Health & Safety General Program & Policies 2019

WOODLAND GOURMET IMPORTS INC.
Health and Safety

Program and General Policies
Supported by
TABLE OF CONTENTS
1.0 OUR HEALTH AND SAFETY POLICY STATEMENT ...................................... 6

2.0 ABOUT THIS POLICY MANUAL ...................................................................... 7
3.0 ROLES AND RESPONSIBILITIES ................................................................... 8
3.1 Management and Supervisory Personnel.................................................. 8
3.2 Directors and Officers .............................................................................. 10
3.3 Owners, Project Owners, Constructors and Suppliers ............................ 11
3.3.1 Owners ....................................................................................... 11
3.3.2 Project Owners ........................................................................... 11
3.3.3 Constructors ............................................................................... 12
3.3.4 Suppliers of Equipment to Workplaces ....................................... 13
3.4 Workers ................................................................................................... 13
3.5 Contractors and Subcontractors .............................................................. 14
3.6 Visitors..................................................................................................... 15
4.0 EDUCATION AND TRAINING ........................................................................ 16
4.1 Posting Health and Safety Literature in the Workplace ........................... 16
4.2 Education and Training Policy ................................................................. 16
4.2.1 General Training ......................................................................... 16
4.2.2 Additional Training and Certified Training ................................... 16
4.2.3 Training Records ........................................................................ 17
4.3 Worker Orientation and Induction ............................................................ 17
5.0 WORKER REPRESENTATION ...................................................................... 18
5.1 Health and Safety Representative ........................................................... 18
5.2 Joint Health and Safety Committee ......................................................... 18
6.0 WORKING CONDITIONS................................................................................ 19
6.1 Housekeeping ......................................................................................... 19
6.2 Inspection and Maintenance.................................................................... 19
6.2.1 Work Equipment and Safety Equipment ..................................... 19
6.2.2 Workplace Inspections and Evaluations ..................................... 20
6.3 Personal Protective Equipment ............................................................... 20
6.4 Lone Working .......................................................................................... 21
6.4.1 Definition ..................................................................................... 21
6.4.2 Lone Working Risk and Hazard Assessments ............................ 21
6.4.3 Lone Working Safety Measures .................................................. 22
7.0 FIRST AID ....................................................................................................... 24
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8.0 WORKPLACE VIOLENCE AND HARASSMENT POLICY ............................. 25
8.1 Workplace Violence and Prevention........................................................ 25
8.1.1 Organizational Commitment ....................................................... 25
8.1.2 Objectives ................................................................................... 25
8.1.3 Application .................................................................................. 25
8.1.4 Definitions ................................................................................... 25
8.1.5 Reporting Procedures for Workers ............................................. 26
8.1.6 Duties of Management and Supervisors ..................................... 26
8.1.7 Investigation ............................................................................... 27
8.1.8 Reporting to the Police ............................................................... 27
8.1.9 Intervention ................................................................................. 27
8.1.10 Corrective Action and Discipline ................................................. 27
8.1.11 Risk Reduction Measures ........................................................... 27
8.1.12 Annual Risk Assessments, Reviews and Inspections ................. 28
8.1.13 Incident Management ................................................................. 29
8.2 Workplace Harassment and Sexual Harassment .................................... 29
8.2.1 Objectives ................................................................................... 29
8.2.2 Application .................................................................................. 30
8.2.3 Definitions of Prohibited Behaviour ............................................. 30
8.2.4 Examples of Prohibited Behaviour .............................................. 30
8.2.5 Examples of What is Not Workplace Harassment ...................... 31
8.2.6 Reporting Procedures for Workers ............................................. 32
8.2.7 Duties of Management and Supervisors ..................................... 32
8.2.8 Investigation ............................................................................... 32
8.2.9 Reporting to the Police ............................................................... 33
8.2.10 Intervention ................................................................................. 33
8.2.11 Corrective Action and Discipline ................................................. 33
8.2.12 Incident Management ................................................................. 33
8.1.13 Risk Assessments ...................................................................... 34
9.0 VIOLENCE AND HARASSMENT INVESTIGATION PROCESS .................... 35
9.1 Step One: Reporting ................................................................................ 35
9.2 Step Two: Workplace Investigation ......................................................... 35
9.3 Step Three: Action ................................................................................... 36
9.4 Employee Cooperation ............................................................................ 37
9.5 Confidentiality .......................................................................................... 37
9.6 Regular Policy Review............................................................................. 37
10.0 HAZARD REPORTING ................................................................................... 38
10.1 What is a “Hazard”? ................................................................................ 38
10.2 Procedure for Reporting Hazards and Unsafe Conditions ....................... 38
10.2.1 Workers ...................................................................................... 38
10.2.2 Supervisors and Management .................................................... 38
10.2.3 Role of the JHSC and HSR (If Applicable) .................................. 39
11.0 ACCIDENT AND INJURY REPORTING ......................................................... 40
11.1 Reporting Policy ...................................................................................... 40
11.2 Accident Reporting Procedures ............................................................... 40
11.2.1 Fatalities and Critical Injuries ...................................................... 40
11.2.2 Non-Fatal Accidents and Injuries ................................................ 41
11.2.3 Occupational Illnesses ................................................................ 42
11.2.4 Accidents and Near Misses at Project Sites ............................... 43
11.2.5 Witnesses ................................................................................... 43
11.3 Accidents and Injuries Investigation Procedure ....................................... 44
11.3.1 Overview of Roles and Responsibilities ...................................... 44
11.3.2 Workers ...................................................................................... 45
11.3.3 Supervisors ................................................................................. 45
11.3.4 Management ............................................................................... 45
11.3.5 JHSC or HSR Investigation (If Applicable) .................................. 48
12.0 REFUSAL TO WORK...................................................................................... 49
12.1 Policy and Application ............................................................................. 49
12.2 Work Refusals ......................................................................................... 49
12.3 Reporting and Investigation Procedure ................................................... 49
12.4 Outcome .................................................................................................. 50
13.0 EARLY AND SAFE RETURN TO WORK POLICY ......................................... 51
13.1 Overview ................................................................................................. 51
13.2 Worker Duties.......................................................................................... 51
13.3 Management’s Duties .............................................................................. 52
14.0 EMERGENCY PROCEDURES ....................................................................... 53
14.1 General.................................................................................................... 53
14.2 Application ............................................................................................... 53
14.3 Communication ....................................................................................... 54
14.4 Emergency Evacuations .......................................................................... 54
15.0 HAZARDOUS MATERIALS IN THE WORKPLACE AND WHMIS ................. 55
16.0 DRUG AND ALCOHOL POLICY .................................................................... 56
16.1 General.................................................................................................... 56
16.2 Definitions................................................................................................ 56
16.3 Application ............................................................................................... 56
17.0 PROGRESSIVE DISCIPLINE POLICY ........................................................... 57
17.1 Identification of performance issues ........................................................ 57
17.2 Progressive Discipline ............................................................................. 57
17.2.1 Step One: Verbal Warning .......................................................... 57
17.2.2 Step Two: Written Warning ......................................................... 57
17.2.3 Step Three: Dismissal................................................................. 58
17.3 Exception for Serious Misconduct ........................................................... 58
18.0 INDEX .............................................................................................................. 59
19.0 FORMS ............................................................................................................ 62
1.0 OUR HEALTH AND SAFETY POLICY STATEMENT
Woodland Gourmet Imports Inc. Operating as Antipastos (the “Business”) is

