Guide To Workplace Health & Safety Programs
Guide To Workplace Health & Safety Programs
INTRODUCTION
ABOUT THIS GUIDE
This guide is for employers, employees, joint health and safety committees (JHSCs), and health and safety (H&S)
representatives. It will help you prepare and maintain your written health and safety program. This guide describes the
elements of a formal health and safety program, and the roles and responsibilities of those preparing and maintaining the
program. It will also assist your workplace in complying with the requirements of the Occupational Health and Safety (OHS)
Act to develop and implement an effective health and safety program.
Having a safe work environment where prevention is a priority to an organization’s success is important to all workplace
parties – employers, employees, supervisors and managers, and JHSC members and H&S representatives. A business that
incorporates safe work practices into its daily work routine can realize savings in human and financial costs.
LEGAL REQUIREMENT
A health and safety program is required under the OHS Act for provincially-regulated employers in New Brunswick with 20 or
more employees regularly employed.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative.
The program requirement is tied to employers, not workplaces. Therefore, employers must take into account all of their
operations in the province of New Brunswick. If, for example, an employer has an operation in one location with 15 regularly
employed employees and another five regularly employed employees in another location, the employer will be required to
comply with the provisions of subsection 8(1) to establish a safety policy and 8.1(1) for a program..
Contractors and sub-contractors must have a program if they have 20 or more employees directly employed. Sub-contractors
and their employees working for the contactors would not be counted in the number.
This guide will help you comply with the health and safety requirements for your workplace. It should be noted however that
your health and safety program may not address all health and safety matters found in your workplace. A thorough review of
the OHS Act and the regulations may be necessary to verify this fact.
WorkSafeNB cannot reasonably monitor the safety activities of each and every New Brunswick workplace; therefore, employers
and employees must work together together to develop the workplace health and safety program and ultimately must take
responsibility for their own safety.
However the legislation requires consultation with employees before implementing the program. Consulting employees about
health and safety can result in many positive outcomes including:
Consultation involves the employer not only giving information to employees but also listening to them and taking account of
their views before making any final health and safety decisions. Consultation does not remove the employer’s right to manage.
They will still make the final decision. However, talking to employees is an important part of successfully managing health and
safety at the workplace.
The legislation requires that the JHSC or H&S representative be consulted on all matters pertaining to the health and safety
program. The JHSC (or H&S representative) is responsible for helping to monitor the program’s effectiveness. Committee
members are encouraged to contribute to the program’s development by ensuring that the topic of health and safety program
monitoring and review becomes a standing item of the committee’s business, or, in the case of H&S representatives, any other
meetings that occur in the workplace that address health and safety matters.
Health & Safety Representatives • Make recommendations on health and safety issues.
• Take employee health and safety concerns to management.
Consider three main factors of due diligence in the event of an incident or accident that could lead to prosecutions and other
liabilities:
1) Was the event foreseeable? Was the event so unlikely that you or your peers would never have expected it to occur?
2) Was the event preventable? Were the hazards identified? The workers trained and supervised? Were they disciplined for
safety infractions? Were safe work procedures enforced?
3) Did you have control over the circumstances? If it is within your authority to control the hazard, did you do it?
Here are the required components of the health and safety program:
Keep in mind that a policy sitting in a filing cabinet does not change anything. Even the best policy will be ineffective if it’s not
properly used – and that starts with communicating it!
The sample policy at Appendix A provides a more detailed format for addressing the required elements.
14(1) Every employer with 20 or more employees regularly employed at a place of employment shall ensure the
establishment of a joint health and safety committee.
14.3(2) A contractor who is responsible for a project site shall ensure that a joint health and safety committee is
established within two weeks after the criteria set out in subsection (1) have been met.
14.4(2) This section applies to a project site that has five hundred or more employees working on the site at any time.
14.4(3) A contractor who is responsible for a project site shall ensure that a joint health and safety committee is
established within two weeks after the criterion set out in subsection (2) has been met.
17(1)Subject to subsection (2), every employer with not fewer than five and not more than nineteen employees
regularly employed at a place of employment shall establish a safety policy in respect of that place of employment which
may include provision for a health and safety representative.
A JHSC is a group of employee and employer representatives working together to identify and solve health and safety problems
at the work site. The committee’s primary purpose is to facilitate communication in the workplace on health and safety issues.
