AlbertaForest Products Association

PIR – II

Enhanced Health and Safety

Audit Report

Prepared for:

Prepared by:

Audit Date(s):

Last Revised 20120514PIR – II Enhanced Health and Safety Audit

Report Template

Table of Contents

Executive Summary......

Description of Activities......

Audit Summary Sheet......

PIR-II Summary Score Sheet......

PIR I Reconciliation Score Sheet......

1. Leadership Commitment......

2. Hazard Assessment......

3. Hazard Control......

4. Training of Workers......

5. Supervision of Workers......

6. Regular Inspection and Monitoring......

7. Hazardous Materials and Substances......

8. Medical Examinations and Health Monitoring......

9. Emergency Response......

10. Investigation of Accidents/Incidents and Occupational Diseases......

11. Joint Occupational Health and Safety Committee......

12. Records and Statistics......

13. Program Review......

Worksite Observations......

Last Revised 20120514PIR – II Enhanced Health and Safety Audit

Report Template

Executive Summary
Description of Activities
PIR II Audit Summary Sheet
Auditor Information
Lead Auditor: / AFPA Certified Auditor Qualification
Audit Team: / AFPA Certified Auditor Qualification
AFPA Certified Auditor Qualification
AFPA Certified Auditor Qualification
Company:
Address:
City: / Province: / P/C:
Phone: / Fax: / E-mail:
Company (Auditee) Information
LegalName:
Address:
City: / Province: / P/C:
KeyContact: / Telephone:
E-mail: / Total # of workers:
Audit Information
WCB Account(s) #: / WCB Industry Code(s) included in Audit Scope:
Audit Date(s): / Operating Site(s)
(List site(s) and location(s)) / Included in Audit Scope
Yes / No
Total # of operating sites:
Audit Sampling Details
Interviews / Tot. # / #Intrvw’d /

By Department

List organizational departments below, and indicate sampling numbers (to the right) based on this type of categorization. / Total Dept. # / Interview Numbers
In Person / By
Questionnaire / Full Time / Part Time / Casual / Shift 1 / Shift 2
Senior Manager(s)
Manager(s)
Supervisor(s)
Workers
Total Employees
Contractors (sub)
Visitors
Pre Audit Letter Pre-Audit Meeting Familiarization Tour Documentation Review
Site Observations Post-Audit Meeting Draft Report & Protocol Forwarded to AFPA
PIR-II Summary Score Sheet

Evaluation of: (Organization)

Date of Audit:

Audited by: (Print and Sign)______

# / Element / Possible Points / Possible
– N/A / Points Awarded / Percentage
1 / Leadership Commitment / 120
2 / Hazard Assessment / 220
3 / Hazard Control / 160
4 / Training of Workers / 165
5 / Supervision of Workers / 90
6 / Regular Inspection and Monitoring / 145
7 / Hazardous Materials and Substances / 45
8 / Medical Examinations and Health Monitoring / 30
9 / Emergency Response / 155
10 / Investigation of Accidents/Incidents and Occupational Diseases / 120
11 / Joint Occupational Health and Safety Committee / 75
12 / Records and Statistics / 45
13 / Program Review / 170
Total / 1540
PIR-I Reconciliation Score Sheet

Evaluation of: (Organization)

Date of Audit:

Audited by: (Print and Sign)______

# / Element / Possible Points / Possible
– N/A / Points Awarded / Percentage
1 / Leadership Commitment / 100
2 / Hazard Assessment / 220
3 / Hazard Control / 160
4 / Training of Workers / 165
5 / Supervision of Workers / n/s
6 / Regular Inspection and Monitoring / 145
7 / Hazardous Materials and Substances / 45
8 / Medical Examinations and Health Monitoring / n/s
9 / Emergency Response / 135
10 / Investigation of Accidents/Incidents and Occupational Diseases / 120
11 / Joint Occupational Health and Safety Committee / n/s
12 / Records and Statistics / 45
13 / Program Review / 125
Total / Score must reach 80% overall and 50% in each element for a “Certificate of Recognition.” / 1260

NOTE: Items numbered 5, 8 and 11 which are scored in PIR-II are not mandated under present PIR regulations. In addition, scores for Questions 1.8, 1.9, 1.10, 9.10, 13.7, 13.8, and 13.9 must be deducted before calculating scores under PIR-I.

1. Leadership Commitment

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

2. Hazard Assessment

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

3. Hazard Control

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

4. Training of Workers

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

5. Supervision of Workers

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

6. Regular Inspection and Monitoring

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

7. Hazardous Materials and Substances

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

8. Medical Examinations and Health Monitoring

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

9. Emergency Response

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

10. Investigation of Accidents/Incidents and Occupational Diseases

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

11. Joint Occupational Health and Safety Committee

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

12. Records and Statistics

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

13. Program Review

Element Score % Points Possible Points Awarded

Existing Strengths:

Suggestions for Improvement:

Worksite Observations

Strengths:

Suggestions for Improvement

Last Revised 20120514F - 1PIR – II Enhanced Health and Safety Audit