committed to the health, safety and wellbeing of its workers and of all individuals who
enter its workplace. For the purposes of this policy, the terms “worker” and “workers”
include any volunteers, trainees, and apprentices.
It is our policy to provide a safe work environment for all of our workers at all times by
continuously promoting safe work practices, educating and training our workers
regarding all applicable health and safety laws and best practices (including their
specific duties and obligations under health and safety legislation) and regularly
inspecting and evaluating our workplace in order to identify any existing or potential
hazards so that they can be avoided, if not eliminated.
The duty to maintain a safe workplace is shared equally by all our workers. Supervisory
personnel and members of our management are responsible for ensuring that our
workers are aware of and carrying out their duties in accordance with all the health
and safety policies and procedures that we have in place from time to time, including
those that are set out in this policy manual.
It is our goal to foster and maintain a culture of health and safety compliance within
our enterprise so that workplace safety becomes an attitude that all our workers carry
with them both on and off the job.
However, we also recognize that the creation, maintenance and promotion of health
and safety programs, policies, procedures and protocols is an organic exercise, and
as a result, our own programs, policies, procedures and protocols will need to be
amended, revised, updated and modified from time to time as the Business changes
and matures to ensure that our workplace is safe.
It is the policy of the Business to abide by all of the rules and provisions contained in
the Ontario Occupational Health and Safety Act, R.S.O. 1990, c. O.1, any successor
legislation, and the regulations thereto, as all of them may be amended from time to
time (collectively, the “OHSA” or the “Act”), including all of the exemptions set out in
Act. Consequently, the Business’s health and safety programs, policies, procedures
and protocols shall be interpreted and applied in accordance with the OHSA. For
further clarity, if any provision of any of our health and safety programs, policies,
procedures or protocols conflict with the provisions of the OHSA, then the provisions
of the Act and/or any other applicable legislation shall prevail.
Signature ...........................................………… Date:
Position ..............................................………..
2.0 ABOUT THIS POLICY MANUAL
This policy manual serves as the foundation of the Business’s health and safety
program. We expect that as the Business grows, evolves and matures, its health and
safety program will grow, evolve and mature with it. The Business thus recognizes that
maintaining a safe workplace is not a static exercise.
For this reason, the terms and provisions of this manual may need to be amended,
supplemented or qualified by additional programs, policies, procedures and protocols
that the Business may issue from time to time as the needs, duties and obligations of
the Business change.
Similarly, should the OHSA, or any other applicable legislation, impose any
requirement(s) that are not included in any of our health and safety programs, policies,
procedures or protocols, or in the event that the Act, and any other applicable
legislation, is amended so as to impose greater obligations than those set out by the
Business in this manual, or in any other program, policy, procedure or protocol, then
the provisions of the Act and/or all other applicable legislation shall prevail.
Peninsula Employment Services Limited cannot and does not in any way represent,
warrant or guarantee that the Business will be compliant will all applicable health and
safety laws, or that it will be immune from enforcement proceedings, including
prosecution, as a result of utilizing this policy manual. Proper compliance with health
and safety laws is ultimately the responsibility of the Business.
The electronic version of this manual constitutes the complete, up-to-date and official
version. A printed copy of this document may not reflect the current official version.
Therefore, paper versions of this policy should be cross-referenced with the electronic
version.
Lastly, neither this policy nor any of the material contained in this policy may be
reproduced, redistributed, or resold in whole or in part without the prior written consent
of Peninsula Employment Services Limited.
3.0 ROLES AND RESPONSIBILITIES
3.1 MANAGEMENT AND SUPERVISORY PERSONNEL

Managers and supervisors shall ensure that:
1. Equipment, materials and protective devices required by law are

provided to workers;
2. Equipment, materials and protective devices provided by the Business

are maintained and in good working condition;
3. All health and safety measures and procedures required by law are
implemented and carried out;
4. All equipment, materials and protective devices provided to workers are

used properly and as required by law; and that
5. All areas of the workplace are capable of supporting all loads to which
they may be subjected in accordance with all applicable laws and
building codes.
Without limiting the generality of the foregoing, management shall also:
Information and Training for Workers
1. Provide workers, supervisors and health and safety committee members

and health and safety representatives (if applicable) with health and
safety training as required by law;
2. Provide information, instruction and supervision to workers with a view

to ensuring their health and safety in the workplace;
3. If required by law, provide workers with written instructions as to the

measures and procedures to be taken for their protection;
4. Acquaint a worker or a person with authority over a worker with any

hazard in their work and in the handling, storage, use, disposal and
transport of any article, device, equipment or a biological, chemical or
physical agent;
5. Notify workers of the results of any occupational health and safety

report(s) in the possession of the Business, written or otherwise, and
make them available to workers on request; and
6. Establish an occupational health and safety service for workers as

required by law;
Health and Safety Practices
7. Only employ or retain workers in the workplace who are of legal working
age;
8. Not knowingly allow underage workers into the workplace;
9. Take every precaution reasonable in the circumstances to protect the

health and safety of workers;
10. When appointing a supervisor, appoint a competent person;
11. Not require a worker to wear footwear with an elevated heel unless it is
required for the worker to perform his or her duties safely (unless the
worker is working as a performer in the entertainment and advertising
industry, in which case this rule does not apply);
12. Regularly monitor the levels of biological, chemical or physical agents in

a workplace and keep and post accurate records thereof as required by
law;
13. Cooperate with third parties in the event of a medical emergency;
14. If required by law, only permit a worker to work or be in a workplace if he

or she has undergone all required medical examinations, tests or x-rays
and is found physically fit to work or to be in the workplace;
15. Limit the exposure of workers to biological, chemical and physical agents
to the amounts and standards prescribed by law;
16. Ensure that all workers are working safely and using protective devices,
equipment and clothing properly at all times;
17. Ensure that all workers are using protective devices, equipment and
clothing as required at all times; and
18. Immediately inform a worker of the existence of any potential or actual