An effective committee is a vital component of your health and safety program, and will help reduce losses associated with
injury and illness.
A H&S representative is normally an employee with no supervisory duties who is responsible for advising management on
behalf of employees at a workplace on health and safety issues. This may include hazards, complaints, PPE, safety policy and
program, and general improvements to make the workplace safe for all employees.
A committee is required in a workplace regularly employing 20 or more employees unless the workplace is a project site. The
JHSC requirements for a project site are addressed in sections 14.2 to 14.5 of the OHS Act. Smaller employers, specifically
those employing between five and 19 employees, can choose to designate a H&S representative or may be ordered to do so by
WorkSafeNB (section 17 of the OHS Act) if it deems your workplace a high risk to the health and safety of employees or your
workplace is experiencing an increase in incidents.
When carrying out their functions with respect to a program, both the committee and representative should be granted access
to a level of management with authority to resolve occupational health and safety matters.
OTHER DUTIES
The duties and tasks of the JHSC members and/or representative should be specified in writing, posted in the workplace, and
a copy issued to the representative or to each committee member. The committee’s function should be written into its terms
of reference. Duties should be discussed, either individually with a representative or with the committee, to ensure everyone
understands their role and its importance. Section 14 of the OHS Act provides further requirements, roles and responsibilities
of JHSCs (Section 17 of the Act for H&S representatives).
JHSC: The following are some activities common to committees and representatives with respect to safety programs in the
workplace:
Now that a JHSC (or H&S representative) has been established, it is necessary for the employer to ensure that workplace
inspections are completed monthly. Inspections can be carried out by supervisors, the JHSC, the H&S representative or any
other person trained to carry out inspections. Additionally, while the legislation mandates workplace inspections be done
at least once a month, depending on the nature of the issue or requirements of legislation and the regulations, required
inspections may be daily, annual or other frequencies as recommended by equipment manufacturers. Areas to consider for
inspections include the physical areas where employees carry out their duties, process and mobile equipment and PPE. All of
the inspections requirement should be identified through the inspections provision required by subparagraph 8.1(1)(d)(ii)
of the Act.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(d) a hazard identification system that includes:
(ii) procedures and schedules for inspections
9(2) Without limiting the generality of the duties under subsection (1), every employer shall
(a.1) ensure that the place of employment is inspected at least once a month to identify any risks to the health
and safety of his employees;
9(3) An employer shall develop a program for the inspection referred to in paragraph (2)(a.1) with the joint health and
safety committee, if any, or the health and safety representative, if any, and shall share the results of each inspection
with the committee or the health and safety representative.
While the entire workplace requires inspections at least once a month, you can use your hazard identification system (see
Step 5) and incident history to help identify areas that may require more frequent inspections. A review of the regulations may
identify other matters subject to inspections. Also, there are examples of checklists available at www.ccohs.ca and through
www.worksafenb.ca. With respect to the regular inspection of the workplace, the workplace can be divided into sections, each
with its own inspection schedule.
Recommendations must be followed up to ensure that action was taken and that it was effective. Also, sometimes the
recommendations themselves may cause an unsafe condition that was not planned. It is important to indicate who will do the
follow-up, both in any training schedules and on posted schedules, as well as when and where the inspection or action will
be recorded. For example, if a serious hazard is noted (from daily inspection of a forklift), list who will be responsible for
immediate control.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(e) a system for the prompt investigation of hazardous occurrences to determine their causes and the actions
needed to prevent recurrences;
Regular workplace inspections are meant to identify unsafe conditions before they lead to an incident. However, when an
incident occurs, it is vital to investigate it to prevent future incidents. Workplace injuries are preventable but if an incident
occurs, an investigation should be conducted to find the root cause(s). Finding the root causes and direct causes will help the
JHSC or H&S representative recommend action to prevent it from happening again. Look at all the factors leading up to the
incident as there will likely be several causes.
It is important that the employer, in consultation with the JHSC or H&S representative, develop a set of procedures to follow for
the incident, investigation process. The intent of the investigation is to prevent a recurrence, NEVER to lay blame.
There is great benefit in conducting near miss investigations. Near misses often result in an injury at some point.
Research quoted by the Industrial Accident Prevention Association indicates there are 189 incidents for every three lost-time
injuries. Recording near misses can be as simple as keeping a notebook for employees to record minor incidents or near
misses. The JHSC or H&S representative can then review the notebook and make recommendations for change.
