: ___________________________
 SAMPLE

WORKPLACE SAFETY ORIENTATION CHECKLIST

1. I have issued and reviewed the contents of this Safety Policy and Reference Manual with the new
employee…………………………………………..__
2. The employee’s Confirmation of Receipt and Understanding has been submitted to head office……………………………………………….__
3. The name of the Safety Representative has been given to the new employee……………………………….__
4. The employee is aware of and will comply with the following requirements:

(i) Personal Protective Equipment

Safety…………………………………………...__
Boots……………………………………………__
Hard Hat………………………………………..__
Eye Protection………………………………….__
Hearing Protection……………………………..__
Respiratory Masks……………………………..__
Safety Belts, Harnesses and Lanyards
Lifelines………………………………………..__
Other…………………………………………..__
(ii) Accident Prevention
Proper Lifting and material handling……………__
Workplace specific hazardous materials…………__
Housekeeping…………………………………….__
Conduct and behaviour ………………………….__
Tools and equipment…………………………….__
Equipment maintenance…………………………__
(iii) Fire Protection, equipment location and
Use, and emergency procedures…………………__
(iv) First Aid Procedures and Location……………….__
(v) Accident Reporting Procedures
Including modified work policy………………….__