danger to their health and safety, and if necessary, or if required by law,
provide the worker with written instructions as to the measures and
procedures to be taken to protect the worker;
Administrative Health and Safety Duties
19. Review the Business’s health and safety programs, policies, procedures
and protocols at least annually and develop, maintain and modify as
necessary a program to implement and enforce them;
20. Post a copy of all applicable health and safety literature and legislation,
including this policy manual, in a conspicuous location in the workplace
as required by law;
21. Assist and cooperate with health and safety committee members, or a
health and safety representative, as the case may be (if applicable), in
carrying out their functions, including, but not limited to, providing the
results of any report(s), written or otherwise, regarding occupational
health and safety that is in the possession of the Business;
22. Keep, maintain and make available to affected workers records of their
exposure to biological, chemical or physical agents as required by law;
23. Notify the Ministry of Labour of the use or introduction into the workplace
of any biological, chemical or physical agents as required by law;
24. Provide for safety-related medical examinations and tests for workers
when and as required by law;
25. Establish a medical surveillance program for workers as required by law;
26. Regularly review and modify as necessary all health and safety policy
and program documentation;
27. Conduct investigations into all workplace incidents, accidents, injuries

and illnesses (including incidents of workplace harassment) as
necessary and as required by law;
28. Ensure that sufficient resources are allocated to manage the health and
safety obligations of the Business;
29. Regularly carry out workplace inspections and risk assessments as a

best practice, and at a minimum, as required by law;
30. Implement a system for detecting and eliminating workplace hazards,

unsafe acts or conditions in a prompt manner; and
31. Complete all required health and safety paperwork and documentation.
3.2 DIRECTORS AND OFFICERS

If the Business is a corporation, then every director and officer of the corporation must
take all reasonable care to ensure that the corporation complies with:
1. All applicable health and safety legislation;
2. Any enforcement orders; and
3. Any court orders.
3.3 OWNERS, PROJECT OWNERS, CONSTRUCTORS AND SUPPLIERS
3.3.1 Owners
Under applicable health and safety laws, an “owner” of a workplace includes, but is
not limited to, a trustee, receiver, mortgagee in possession, tenant, lessee, or occupier
of any lands or premises used or to be used as a workplace, as well as any person
who acts for or on behalf of an owner as an agent or delegate.
If the Business is ever the owner of a workplace that is not a construction project (see
section 3.3.2, “Project Owners”, below for an explanation of what constitutes a
“construction project”), then it must:
1. Provide and maintain all facilities as required by law;
2. Ensure that its workplace complies with all applicable laws and
regulations;
3. Ensure that its workplace is only constructed, developed, reconstructed,

altered or added to in accordance with provincial health and safety
legislation;
4. If required by law, not begin any construction, development,

reconstruction, alteration, addition or installation to or in its workplace
until all necessary drawings, layouts and specifications, and any
modifications thereto, have been filed with the requisite government
authorities and reviewed and approved as required by law (“Construction
Documentation”); and
5. If required by law, keep copies of all Construction Documentation in a

convenient location at or near the workplace and produce them for
inspection as required by law.
3.3.2 Project Owners
Under applicable health and safety laws, a “project” is a construction project, whether
public or private, including, but not limited to:
1. The construction of a building, bridge, structure, industrial establishment,

mining plant, shaft, tunnel caisson, trench, excavation, highway, railway,
street, runway, parking lot, cofferdam, conduit, sewer, watermain,
service connection, telegraph, telephone or electrical cable, pipe line,
duct or well, or any combination thereof;
2. The moving of a building or structure; and
3. Any work or undertaking, or any lands or appurtenances used in

connection with construction.
Under applicable health and safety laws, “construction” means, but is not limited to,
erection, alteration, repair, dismantling, demolition, structural maintenance, painting,
land clearing, earth moving, grading, excavating, trenching, digging, boring, drilling,
blasting, or concreting, the installation of any machinery or plant, and any work or
undertaking in connection with a project. However, “construction” does not include any
work or undertaking underground in a mine. A “project owner” is thus the owner of a
workplace (as defined in section 3.3.1, “Owners”, above) that is a construction project.
If the Business is ever the owner of a construction project, as explained above, then it
must:
1. Before beginning a project, determine whether any of the following

substances are present at the project site, and if they are present,
prepare a list of them:
a. Acrylonitrile;
b. Arsenic;
c. Asbestos;
d. Benzene;
e. Coke oven emissions;
f. Ethylene oxide;
g. Isocyanates;
h. Lead;
i. Mercury;
j. Silica;
k. Vinyl chloride; and
l. Any other substances as may be prescribed by law from time to time
(“Dangerous Substances”);
2. Ensure that if any work on a project is tendered, that the person issuing
the tenders includes the list of Dangerous Substances referred to in
paragraph one (1) above as part of the tendering information; and
3. Ensure that a prospective constructor of a project on the owner’s

property has received a copy of the list of Dangerous Substances
referred to in paragraph one (1) above before entering into a binding
contract with the constructor.
3.3.3 Constructors
Under applicable health and safety laws, a “constructor” means a person who
undertakes a construction project for a construction project owner (as explained in
section 3.3.2, “Project Owners”, above). If the Business is ever a constructor, then it
must ensure that each prospective contractor and subcontractor for the project has
received a copy of the list of Dangerous Substances referred to in paragraph one (1)
in subsection 3.3.2 above before the prospective contractor or subcontractor enters
into a binding contract for the supply of work on the project.
3.3.4 Suppliers of Equipment to Workplaces
Under applicable health and safety laws, a “supplier” means any person who supplies
any machine, device, tool or equipment (including safety equipment) under any rental,
leasing or similar arrangement for use in or about a workplace.
If the Business is ever a supplier, then it must:
1. Ensure that every machine, device, tool or item of equipment (including

safety equipment) is in good condition and complies with all applicable
health and safety laws; and
2. If it is the responsibility of the supplier under the rental, leasing or similar

arrangement to do so, ensure that every machine, device, tool or item of
equipment is maintained in good condition.
3.4 WORKERS
All workers, including supervisors and management personnel, must:
General Duties
1. Complete all necessary health and safety training and orientation

programs;
2. Arrive at work on time and be prepared to undertake all of their assigned

work and health and safety duties, including those set out in this manual;
3. Be familiar with all health and safety rules, policies (including this one),
programs, laws and regulations and comply with them at all times;
4. Use and wear all protective equipment, protective devices and clothing
as instructed, or as required by law;
5. Never remove, adjust, modify or in any way tamper with or alter

whatsoever any work equipment, devices or machinery, or any protective
equipment, devices or clothing;
6. Never use substitute protective equipment, devices or clothing unless

expressly authorized by management;
7. Never perform work without using any required protective equipment,

devices or clothing;
8. Never operate any equipment, tools, machinery or thing or work in an

unsafe manner;
9. Never engage in any prank, contest, feat of strength or unnecessary