Remember that incidents and near misses are warning signs that something is wrong in the workplace. The purpose of an
investigation is to determine all incident causes and to make the necessary changes. An investigation form should be used
to conduct an investigation to document findings and the recommendations to prevent recurrence. Persons designated to
conduct investigations should be trained in the task. While the workplace decides the people responsible, they can include the
department supervisor, members of the JHSC or the H&S representative.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(d) a hazard identification system that includes:
(i) evaluation of the place of employment to identify potential hazards,
(ii) procedures and schedules for inspections, and
(iii) procedures for ensuring the reporting of hazards, prompt follow-up and control of the hazards;
A hazard is anything (a condition, situation, practice or behaviour) with the potential to cause harm—including injury,
disease, death, environmental or property and equipment damage.
A hazard identification system is a list of all the hazards in the different work areas and ways to control those hazards.
Essentially, it involves looking closely at work tasks to recognize where potential injury and harm could occur and be
controlled. For example, employees on a production line may have a long reach to bring product closer to them on the line.
This over-reaching may cause employees to experience shoulder and back pain. In a hazard identification system, this hazard
would be noted and it may be recommended that the workstation be redesigned so employees do not reach too far to access
the product.
A careful examination of work practices in your workplace provides essential information for building an effective health and
safety program. By using the hazard identification system in your workplace, you will identify high risk tasks, break down each
task into steps, identify potential hazards in each step, and suggest ways to control or eliminate the hazard.
GETTING STARTED
To start the hazard identification process, many companies designate and provide training to person(s) responsible to
establish and implement the system. This person may be a supervisor familiar with the work and needs to work co-operatively
with people doing the work. The co-ordinator must use employee input to identify the hazards in each task, find the safest way
to work, and help write and train everyone in the correct procedures.
Some workplaces may seek outside help by hiring a consultant. If possible, choose one with experience in your type of business.
They can help you set up the initial hazard identification plans and work procedures and put a monitoring system in place.
Ideally, all jobs in a company should be subjected to the hazard identification analysis. In some cases, however, there simply is
not enough time to do a thorough analysis. Also, each hazard identification analysis needs updating whenever any equipment,
raw materials, processes, or the environment change. For these reasons, it is usually necessary to narrow down which jobs are
to be analyzed.
The hazard identification system or job hazard analysis identifies high-risk tasks and breaks down each task into steps as
above. This process should result in a record of hazards. The next step is to use the job hazard analysis as a basis for all
procedures, training, orientation, and monitoring requirements.
See Appendix D for examples of hazards, ways to control them, and the resulting work procedures that are developed from
the process.
Work procedures are step-by-step instructions that describe the way a task must be done for improved health, safety,
efficiency or accuracy. Here’s what the OHS Act says about making written work procedures a part of your company’s health
and safety program:
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(b) the preparation of written work procedures and codes of practice for the implementation of health and
safety work practices, required by this Act, the regulations or by any order made in accordance with this Act;
(c) the identification of the types of work for which the work procedures are required at the places of
employment of the employer;
Using the results found from the hazard identification process in the previous step, write the correct work procedures for each
critical task identified.
Because employees know their job tasks better than anyone, they should be involved in developing safe work procedures.
This will also give employees a sense of ownership for their own work and for the health and safety program.
Once you have the results of regular work inspections from the JHSC or H&S representative, have carried out the hazard
identification process, and have consulted with your injury records and with employees doing the tasks, you are ready to begin
writing safe work procedures.
3. Include a brief explanation of why the work must be done in this way. Procedures will more likely be followed if the
reasons are understood.
Example: “Handling garbage safely will help prevent contact with sharp objects and other items improperly discarded in
waste.”
4. Include the requirements for PPE. Remember that removing, substituting or reducing the hazard is preferable to the use
of PPE.
Example: “Wear puncture-resistant and liquid-resistant gloves at all times when handling waste.”
5. Consider the environment in which the work will be performed. How will this impact the work?
Example: “In areas where more waste is generated, frequently change bags to prevent them from getting too full. This will
also make them lighter and easier to hold away from the body.”
Note: Make sure everyone reads and approves the procedure, in particular the person(s) doing the job. Consider having the
JHSC or H&S representative review it.
