SAFE Companies Program

BC Forest Safety Council

BASE Audit 2.1 Forms

BASE AUDIT

SUBMISSION PACKAGE

Version 2.1

Designed for

Large employers
(20 or more employees and dependent contractors)

Table of Contents

Notice of Audit Activities - NOAA

Executive Summary......

Audit Questions......

A. Management Leadership – Basic......

B. Hazard Identification and Risk Control - Basic......

C. Standards, Procedures and Work Instructions - Basic......

D. Training, Education and Certification - Basic......

E. Health and Safety Communication Systems - Basic......

F. Incident Reporting and Investigating Systems - Basic......

G. Non-Prime Contractor Management - Basic......

H. Prime Contractor Management - Basic......

I. Injury Management/Return-to-Work Programs (optional)......

Technical Audit Modules......

LO. Technical Audit Module - Lockout......

CS. Technical Audit Module – Confined Spaces......

WH. Technical Audit Module – Working at Heights......

HW. Technical Audit Module – Hot Work......

RP. Technical Audit Module – Respiratory Protection......

RA. Technical Audit Module – Camps and Remote Accommodation......

PL. Technical Audit Module – Working near High Voltage Power Lines......

CD. Technical Audit Module – Combustible Dusts......

CH. Technical Audit Module – Chemicals and Asbestos......

MF. Technical Audit Module – Manual Tree Falling......

Scoring Summary – OH&S Elements - Basic......

Scoring Summary - Injury Management/Return-to-Work Programs......

Scoring Summary – Technical Audit Modules......

Notice of Audit Activities - NOAA

Complete all fields – an incomplete NOAA cannot be processed

Pre-Audit / Post-Audit

Type of Audit (check as needed):

Certification / Team / Targeted Operations / IM/RTW only
Maintenance / Student / Limited Scope / SAFE Cert. #
Recertification / Gap Analysis / Phased Operations
Elements A-F / Element G / Element H / Element I

Company Information

Legal Company Name: / Company Trade Name/dba:
Address: / City: / Province / Postal Code
Company Contact: / Phone: / E-mail:
Combined (Joint) Submission Audit – list name and WorkSafeBC account for the other company(s) (complete separate Notice of Audit Activities for each company being audited)
Name: / WorkSafeBC #
Name: / WorkSafeBC #
Name: / WorkSafeBC #
Name: / WorkSafeBC #

Audit Period

Estimated start date / Est. date of last onsite audit activities / Estimated report submission date
Actual audit date / Actual date of last onsite audit activities / Actual report submission date

Company WorkSafeBC Account Information

WorkSafeBC account: / List all company site names and all company CU’s and indicate if the work activity is intended (pre-) and actually (post-) present in the audit.
Yes - means payroll for the activity is present at that site during the audit year and the activity is included in the audit
No - means payroll for the activity is present at that site during the audit year but the activity is not sampled at that site in the audit
 Blank - means payroll for the activity did not occur at that location during the audit year
WSBC fixed site name / Audit site name / CU1 / CU2 / CU3 / CU4 / CU5 / CU6
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Y / N / Y / N / Y / N / Y / N / Y / N / Y / N
Describe the scope (nature and type) of the company’s activities included in this audit:

Technical Audit Modules

Review audit module text for guidance and check all that apply
Lockout / Camps and Remote Accommodations
Confined Space / Working near High Voltage Power Lines
Work at Heights / Chemicals and Asbestos
Hot Work / Manual Tree Falling
Respiratory Protection / Combustible Dust
Pellet Industry Addendum

Personnel Count

Total count per month for last 12 months:
(Total = owners + management + supervisors + workers + workers of dependent contractors)
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12
Year
(yyyy)
Month
(mmm)
Count
Attach an Organizational Chart or other description of the structure of the company.

Operation Details

Has the Organization hired anyNon-DependentForestry Contractors during the past 12 months? / Has the organization assigned Prime Contractor Status to any other company(s) during the past 12 months?
Yes -complete Element G / No - do NOT complete Element G / Yes - complete Element H / No - do NOT complete element H

Auditor Information

Audit Completed by: / Auditor Number (or ‘Student’):
Contact Telephone: / Email address:

Audit SchedulePlan–List where each auditor will be and when for both solo and team audits

Audit Site Name / Auditor name / Location and nature of operation audited / Start Date / End Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Number of Interviews.