running or rough or boisterous conduct;
10. Ensure that all tools, equipment and machinery are properly maintained,
operated and stored according to any applicable policies or
specifications, and as required by law;
11. Never smoke or consume any alcohol, illicit drugs or impairing

substances in the workplace;
12. Refrain from using handheld devices, including smartphones and other
portable electronic devices, while working, and especially when
performing safety sensitive work;
13. Practice good housekeeping and adhere to any waste management and
environmental protection procedures; and
14. If applicable, comply with all of their duties as health and safety
committee members or as a health and safety representative;
Specific Reporting Obligations
15. Immediately report to a supervisor or to a member of management the

absence of or a defect in any equipment or protective device that may
endanger another person;
16. Immediately report to a supervisor or to a member of management any

contravention of this policy or of any health and safety laws or
regulations;
17. Immediately report to a supervisor or to a member of management any

unsafe or potentially unsafe working conditions or workplace hazards;
18. Immediately report any medical condition or medical prescription (in

confidence, if necessary) that could affect a worker’s ability to complete
his or her work safely or that could endanger another worker or person,
including a prescription for medicinal cannabis; and
19. Immediately report any workplace incidents (including workplace

harassment), accidents, spills, injuries and near-misses to a supervisor
or to management and complete any required incident reporting forms
(see Section 19.0, “Forms”).
3.5 CONTRACTORS AND SUBCONTRACTORS

In addition to any existing obligations under applicable health and safety laws, and
subject to the terms and provisions contained in Section 3.0 above (Owners, Project
Owners, Constructors and Suppliers), all contractors and subcontractors of the
business must:
1. Provide sufficient proof (as determined by the Business in its sole

discretion) of its own health and safety policies and programs and of work
standards capable of ensuring a safe working environment;
2. Provide sufficient proof (as determined by the Business in its sole
discretion) that the workers in their employ have received proper health
and safety training;
3. If applicable, provide a WSIB clearance certificate or any other proof (as

determined by the Business in its sole discretion) of insurance that the
Business determines is necessary; and
4. Ensure that the workers in their employ are aware of any hazardous or
Dangerous Substances (as defined in subsection 3.3.2. “Project
Owners”, above) that may be in use in any workplace and that they use
appropriate safety equipment.
3.6 VISITORS
Every person who visits a workplace of the Business must:
1. Follow any sign in and sign out policy or protocol;
2. Not smoke anywhere in the workplace;
3. Wear appropriate safety equipment, if necessary;
4. Comply at all times with the Business’s health and safety policies and
protocols;
5. Refrain from harassing any of the Business’s workers, supervisors,

managers or patrons;
6. Report any unsafe or potentially unsafe condition(s) to any worker or

member of management; and
7. Not enter areas of the workplace that are normally restricted to workers.
Workers, supervisors and members of management shall be jointly responsible for

monitoring the conduct of visitors to the workplace.
4.0 EDUCATION AND TRAINING
4.1 POSTING HEALTH AND SAFETY LITERATURE IN THE WORKPLACE

The following documents shall be posted in a conspicuous location within the
workplace:
1. A complete copy of the Ontario Occupational Health and Safety Act;
2. A complete and up-to-date copy of this manual;
3. An up-to-date copy of the Ontario Ministry of Labour’s “Health & Safety at

Work: Prevention Starts Here” poster, as amended from time to time;
4. An up-to-date copy of the Business’s workplace violence and harassment

policy, including our reporting procedure;
5. Information regarding hazardous materials in the workplace, as required

by law;
6. An up-to-date copy of the “In Case of Injury” information as published by

the Workplace Safety and Insurance Board, as amended from time to
time;
7. An emergency contact list; and
8. If applicable, a list of the names and work locations of current joint health
and safety committee members.
4.2 EDUCATION AND TRAINING POLICY

4.2.1 General Training
All workers of the Business shall be provided with basic occupational health and safety
training that complies with applicable health and safety laws.
All supervisors shall be provided with basic occupational health and safety training for
supervisors that complies with applicable health and safety laws.
4.2.2 Additional Training and Certified Training
The Business will provide any additional training that is mandated by law and that is
required for a worker to carry out his or her duties safely, including, but not limited to,
certified training to joint health and safety committee members and health and safety
representatives, as the case may be (if applicable), working at heights training and
WHMIS (Workplace Hazardous Materials Information System) training.
4.2.3 Training Records
All worker training activities will be documented by the Business, including the
completion and retention of a list of all workers who have received health and safety
training, the nature of the training received (i.e., training program type) and the training
completion date.
The information will be listed in the Training/Certification Training Record Form A

found in Section 19.0, “Forms”.
4.3 WORKER ORIENTATION AND INDUCTION

Every new worker will be required to undergo basic health and safety training and
orientation prior to commencing work.
5.0 WORKER REPRESENTATION
5.1 HEALTH AND SAFETY REPRESENTATIVE

The Business shall have in place a health and safety representative (“HSR”) as
required by law according to the following conditions:
Required
or JHSC
No HSR
Number of Workers Regularly
JHSC
HSR
Employed by the Business
1 to 5 workers ✓
6 to 19 workers ✓
20+ workers ✓
(In this case, a Joint Health and Safety Committee must be
installed. See subsection 5.2 below)
5.2 JOINT HEALTH AND SAFETY COMMITTEE

The Business shall have in place a joint health and safety committee (“JHSC”) as
required by law according to the following conditions:
JHSC - JHSC required

JHM - Minimum number of JHSC members required
ERM - Minimum number of employer members required
WKM - Minimum number of worker members required
CRT - Certified training required for member
JHSC
Number of Workers Regularly

WKM
ERM
JHM
CRT
CRT
Employed by the Business
20 to 49 workers ✓ 2 1 ✓ 1 ✓
50+ workers ✓ 4 2 ✓ 2 ✓
6.0 WORKING CONDITIONS
6.1 HOUSEKEEPING
All workers are required to maintain good housekeeping habits, including, but not
limited to:
1. Refraining from leaving cabinet and desk drawers and doors open when
they are not being used;
2. When accessing filing cabinets, only open one drawer at a time. Opening
multiple drawers can give rise to a serious tipping or tripping hazard;
3. Not leaning back in or tilting chairs;
4. Not using or standing on tables, chairs, desks, cabinets or other elevated

objects to obtain items that are out of reach;
5. Refrain from using a ladder or other elevation device when alone, or using
a ladder or device that is improperly positioned, broken, tilted, unsecure
or unstable;
6. Not leaving office supplies, boxes, bags or any other storage equipment
or items on the floor or in any other area in such a way as to pose a tripping
hazard, or in a manner that would result in an obstruction during an
emergency;
7. Not placing power cords, phone and internet cables and similar objects in
any location or in any manner that would create a tripping hazard, or that
would result in an obstruction during an emergency; and
8. Immediately reporting any defects, or potential defects, in any flooring,

door mechanisms or other devices that if left uncorrected could pose a
safety risk to other workers.
6.2 INSPECTION AND MAINTENANCE