Compliance with these rules should be considered a condition of employment. Supervisors are responsible for monitoring and
enforcing the use of proper procedures. Accurate written procedures, with records of training and supervision, are a big part
of a due diligence defence.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(d) a hazard identification system that includes:
(iii) procedures for ensuring the reporting of hazards, prompt follow-up and control of the hazards;
• Emergency response
• Training and orientation
• Reporting near misses and accidents
• Reporting on inspections and follow-up
• Discipline
• Monitoring and follow-up
An effective health and safety program ensures that everyone in the workplace is educated in their responsibilities for following
safe work procedures. It also ensures employees are trained in how to protect their own health and safety as well as others
at or near the workplace. Ensuring all employees take this responsibility seriously shows that the employer is serious about
preventing injury and illness in the workplace.
Evacuation is a primary component of most emergency plans. Start with a floor plan and note the location of the primary
hazards. Plan exit routes from all parts of the workplace. Add alternates if any of these could be blocked. Try to have the exit
routes away from the major hazards. Make a list of possible emergencies in your workplace.
Develop an evacuation plan and ensure everyone is aware of it. Most importantly, practise!
Safe work procedures are an excellent tool as long as they are actually put to use and not ignored. All employees must be
familiar with the procedures so they can do their jobs as safely as possible. Doing their jobs safely starts with employees being
trained and oriented, an important component of the health and safety program. A program that includes consistent training
and orientation of employees is one that will help everyone in the workplace take their health and safety responsibilities
seriously and help reduce injuries.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(a) the training and supervision of the employees in matters necessary to their health and safety;
8.2(2) The employer shall ensure that a new employee receives orientation and training specific to the new employee’s
position and place of employment before the new employee begins work.
Training involves hands-on, job-specific instruction provided individually or in small groups to employees. It often includes
demonstrations and active participation by employees so that supervisors can confirm that employees understand safe work procedures.
Orientation is a process designed to help new and young employees adapt to a new work environment. A strong safety culture
will be communicated to new employees at this stage, and expectations with respect to safe behaviours must be clearly stated.
Hands-on training also begins at this stage.
8.2(1) For the purposes of this section, “new employee” means an employee who is
(a) new to a position or place of employment,
(b) returning to a position or place of employment in which the hazards have changed during the employee’s absence,
(c) under 25 years of age and returning to a position or place of employment after an absence of more than six
months, or
(d) affected by a change in the hazards of a position or place of employment.
8.2(4) The orientation for a new employee shall include the following:
(a) the name and contact information of the new employee’s supervisor;
(b) the contact information of the committee or the health and safety representative;
(c) the new employee’s rights, liabilities and duties under this Act and the regulations, including reporting
requirements and the right to refuse to perform an act under section 19;
(d) the health and safety procedures and codes of practice related to the new employee’s job tasks;
(e) the location of first aid facilities and how to obtain first aid;
(f) the procedures related to the reporting of illnesses and injuries;
(g) the procedures related to emergencies; and
(h) the use of personal protective equipment, if applicable.
Every new construction site should have an orientation session to cover issues such as location of hazards, first aid kit, first aid
providers, and communication equipment and protocols.
Training is required in all work procedures that apply to the individual’s job as well as all emergency response and reporting
procedures. Inadequate performance of procedures is a reason to retrain. Repeated problems with the use of correct work
procedures may also be a signal to review how effective the procedures are and the reasons for noncompliance (for example,
employees are not properly reporting hazards because the procedure is too complicated).
9(2)Without limiting the generality of the duties under subsection (1), every employer shall
(c.1) provide the instruction that is necessary to ensure an employee’s health and safety;
(c.2) provide the training that is necessary to ensure an employee’s health and safety;
The health and safety program should include the following factors:
• The identification of the person(s) responsible for each type of training. Communicate this to staff.
• Keep records for three years of all training done, including type, instructor, dates and attendees.
• Allow time for clarification and questions.
• Make demonstration and practice a part of the training.
• If PPE is to be used, provide training on appropriate use, cleaning, maintenance and fit.
Remember—Supervisors are responsible for ensuring safe work procedures are followed.
