Firm Name:
/ Date:
WSIB Account #: / WSIB Firm #:
Completed by:
Job Title: / Telephone:
Email:
2015 Advantage Program / Completed Program Requirements
(Refer to the 2015 Employer
Requirements for details) / Ongoing Program
Requirements to complete / Assignment of Responsibilities
Reviewed / Due Dates
Reviewed
1. Write & Implement Standard for HSMS Audit Program:
/ ☐Write or Review & implement standard (policy & procedures) for HSMS Audit Program including:☐Current (2015) date
☐Company reference
☐Roles & Responsibilities
☐Auditor qualifications
☐Documented Audit Plan
☐Documented Continual Improvement Plan (CIP) process.
2. Auditor Training:
(Refer to page 4 & 7 of 2015 Employer Requirements for qualification standard) / ☐Specify Auditor training qualifications in the written standard.
☐Train or verify Auditor(s) meet the specific qualifications of the written standard.
3. Review 2014 HSMS Audit and Continual Improvement Plan (CIP): 1st year SGAP firms review 2014 or most recent, Evaluation and Making Improvements steps. / ☐Auditor formally reviews 2014 or most recent HSMS Audit and CIP (or SG Evaluation and Making Improvements) for deficiencies.
4. Complete an approved
2015 HSMS Audit: / ☐Select and complete an approved HSMS Audit, by the qualified Auditor(s).
☐The selected HSMS Audit must include a Return-to-Work (RTW) section that is audited to the WSIB Work Reintegration (WR) Operational Policies.
☐All supporting audit evidence documented/listed for each audit requirement.
☐Based on the audit evidence a stated audit finding is documented for each audit requirement.
☐Auditor(s) sign and date completed audit.
☐Documented evidence of completed audit being reviewed and accepted by Senior Management.
5. Develop and Implemented a documented 2015 HSMS Audit Continual Improvement Plan (CIP) / ☐All 2015 HSMS Audit non-conformities, and 2014 Audit Review deficiencies prioritized on 2015 CIP with detailed action points to resolution with responsibilities assigned and timelines established.
☐CIP must start in 2015 and all remaining non-conformities are started within 6 months of audit completion.
☐Documented evidence of 2015 CIP being reviewed and approved, by Senior Management.
☐Documented quarterly reviews of the CIP by Senior Management until all non-conformities/deficiencies are corrected.
Signature/Title/Date: / Joint Health & Safety Representative(s) (Optional):