6.2.1 Work Equipment and Safety Equipment
All work and safety equipment will be identified and inventoried. In addition, the
Business will, subject to any amendments to or modifications of this policy as may be
required from time to time, follow the inspection routine set out in Table 1 below for all
work tools, equipment and safety equipment (collectively, “Equipment”), including:
1. Motor vehicles and similar machinery (if any);

2. Personal protective equipment, such as safety glasses and safety boots
(if any);
3. Fire extinguishers and first aid kits; and
4. Fall protection accessories, such as ropes, harnesses and belts, and
rescue equipment (if any).
Table 1 – Inspection Routine for Equipment
Annually
Monthly
Pre-use
Weekly
Visual
Daily
Items to be visually inspected*
Company vehicles and all similar machinery and ✓ ✓ ✓ ✓ ✓

equipment (if any)
Personal protective equipment (if any) ✓ ✓ ✓ ✓ ✓
Fire extinguishers ✓ ✓ ✓
Fire alarms ✓ ✓
Fall protection equipment (if any) ✓ ✓ ✓ ✓ ✓
First Aid kits and accessories ✓ ✓
Rescue equipment (if any) ✓ ✓ ✓ ✓ ✓
Workplace tools, equipment and machinery (if any) ✓ ✓ ✓ ✓ ✓
*All workers must also follow manufacturers’ specifications and any additional
inspection protocols required by law for all vehicles, machinery, tools, equipment and
fire safety equipment (i.e., the Ontario Fire Code, etc.) at all times.
6.2.2 Workplace Inspections and Evaluations
The Business shall maintain an inspection log for all equipment, as required, using the
Equipment Inspection Log Form B found in Section 19.0, “Forms”.
6.3 PERSONAL PROTECTIVE EQUIPMENT

If applicable, all workers must use suitable safety equipment at all times, including, but
not limited to, safety glasses, protective footwear (e.g., steel toe boots), hard hats,
hearing protection (e.g., noise cancelling ear muffs), flame retardant clothing, face
shields, hand protection (e.g., gloves), weather-appropriate clothing and reflective
vests.
All workers will receive proper training regarding how to use any necessary protective
equipment. If any worker is unsure of how to properly use any protective equipment,
they must notify their supervisor or a member of management immediately and must
not perform any work until they have been properly instructed on how to use the
equipment.
Also, all workers must immediately report any defective or non-functional safety
equipment to their supervisors, or to a member of management.
6.4 LONE WORKING
6.4.1 Definition
“Lone working” is defined as a situation where a worker is in the workplace and

assistance is not readily available in the event of an injury, illness or emergency.
6.4.2 Lone Working Risk and Hazard Assessments
Whenever a worker is required to work alone, the Business shall first:
1. Conduct an assessment that is reasonable in the circumstances to

identify any existing or potential risks or hazards arising from the
conditions and circumstances of the lone work, considering factors such
as, but not limited to:
a. The amount of time that the worker can expect to be working alone;
b. The physical and geographic location of the work (e.g., will the
worker be in an isolated area with limited access to communication
or food and water? Will the worker be working outside? Will the
worker be working in a position of visibility?);
c. Whether the worker might require assistance at any point while

working alone (e.g., using a ladder, handling dangerous
substances or lifting heavy materials);
d. The time(s) of day during which the worker will be performing the
lone work;
e. The modes of communication that will be available to the worker

while he or she is working alone;
f. Whether the workplace has functioning security equipment, such

as security cameras and alarm systems;
g. Whether emergency response personnel, such as the police and

paramedics, can easily access the workplace;
h. The transportation needs of the worker (e.g., will the worker be

driving or require access to public transit, and if so, will it be
available to the worker?);
i. Whether the worker will have access to first aid equipment in the
workplace;
j. Whether the worker will be working with large amounts of money or

valuables (i.e., is the worker at risk of being robbed?);
k. Whether the worker is competent to perform the work alone (e.g.,

has the worker received appropriate training, including training and
instruction regarding working alone, etc.?); and
l. Whether the worker will have access to any necessary safety
equipment, and if so, whether the worker has been properly trained
on how to use the equipment;
2. Establish an effective means of communication (e.g., telephone, radio,

intercom, etc.) between the worker and a person or persons capable of
providing immediate assistance to the worker in the event of a hazardous
situation or emergency;
3. If an effective means of communication is not possible, establish a system

for monitoring and supporting the worker (e.g., a “buddy system”) as
appropriate having regard for the conditions and circumstances of the lone
work; and
4. Take all reasonable measures to ensure that all chosen communications

systems (e.g., telephones, cell phones, etc.) are available and in proper
working order.
6.4.3 Lone Working Safety Measures
To ensure the ongoing safety of workers who are working alone, or who might find
themselves working alone, the Business shall, in addition to the foregoing:
1. Take all reasonable steps to control, and if possible, eliminate any risks
or hazards identified during the risk assessment process, as set out in
subsection 6.4.2 (Lone Working Risk and Hazard Assessments) above,
including establishing a procedure for monitoring a worker who will be
working alone (such as a check-in and check-out procedure), requiring
the worker to report to a designated contact person in regular intervals
by way of an audio or visual device;
2. Provide worker training and education to all workers to limit the dangers
of working alone;
3. Investigate any incidents, accidents or near-misses (including incidents

of workplace violence and harassment, whether formally reported or not)
that occur while a worker is working alone and then take all reasonable
measures to prevent a reoccurrence;
4. If necessary, report any incidents, accidents or near-misses to the

appropriate authorities (e.g., the police);
5. If possible, schedule higher risk work to be done either during regular

working hours or during periods when a worker will not be working alone,
or where there is a greater likelihood of a worker not having to work
alone;
6. If possible, avoid scheduling hazardous or high-risk work to be

performed while a worker is or can be expected to be working alone;
7. Take all reasonable measures to ensure that a worker who is working
alone has immediate and unimpeded access to emergency assistance
(e.g., from the police or from paramedics);
8. Develop and implement an action plan for workplace incidents or

emergencies that occur while a worker is working alone; and
9. Establish a travel plan for the worker to get to and from the workplace,
including ensuring that the worker’s vehicle is in working order if he or
she intends to drive.
7.0 FIRST AID
The Business understands that employers who are covered by the Ontario Workplace
Safety and Insurance Act (“WSIA”) must have first aid equipment, first aid facilities and
trained first aid personnel at all workplaces.
The Business shall comply with the WSIA at all times. The expense of furnishing and
maintaining required first aid services and equipment shall be borne by the Business.
The Business shall have in place an appropriate and compliant first aid policy at all
times that is in accordance with the provisions of the WSIA, and any successor
legislation, as amended from time to time.
8.0 WORKPLACE VIOLENCE AND HARASSMENT POLICY
8.1 WORKPLACE VIOLENCE AND PREVENTION