• First aid
• WHMIS
• Material Safety Data Sheets
• Lock out procedures
• Material handling rules(how heavy material is lifted and moved, for example)
• Maintenance schedules and operations
• Working alone guidelines
• PPE: guidelines for use
• Fall protection
• Confined space procedures
• Forklift operation procedures
• Rescue from confined space or after a fall in fall arrest equipment
• Emergency procedures
• Electrical hazards
• Safe hazardous materials handling
SUPERVISION
Ensuring everyone practises safe work procedures
9(2)Without limiting the generality of the duties under subsection (1), every employer shall
(c.3) provide the supervision that is necessary to ensure an employee’s health and safety;
Once safe work procedures are in place, and once requirements for training and orientation are met, there must be adequate
supervision of employees. Adequate supervision ensures that employees are actually following the safe work procedures. Due
diligence requires consistent enforcement of health and safety standards. Failure to do this can make the supervisor liable in
the event of an injury.
A discipline process begins with a discipline policy. The policy needs to be clear, fair and consistently applied. Making
employees familiar with the discipline policy and enforcing it will clearly deliver the message that safety infractions are not
acceptable. Infractions can include failure to wear PPE, failure to follow safe work procedures, or harassment or horseplay at
the workplace. Disciplining employees on safety infractions must be followed up by a written record; therefore, keep records
on the monitoring of safe work procedures and on the use of the discipline policy.
It is sometimes helpful to divide health and safety violations into serious and minor categories. In all cases, a record should be
kept in the employee’s file.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(f) a record management system that includes reports of employee training, accident statistics, work procedures
and health and safety inspections, maintenance, follow-up and investigations;
8.1(3) The employer shall make a copy of the program and all records available
(a) to the committee or the health and safety representative, and
(b) on request, to an employee at the place of employment or the Commission.
Written records and statistics can help identify trends for unsafe conditions or work practices so you can take steps to correct
these potential hazards. To establish due diligence, records must be kept of all the components of the health and safety
program as it is developed and used.
COMPARING INJURY RATES IS ONE OF MANY INDICATORS USED TO MEASURE SUCCESSFUL PROGRAMS.
8.1(1) Every employer with 20 or more employees regularly employed in the Province shall establish a written health
and safety program, in consultation with the committee or the health and safety representative, that includes provisions
with respect to the following matters:
(g) monitoring the implementation and effectiveness of the program.
8.1(2) The employer shall review its health and safety program at least once each year, in consultation with the
committee or the health and safety representative, and shall update the program as required.
It is important to know whether your safety program is actually working. The evaluation process should reveal that the
program is achieving its objectives (as stated in your health and safety policy) and is addressing new or emerging safety issues.
One way to monitor your program is by tracking and comparing incident and injury statistics. Fewer incidents may indicate
that your program is effective.
Monitoring the program’s effectiveness is, in part, a role of the JHSC. This is done through regular workplace inspections,
identification of hazards, investigating incidents and near misses and concerns from all employees. Ultimately, though, the
responsibility for effectiveness lies with supervisors and managers. They are responsible for responding to and following up
on all recommendations made by the JHSC or H&S representative, as well as any changes that were made as a result of those
recommendations.
A procedure should be developed to regularly evaluate and revise the program. The procedure should clearly identify
responsibilities for monitoring and evaluating the components of the program. Accountability will ensure that the program is
kept current and active. Keeping the program current and active involves the following:
• Yearly evaluation.
• Assigning appropriate people to review the program gradually over the year to make the task easier.
• Involving the JHSC or H&S representative in evaluating and revising the program. Legally, they are not responsible for the
evaluation, but rather for participation. The employer is ultimately responsible.
• Making the program accessible to your JHSC or H&S representative, to any employee upon request, and to an officer on
request.
POLICY
is committed to providing a healthy and safe work environment for its workers and preventing
occupational illness and injury. To express that commitment, we issue the following policy on occupational health and safety.
As the employer, is responsible for the health and safety of its workers.
will make every effort to provide a healthy and safe work environment. We are dedicated to
the objective of eliminating the possibility of injury and illness.
As , I give you my personal promise to take all reasonable precautions to prevent harm to workers.
Supervisors will be trained and held responsible for ensuring that the workers, under their supervision, follow this policy.
They are accountable for ensuring workers use safe work practices and receive training to protect their health and safety.
Supervisors also have a general responsibility for ensuring the safety of equipment and facility.
through all levels of management, will co-operate with the joint occupational health and safety
committee, (if you have one) or the representative and workers to create a healthy and safe work environment. Co-operation
should also be extended to others such as contractors, owners, officers, etc.