Total Number of Employees (all sites) / Total of Planned Interviews / Actual Interviews Completed
M
S
W
Total
Minimum number of Interviews
(as per manual)

Audit Sampling Plan – Please list all sites, whether sampled or not

WSBC fixed site name (list all) / Audit site name / Sites Selected for Audit / Number of Employees Interviewed per Site for current audit
(include plans in pre-NOAA)
Current year / 1 yr ago / 2 yrs ago / 3 yrs ago
1 / M / S / W
2 / M / S / W
3 / M / S / W
4 / M / S / W
5 / M / S / W
6 / M / S / W
7 / M / S / W
8 / M / S / W
9 / M / S / W
10 / M / S / W
11 / M / S / W
12 / M / S / W
13 / M / S / W
14 / M / S / W
15 / M / S / W
Comments, notes, descriptions regarding sampling plan:

Attach additional pages for proposals for and/or outcomes of special time frames, unique sampling protocols, etc. or if more space needed.

Audit Sampling Plan (IM/RTW)

Injury Management not attempted in audit
Scope of IM/RTW Records / Number of case files in organization / Number of cases sampled in audit
Last 6 months
Last 12 months
Current Calendar Year / Since last audit
Other:

Post Audit Signatures

Please complete and submit with your post-audit notice of audit activities

Company Management Representative (for internal and external audits)
I hereby acknowledge that I have provided true and accurate information to the auditor to the best of my abilities and agree that the audit sampling was completed as stated above.
Name / Signature / Date
External Auditor
I hereby acknowledge that I have not violated the Auditor Code of Ethics during this audit, and have not received any economic benefit from OH&S consulting activities from this company in the 12 months preceding the audit. In addition, I have not been in a position which could be interpreted as a conflict of interest.
Name / Signature / Date
Internal Auditor
I hereby acknowledge that I have not violated the Auditor Code of Ethics during this audit and that I have done my best to be objective in conducting this audit.
Name / Signature / Date

Submission

You will receive an email confirmation of receipt. If you do not receive this within three (3) business days, please phone the Council.

Audits must NOT start until your sampling plan is approved by email. If you have not received approval within one (1) week of NOAA submission, please phone the Council.

Please submit this form to:

Executive Summary

Please delete this description of the Executive Summary from the final report and replace with the actual Executive Summary that meets requirements.

The Executive Summary must be presented with each submission and gives an overview of the audit activities. The following requirements should be presented:

□State the type(s) of audit (Student, Certification, Maintenance, Joint, Phased, etc.).

□State when and where audit occurred and number of site days.

□Ensure the last day of onsite activities is clearly stated.

□List all the CU’s the company has and all the CU’s included in the audit activities.

□Provide a brief statement of the audit process covering documentation review, site observation and interviews.

□Give actual score and score of lowest element and state the requirements of achieving >80% overall and >50% in every element.

□Clearly state whether company meets requirements (or would, in external student case).

□Clearly state which audit elements apply.

□Give bullet list of major (3-5) strengths that logically flow from the notes.

□Give bullet list of major (3-5) areas for improvement that logically flow from the notes.

□Written in professional style and grammar, in third person and with no spelling errors.

□Include statement that there are more recommendations included in the audit report that gives the company further guidance to improve on their health and safety program.

□Scoring Summary should include a clear table with at least the minimum row and column headings in order from the BASE Audit template

□Provide correct numbers and scores based on the auditor notes.

□Signed by the Auditor.