8.1.1 Organizational Commitment
The Business is committed to providing a working environment that is safe, secure,

and free from threats, intimidation and violence. We maintain a zero-tolerance
approach to workplace violence. As such, the Business will not tolerate violent
behaviour and will take all reasonable and practical measures to prevent workplace
violence and to protect workers from acts of violence.
8.1.2 Objectives
The objectives of this policy are to:
1. Ensure that no worker is exposed to violence in the workplace; and
2. Ensure that appropriate disciplinary measures are taken against any

worker found to have committed violence against another worker up to
and including immediate dismissal for cause.
8.1.3 Application
This policy applies to all of the Business’s workers, including full-time, temporary and
contract staff, as well as to any volunteers, students, interns and apprentices. This
policy applies to every level of our organization and to every aspect of the workplace
environment, including events that occur outside of the physical workplace, such as
during business trips and staff events, and where applicable, to digital work
environments.
Every worker is responsible for taking measures to prevent workplace violence and
must promptly report any acts of violence that threaten, or are perceived to threaten,
a safe working environment.
All reported incidents will be taken seriously and investigated in accordance with the
investigation procedure set out in Section 9.0 (Violence and Harassment Investigation
Process).
8.1.4 Definitions
For the purposes of this policy:
“Workplace violence" occurs when a person is abused, threatened,

intimidated or assaulted in the course of employment. Workplace violence
includes threatening behaviour, verbal or written threats, verbal abuse and
physical attacks and includes domestic violence. Examples of workplace
violence include, but are not limited to:
• Expressions of intent to inflict harm;

• Threatening activity, such as waving a fist;
• Using, or attempting to use, physical force against another person;
• Shoving;
• Pushing;
• Hitting; and
• Verbal abuse.
“Domestic violence” is a pattern of behaviour used by one person to gain

power and control over another person with whom he or she has, or has had,
an intimate relationship with. This pattern of behaviour may include, but is not
limited to, physical violence, sexual, emotional, and psychological intimidation,
verbal abuse, stalking, and using electronic devices to harass and control.
8.1.5 Reporting Procedures for Workers
Any worker who believes that they are the victim of workplace violence by another
worker should immediately report the incident to management using Form C found in
Section 19.0, “Forms”. Any worker who believes that thy are the victim of workplace
violence by a supervisor or a manager should report the incident to a third party
(designated by the business) using Form C.
Similarly, anyone who has good reason to believe that workplace violence is occurring
or has occurred should immediately report the matter to management by using Form
C found in Section 19.0, “Forms”.
A report of workplace violence must include details about the alleged incident(s),
including the date(s), time(s) and location(s), what happened, who was involved and
the names of any witnesses.
If an emergency exists and the situation is one of immediate danger, then it should be
reported to the police by dialling “9-1-1” as soon as it is safe to do so. A person in a
situation of immediate danger must at the same time take whatever steps are
necessary to ensure their own safety and to protect themselves from harm or injury.
Once a worker is safe, he or she can then report the matter to management.
Workers must notify management if a restraining order is in effect, or if a potentially

violent non-work-related situation, such as domestic violence, exists and could result
in violence in the workplace.
8.1.6 Duties of Management and Supervisors
Managers and supervisors must act immediately if they observe or are presented with
allegations of a potentially dangerous situation, including domestic violence.
Managers and supervisors are responsible for addressing potential problems
immediately and before they become serious. The business must have an objective
third party investigate if allegations of violence or harassment name the owner or
manager, as no one who reports to the accused person can perform an investigation
into their conduct.
8.1.7 Investigation
All reports and incidents of workplace violence or domestic violence (including

incidents that are observed but not formally reported) will be taken seriously and will
be investigated promptly and thoroughly in accordance with the investigation
procedures set out in Section 9.0 (Violence and Harassment Investigation Process).
Potentially dangerous situations and any necessary precautionary measures will be

promptly communicated to individuals who could be affected. Furthermore, the
applicable investigation protocol set out in Section 9.0 (Violence and Harassment
Investigation Process) may be altered if it is determined that it is necessary to do so,
such as where there is a reasonable and imminent threat to a worker’s safety.
8.1.8 Reporting to the Police
All physical assaults will be reported to the police, as will any other behaviour that
requires police intervention or follow-up, such as a situation of immediate or serious
danger.
8.1.9 Intervention
The Business will intervene as appropriate if there is any indication of a violent or

potentially violent situation.
If a worker is considered to be at risk of violence either from within or outside of the

workplace, a plan will be developed to minimize the risk and respond to any potential
emergency situation.
Should the Business become aware of a potential incident of domestic violence, every
reasonable precaution will be taken in the circumstances to protect the affected
worker.
8.1.10 Corrective Action and Discipline
If the Business determines that a worker has engaged in workplace violence,

appropriate corrective action will be taken, up to and including immediate dismissal for
cause.
In addition, the Business may require that a worker participate in an anger

management program or other form of counselling, either voluntarily or as a condition
of continued employment.
If the violent behaviour is that of a non-employee, then the Business will take
appropriate action in an effort to ensure that such behaviour is not repeated, and if
necessary, take measures to prevent the person from returning to the workplace.
However, not every complaint will warrant corrective action. Rather, corrective action
will be determined on a case-by-case basis.
8.1.11 Risk Reduction Measures
The following measures are in place to minimize the potential for violence in the
workplace:
Visitors
Visitors are required to sign in while on the premises. Any person with a history of
violence or harassing behaviour may be barred from entering the workplace.
Exterior Entrances
All exterior entrances to a workplace are to be locked at all times except for the main
entrance. No exterior doors are to be propped open. The main entrance will be open
during normal business hours, unless the Business determines that the main entrance
should be locked at all times for safety or operational purposes.
In the event that a worker has reason to believe that an individual may be violent or is
exhibiting potentially violent behaviour at any entry point to the workplace, he or she
must notify management immediately and take any protective action that is reasonably
necessary in the circumstances.
Screening
All new workers, including students and apprentices, may be subject to appropriate
security checks by management to ensure that they do not pose a risk of harm in the
workplace.
Orientation
All new workers will be oriented to this policy, to any risks of violence relating to their
employment and to procedures for managing potentially violent situations.
Training
As part of its general training protocols (see Section 4.0, “Education and Training”
above), the Business will provide all of its workers with training regarding violence
prevention as appropriate and as required by law.
8.1.12 Annual Risk Assessments, Reviews and Inspections
The Business shall conduct regular and annual reviews of this policy, and any other
applicable policies, programs and procedures, and conduct regular and annual
inspections of its workplace(s) in order to assess hazards related to workplace
violence and make any amendments to this policy, and any other applicable policies,
programs and procedures, as may be necessary based on the results of its reviews.
The Business will also ensure that appropriate corrective action is taken to reduce
risks.
The results of any assessment will be reported to the health and safety representative
or joint health and safety committee, as the case may be (if applicable).
If there is no health and safety representative or committee in place, then workers will
be directly advised of any assessment. If the assessment is in writing, then workers
will be provided with a copy on request or told how they might obtain a copy.
8.1.13 Incident Management
In the event of a significant incident of workplace violence, the Business will

immediately assess the situation and arrange for the following interventions as
appropriate:
• Facilitation of medical attention;

