Safety Award

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
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
NEW THIS YEAR: Please note that each question now has a 7,000 character maximum.
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.
Joint health and safety committee (5)
Explain how participation in the JHSC works at your organization, as well as how often it meets, how meetings are documented and any training participants receive.
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(5)
Describe how you are communicating safety messages.
Health and wellness (10)
Describe your health and wellness program.
Innovative approach (10)
Describe, if any, some of the innovative approaches and programs around health and safety (not previously mentioned) that you have implemented and the result of those programs.
Injury / incident investigation (5)
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)
Total number of lost-time injury
Total number of medical aid incidents
Total number of other incidents (with no lost-time and no medical aid)

Full time equivalents (includes full time, part-time and casual employees)
If you wish, you can use the space below to provide more information or elaborate on your injury statistics.
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.

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Deadline for submission: June 1
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