Audit Questions

A. Management Leadership – Basic

A1. Company Health and Safety Policies
Question / Award
A1.1 / Does the company have a written health and safety policy that discusses health and safety responsibilities of management, supervisors and workers? / O / D
0,15 / I / Total
/15
□Yes
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
A1.2 / Is the current safety policy physically posted or made available to the workers? / O
0,5 / D / I / Total
/5
Audit Note:
A2. Health and Safety Responsibilities
Question / Award
A2.1 / Have specific safety responsibilities for all occupations been written and communicated to relevant workers? / O / D
0,7 / I
0,8 / Total
/15
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
A2.2 / Are supervisors monitoring the health and safety of all workers under their direct supervision? / O
0-5 / D
0-5 / I
0-5 / Total
/15
Audit Note:
A2.3 / Do supervisors know the applicable standards and required control measures when evaluating safety of work activities? / O / D
0-5 / I
0-10 / Total
/15
Audit Note:
A2.4 / Are managers measuring and evaluating the performance of the company’s safety program? / O / D
0-8 / I
0-7 / Total
/15
Audit Note:
A2.5 / Are managers and supervisors leading by example and following the health and safety rules and procedures? / O
0,10 / D / I
0,10 / Total
/20
Audit Note:
A2.6 / Have managers ensured that relevant health and safety regulations, industry safety codes of practice and safe work procedures are available to supervisors and workers? / O
0-12 / D / I
0,3 / Total
/15
Audit Note:
A2.7 / Has a management review been conducted to identify opportunities for improvement and changes needed for the safety program? / O / D
0-10 / I / Total
/10
Audit Note:
A2.8 / Has management allocated the resources necessary for the safety program? / O / D / I
0-20 / Total
/20
Audit Note:
A. Management Leadership
Awarded / Available / N/A / Available – N/A / % awarded
Total / 145 / Min 50%

B. Hazard Identificationand Risk Control - Basic

B1. Hazard Identification
Question / Award
B1.1 / Is there a process to determine what the hazards and risks are in the work place before the job starts for routine, modified and non-routine job tasks? Does this include ergonomic issues? / O / D
0-20 / I / Total
/20
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
B1.2 / Are hazard identifications and risk assessments being conducted prior to starting job tasks or when there are work process changes impacting on safety? / O / D
0-5 / I / Total
/5
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
B1.3 / In situations where workers performing different work functions may be interacting, has the organization planned and assessed its activities to ensure there are controls in place to protect everyone’s health and safety? / O
0-10 / D / I / Total
/10
Audit Note:
B1.4 / Are documented hazards, risks and controls communicated to all workers before the job starts and as they become identified during operations? / O / D
0-7 / I
0-8 / Total
/15
Audit Note:
B1.5 / Is there a process in place to ensure that risks associated with new products, equipment and tools are assessed before they are purchased? / O / D
0,3 / I
0,2 / Total
/5
B2. Risk Controls
Question / Award
B2.1 / Is there a maintenance program in place for facilities, tools and equipment meeting the manufacturer, regulatory and company safety requirements? / O / D
0-15 / I
0-5 / Total
/20
Audit Note:
B2.2 / Is there evidence that the maintenance program is being followed? / O
0-5 / D
0-10 / I
0-5 / Total
/20
Audit Note:
B2.3 / Do workers operate within limits set by engineering, administrative and operational controls? / O
0-20 / D / I / Total
/20
Audit Note:
B2.4 / Have the risk control measures and safe work procedures been reviewed and updated on a regular basis and when there are changes in work conditions? / O / D
0-5 / I / Total
/5
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
B2.5 / Are workers involved directly or by representation in the development, evaluation and revision of the safe work procedures and risk control measures? / O / D / I
0,5 / Total
/5
Audit Note:
B2.6 / Does the company have a progressive enforcement policy to address safety non-compliance and is it being used by managers and supervisors where required? / O / D
0,5 / I
0-5 / Total
/10
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
B3. Inspections
Question / Award
B3.1 / Does the company have a site inspection program? / O / D
0,5 / I / Total
/5
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
B3.2 / Does the inspection program outline what is to be inspected and the inspection frequency? / O / D
0-10 / I / Total
/10
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
B3.3 / Are the inspections being conducted in accordance with defined frequency of the inspection program and regulatory requirements by a qualified individual? / O / D
0-10 / I / Total
/10
Audit Note:
B4. Risk Management
Question / Award
B4.1 / Are deficiencies being reported and the corrective/preventive actions being implemented in a timely manner? / O
0-10 / D
0-5 / I
0-5 / Total
/20
Audit Note:
B. Hazard Identificationand RISK Control - Basic
Awarded / Available / N/A / Available – N/A / % awarded
Total / 180 / Min 50%