• If necessary, report the matter to the police;
• Individual debriefing; and
• If necessary, and if possible, arrange for the provision of counselling
services to affected workers.
The Business will investigate the incident(s), and if necessary, the Business will
conduct a review of its workplace(s) and reassess the risk of workplace violence
having regard for the circumstances that gave rise to the incident(s) in question.
8.2 WORKPLACE HARASSMENT AND SEXUAL HARASSMENT

The Business is committed to providing an environment free of harassment of any kind
in which all individuals are treated with respect and dignity.
Workplace harassment of any kind, sexual or otherwise, will not be tolerated,

condoned, or ignored. If a claim of harassment is proven, disciplinary measures will
be applied against the offending worker(s), up to and including immediate dismissal
for cause.
8.2.1 Objectives
The objectives of this policy are to:
1. Ensure that all workers and visitors are aware that workplace
harassment and sexual harassment is unacceptable and incompatible
with the Business’s standards, as well as being a violation of the law;
and
2. Set out the types of behaviour that may be considered offensive and are
prohibited by this policy.
This policy is intended to promote appropriate standards of conduct at all times.
8.2.2 Application
The right to freedom from workplace harassment extends to all workers, including full-
time, part-time, temporary and contract staff, as well as volunteers, interns and
apprentices.
It is unacceptable for workers or contractors working on the Business’s behalf to

engage in harassing behaviour in the workplace or when interacting with clients and
others with whom they have professional dealings, such as suppliers, service
providers and potential clients.
This policy applies to every level of our organization and to every aspect of the
workplace environment, including events that occur outside of the physical workplace,
such as during business trips and staff events, and where applicable, to digital work
environments.
8.2.3 Definitions of Prohibited Behaviour
For the purposes of this policy:
“Harassment” and “workplace harassment” means:
• A course of comments or actions that are known, or ought reasonably

to be known, to be unwelcome. It can involve words or actions that are
known or should be known to be offensive, embarrassing, humiliating,
demeaning, or unwelcome;
• Engaging in a course of vexatious comment or conduct against a worker
in a workplace that is known or ought reasonably to be known to be
unwelcome;
• Psychological harassment or personal harassment, such as prolonged
and repeated verbal abuse, teasing or hostile commentary; and/or
• Workplace sexual harassment.
“Workplace sexual harassment” means:
• Engaging in a course of vexatious comment or conduct against a worker

in a workplace because of sex, sexual orientation, gender identity or
gender expression, where the course of comment or conduct is known
or ought reasonably to be known to be unwelcome; and/or
• Making a sexual solicitation or advance where the person making the
solicitation or advance is in a position to confer, grant or deny a benefit
or advancement to the worker and the person knows or ought
reasonably to know that the solicitation or advance is unwelcome.
8.2.4 Examples of Prohibited Behaviour
Examples of the type of behaviour prohibited by this policy include, but are not limited
to:
• Any form of sexual harassment, including touching, petting, pinching,
kissing, unwelcome sexual flirtations, advances, requests, or invitations
and leering or other suggestive gestures;
• Rough or vulgar humour or language related to sexuality, sexual

orientation or gender;
• Invading personal space;
• Demanding hugs, dates or sexual favours;
• Asking questions, talking or writing about sexual activities;
• Leering or inappropriate staring;
• Unnecessary physical contact;
• Threatening to penalize or otherwise punish a worker if they refuse a

sexual advance;
• The display of visual sexual material that is offensive, or which one ought
to know, is offensive;
• Bullying;
• Demeaning and/or belittling comments;
• Offensive nicknames, remarks, jokes or innuendos;
• Obscene remarks or gestures;
• Display or circulation of offensive pictures, graffiti or materials, whether

in print form or via e-mail or other electronic means;
• Singling out an individual for humiliating or demeaning teasing or jokes;
• Comments ridiculing an individual; and
• Creating a poisoned work environment thorough comments or conduct

(including comments or conduct that are condoned or allowed to
continue when brought to the attention of management). The comments
or conduct may not be directed at a specific individual, and may be from
any individual, regardless of position or status. A single comment or
action, if sufficiently serious may create a poisoned environment.
8.2.5 Examples of What is Not Workplace Harassment
Reasonable action or conduct by a manager, supervisor or worker that is part of his

or her normal work function will not normally be considered harassing. This is the case
even if there are sometimes unpleasant consequences for a worker. Examples
include:
• Changes in work assignments;
• Scheduling;
• Job assessments and evaluations;
• Workplace inspections;
• The implementation and enforcement of dress codes; and
• Counselling or disciplinary action.
Differences of opinion or minor disagreements between co-workers will also not

generally be considered to be workplace harassment.
8.2.6 Reporting Procedures for Workers
Anyone who believes that they are the victim of workplace harassment should
immediately report the incident to management by using Form C found in Section
19.0, “Forms”. Workers who believe they are the victim of the workplace harassment
by a supervisor or the management should report the incident to a third party
(designated by the business) using From C found in Section 19.0, “Forms”.
A report of workplace harassment must include details about the alleged incident(s),
including the date(s), time(s) and location(s), what happened, who was involved and
the names of any witnesses.
Anyone who has good reason to believe that workplace harassment is occurring or
has occurred must immediately report the matter to management.
If an emergency exists and the situation is one of immediate danger, then it should be
immediately reported to the police by dialling “9-1-1” as soon as it is safe to do so. A
person in situation of immediate danger must, at the same time, take whatever steps
are necessary to ensure their own safety and to protect themselves against harm or
injury. Once a worker is safe, he or she can then report the matter to management.
8.2.7 Duties of Management and Supervisors
Managers and supervisors have the additional duty to act immediately on observations
or allegations of workplace harassment. Managers and supervisors are responsible
for addressing potential problems immediately and before they become serious. The
business must have an objective third party investigator if allegations or violence or
harassment name the owner or manager, as no one who reports to the accused
person can perform an investigation into their conduct.
8.2.8 Investigation
All reports and incidents of workplace harassment will be taken seriously and will be
investigated promptly and thoroughly in accordance with the investigation procedures
set out in Section 9.0 (Violence and Harassment Investigation Process).
Potentially dangerous situations and precautionary measures will be communicated