The workers of will be required to support this organization=s health and safety initiative and
to co-operate with the occupational health and safety committee or representative and with others exercising authority under
the applicable laws.
It is the duty of each worker to report to the supervisor or manager, as soon as possible, any hazardous conditions, injury,
accident or illness related to the workplace. Also, workers must protect their health and safety by complying with applicable Acts
and Regulations and to follow policies, procedures, rules and instructions as prescribed by .
will, where possible, eliminate hazards and, thus, the need for personal protective equipment.
If that is not possible, and where there is a requirement, workers will be required to use safety equipment, clothing, devices
and materials for personal protection.
recognizes the workers duty to identify hazards and supports and encourages workers to play
an active role in identifying hazards and to offer suggestions or ideas to improve the health and safety program.
Signed: Title:
This policy has been developed in co-operation with the joint health and safety committee, health and safety
representative or workers.
28
1/day 1/m 1/3 m 1/12 m Yes No
A) GENERAL WORKPLACE CONDITIONS
Floors, Aisles and Passageways X
Exits, Stairs and Handrails X
Lighting X
Ventilation X
Workstations X
Parking X
Washrooms X
Lunch Room X
APPENDIX B
WorkSafeNB
Industrial Lift Truck (Forklift) X
Overhead Hoist Log Book (>1,815 kg / > 2 tons) X X
Other Hoisting Apparatus (>1,815 kg / > 2 tons) X X
E) APPROPRIATE TRAINING OR CERTIFICATION X
Other
SAMPLE WORKPLACE INSPECTION REPORT FORM
F) WHIMIS
MSDS X X
Hazardous Products X
User Training X
G) PROTECTIVE EQUIPMENT (PPE)
PPE Zone Warning Signs X
Adequate Eye Protection X
Safety Boots X
Protective Handware X
Respiratory Protective Equipment X
Adequate Ear Protection X
Appropriate Sound Level Signs X
Adequate Protective Clothing X
Fall-Arresting Systems X
Other X
H) EMERGENCY MEASURES
First Aid X
Emergency Showers X
First Aid Provider List X
Eye-wash Showers X
Emergency Numbers X
Emergency Lighting X
Alarm and Fire Detection Systems X
Fire Extinguishers X
Other X
APPENDIX C
INCIDENT/INJURY INVESTIGATION REPORT FORM
ACCIDENT/INCIDENT INVESTIGATION REPORT
Date of accident / incident (mm/dd/yy): Date reported (mm/dd/yy):
Time: A.M. P.M. Time: A.M. P.M
To whom reported:
Is there a written job procedure for the job being performed when the accident/incident occurred? Yes No don’t know
Identify equipment/material involved (make and model, size, weight, shape where pertinent)
Witness name (#1): ______________________ Witness name (#2) _____________________ Witness name (#3) _____________________
Contact Information: Contact Information: Contact Information:
Describe how the accident/incident occurred: Sketch, diagram and/or additional notes
STEP 2 - Circle the letter(s), which best identif(y)ies the loss potential if the hazard(s) is (are) not eliminated or controlled.
L ACTUAL / POTENTIAL SEVERITY
O
S PROBABILITY Death, permanent Lost-time injury or Medical aid injury only First aid injury only
S OF total disability or property damage or property damage or
P RECURRENCE property damage › $10,000 › $1,000 property damage
O
T › $100,000 ‹ $100,000 ‹ $10,000 ‹ $1,000
E
N Frequent A D G J
T
I Occasional B E H K
A
L Rare C F I L
C
A
U
S
E
S
B STEP 5: . Place mark to identify the basic/root cause(s) that caused or could have caused this accident/incident
A
Lack of training/skills Inadequate maintenance
S
Inattentive Inadequate tools & equipment
I
Rushing (in a hurry) Inadequate work standards
C Not following SOP (Standard operating procedures) Wear & tear
Improper motivation Abuse & misuse
/ Inadequate leadership & supervision Other (specify) ____________________________________
Inadequate engineering
R Inadequate purchasing
O
O
T How did the basic/root cause(s) contribute to the accident/incident? (Brief description)
C
A
U
S
E
S
___________________________________________________________ __________________________________________________________
WorkSafeNB
Phone: 1 800 222-9775
www.worksafenb.ca
Government of Australia
www.safetyline.wa.gov.au/
WorkSafeBC
http://www.worksafebc.ca
Worksafe bulletins provide health and safety details for different sectors.