Young Worker Safety

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.
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 safety perception survey to your employees who are under the age of 25, provided by the
Canada’s Safest Employers organizing committee, 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, have you incurred any workplace fatalities? (If yes, please explain)
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.)
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
What percent of your employees are under 25 years of age?
Please note that each question has a 7,000 character maximum.
In what capacity do you employ young workers? (e.g. largely seasonal or regularly throughout the year) (5 points)
How do you determine what work is suitable for young workers? (5)
Do you conduct a hazard assessment specifically for the types of hazards young workers may encounter? (5)
How does a young worker’s immediate manager as well as upper management demonstrate a commitment to young worker safety? (5)
How do co-workers participate in young worker safety? For example, do you have a mentorship program or buddy system in place? (5)
Please describe your orientation program for young workers? How do you deliver it in a way that resonates with this age group? (10)
What additional training do you offer young workers? (10)
What tools and equipment do you offer young workers so they can do their job safely? (5)
How do you make sure young workers are aware of their fundamental safety rights and communicate safety messages? (10)
How do you engage these workers in safety and make sure it is a priority for them? (10)
Do you educate young workers about more than just traditional safety risks, such as workplace harassment and bullying? (5)
What are some innovative health and safety programs around young worker safety not mentioned above? (10)
What inspires you to make young worker health and safety a priority? (5)
Injury statistics in the last three years (5)
Lost time injury frequency rate


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: May 24
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