C. Standards, ProceduresandWork Instructions - Basic

C1. Safety Rules
Question / Award
C1.1 / Does the company have general health and safety rules (other than safe work procedures or work instructions) for expected standards of safe work behaviour in the work place? / O
0-5 / D
0-5 / I
0,5 / Total
/15
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
C1.2 / Does the company have a Personal Protective Equipment(PPE)policy governing the selection, training, provision and maintenance of PPE in accordance with regulatory requirements and established risk control measures? / O
0-6 / D
0-5 / I
0,4 / Total
/15
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
C1.3 / Does the company have written standards or rules regarding alcohol and drug use/abuse and impairment by any means including fatigue? / O / D
0-2 / I
0-3 / Total
/5
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
C2. Regulatory Compliance
Question / Award
C2.1 / Are worksite conditions in line with required company safety standards and regulatory requirements? / O
0-8 / D
0-8 / I
0-4 / Total
/20
Audit Note:
C2.2 / Are workers complying with all company safety rules, manufacturer standards and regulatory requirements? / O
0-10 / D / I
0-10 / Total
/20
Audit Note:
C2.3 / Has a Workplace Hazardous Materials (WHMIS)Information Systemprogram been implemented within the company? / O
0-3 / D
0-5 / I
0-2 / Total
/10
Audit Note:
C2. Standards and Work Procedures
Question / Award
C3.1 / Are there written safe work procedures for allhigh risk routine and normal non-routine activities? Do these include ergonomic concerns? / O / D
0-15 / I / Total
/15
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
C3.2 / Are there written safe work procedures for transportation of workers to and from worksites? Are the worker transportation Safe Work Procedures(SWPs)being followed? / O
0-5 / D
0-5 / I
0,5 / Total
/15
Audit Note:
C4. Emergency Response
Question / Award
C4.1 / Has a first aid assessment been done for each worksite in accordance with WorkSafeBC(WSBC)regulations? / O / D
0-5 / I / Total
/5
□Yes
Audit Note:
C4.2 / Are the first aid personnel, supplies and equipment adequate for each work site? / O
0-15 / D / I / Total
/15
Audit Note:
C4.3 / Does the company have instructions within their safety program which direct first aid services? Do the first aid procedures clearly state how assistance is to be obtained by workers? / O / D
0-10 / I / Total
/10
□Maintenance audit: There has been no material change since the last certification or recertification audit.
Audit Note:
C4.4 / Are there written Emergency Response Plans(ERPs)for handling other potential emergencies relevant to the company’s operations? Are workers on the site knowledgeable regarding the ERPs? / O / D
0-10 / I
0-5 / Total
/15
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
C4.5 / Are there communication devices readily available, such as whistles, radios and phones, so that assistance can be contacted when needed? / O
0,5 / D / I / Total
/5
Audit Note:
C4.6 / Are drills being conducted to periodically test the effectiveness of the ERP? / O / D
0-5 / I / Total
/5
Audit Note:
C. Standards, Proceduresand Work Instructions - Basic
Awarded / Available / N/A / Available – N/A / % awarded
Basic / 170 / Min 50%

D. Training, Educationand Certification - Basic

D1. Orientations
Question / Award
D1.1 / Does the orientation program for employees and contractors meet regulatory requirements? / O / D
0-10 / I
0,5 / Total
/15
Audit Note:
D1.2 / Are visitors given an orientation to the worksite, ensuring they have the correct information required so that they do not get injured during their time on the site or in the operation? / O
0,2 / D
0,3 / I / Total
/5
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
D2. Training and Education
Question / Award
D2.1 / Does the company ensure workers are competent before they are permitted to perform their assigned tasks? / O / D
0-7 / I
0,3 / Total
/10
□Maintenance audit: Documentation only - There has been no material change since the last certification or recertification audit.
Audit Note:
D2.2 / Is training being conducted with employees on an ongoing and as required basis? / O / D