to individuals who could be affected.
Furthermore, the applicable investigation protocol may be altered if it is determined
that it is necessary to do so, such as where there is a reasonable and imminent threat
to a worker’s safety.
8.2.9 Reporting to the Police
Any incident involving workplace harassment will be reported to the police if the
Business deems it to be serious enough to require police intervention.
8.2.10 Intervention
If a worker is considered to be at risk of harassment in the workplace, a plan will be

developed to minimize the risk and respond to any potential emergency situation.
Should the Business become aware of an actual or potential incident of workplace

harassment, every reasonable precaution will be taken in the circumstances to protect
the affected worker.
8.2.11 Corrective Action and Discipline
If the Business determines that a worker has engaged in workplace harassment, then
appropriate corrective action will be taken, up to and including immediate dismissal for
cause.
In addition, the Business may require that a worker participate in an anger

management program or other form of counselling, either voluntarily or as a condition
of continued employment.
If the harassing behaviour is that of a non-employee, the Business will take appropriate
action in an effort to ensure that such behaviour is not repeated, and if necessary, take
measures to prevent the person from returning to the workplace.
However, not every complaint will warrant corrective action. Rather, corrective action
will be determined on a case-by-case basis.
8.2.12 Incident Management
In the event of a significant incident of workplace harassment, the Business will assess
the situation and arrange for the following interventions as appropriate:
• Facilitation of medical attention;

• If necessary, report the matter to the police;
• Individual debriefing; and
• If necessary, and if possible, arrange for the provision of counselling
services to affected workers.
The Business will investigate the incident(s), and if necessary, the Business will
conduct a review of its workplace(s) and reassess the risk of workplace harassment
having regard for the circumstances that gave rise to the incident(s) in question.
8.1.13 Risk Assessments
At least annually and minimally after each and every incidence of workplace
harassment, the Business shall complete an evaluation to determine whether a risk of
workplace harassment exists due to the nature of the work or work environment.
Where workplace harassment risks are identified, the Business will implement any
corrective measures that are required to reduce or eliminate the identified risks.
If there is no health and safety representative or committee in place, then workers will
be directly advised of any assessment. If the assessment is in writing, then workers
will be provided with a copy on request or told how they might obtain a copy.
9.0 VIOLENCE AND HARASSMENT INVESTIGATION PROCESS
9.1 STEP ONE: REPORTING

Any worker who believes that he, she or another worker has been subjected to
workplace violence or harassment must immediately report the matter to any
supervisor or to a member of management using Form C found in Section 19.0,
“Forms”.Workers who believe they are the victim of workplace harassment by a
supervisor or the management should report the incident to a third party (designated
by the business) using Form C found in Section 19.0, “Forms”.
A report should include details about the alleged incident(s), including the date(s),
time(s) and location(s), what happened, who was involved and the names of any
witnesses.
Any worker who receives any report or complaint by a worker of workplace violence
or harassment, or who otherwise becomes aware of an allegation or incident of
workplace violence or harassment, must immediately notify a member of
management.
No retaliation or reprisals will be undertaken or tolerated against any worker who, in

good faith, complains of, reports or participates in any investigation into allegations of
workplace violence or harassment.
9.2 STEP TWO: WORKPLACE INVESTIGATION

Upon receipt of a complaint(s) or allegation(s) of workplace violence or harassment,
the Business shall conduct a prompt, thorough and confidential investigation into the
allegation(s) or complaint(s).
The Business will also conduct an investigation if it indirectly becomes aware of an

incident of workplace violence or harassment that is not formally reported, such as
when a worker, supervisor or manager witnesses an incident of workplace violence or
harassment or learns about it from a third party.
The Business may, at its discretion, or where required by law (e.g., in the case of a
conflict of interest), utilize the services of a third-party investigator. The Business may
also, at its discretion, or where required by law, utilize the services of outside legal
counsel, or such other external expertise as the Business may deem necessary in the
circumstances. Ultimately, it is the aim of the Business to conduct investigations that
are appropriate in the circumstances.
A complaint or allegation of workplace violence or harassment cannot be investigated

by the individual who is the alleged harasser, or by the individual who is alleged to
have engaged in violent or harassing conduct.
Furthermore, under no circumstances will a complaint or allegation of workplace

violence or harassment be investigated by an individual who is under the direct control
of the alleged harasser.
The Business will take all reasonable steps to ensure that conflicts of interest are
avoided.
The investigation procedure is as follows:
1. Interview the complainant(s): The investigator(s) shall interview the

complainant(s) and reporting person (s) concerning the facts underlying
his, her or their allegation(s).
2. Interview with the respondent(s): The investigator(s) will interview the

worker(s) accused of committing the workplace violence or harassment.
The worker(s) will be asked for his, her or their response to the
allegation(s) being made and for his, her or their side of the story.
3. Interviews with witnesses and other individuals: The investigator(s) will

then interview any other workers or other individuals who may have
witnessed the incident(s) of alleged workplace violence or harassment,
or who may otherwise be able to provide information relevant to the
investigation.
4. Records: The investigation will be documented, and the record will

consist of, among other things, detailed notes of all interviews with
workers and witnesses and all other information relevant to the
investigation. And,
5. Report: The results of the investigation will be reported, in writing, to

management. The results will include an assessment of the validity of
the complaint(s).
9.3 STEP THREE: ACTION

Upon completion of an investigation, the results will be communicated in writing to the
worker(s) who reported the alleged violence or harassment. It is important to note that
the outcome of an investigation and any resulting reports are not reports for the
purposes of section 25 of the OHSA. Rather, the affected parties will be provided with
a summary of the outcome and of any corrective or disciplinary action(s).
If the investigation corroborates the complaint(s), to the satisfaction of the Business,

then it will, among other things, take appropriate disciplinary action against the
offending worker(s) and take any other actions or measures it deems necessary to
properly address the incident(s) and prevent future incidences of workplace violence
or harassment from occurring. The nature and extent of any disciplinary or remedial
action shall be determined by the Business in its sole discretion and may include the
immediate dismissal of the offending worker(s) for cause.
Where an investigation results in disciplinary action, the complainant(s) and the

respondent(s) will be informed in writing. If the investigation does not corroborate the
complaint(s), then the complainant(s) and the respondent(s) will be also advised in
writing and the matter will be closed.
The amount of information provided about the corrective action will depend on the
circumstances but must, at a minimum, indicate what steps the Business has taken,
or will take, to prevent a similar incident of workplace violence or harassment if
workplace violence or harassment is found to have occurred.
9.4 EMPLOYEE COOPERATION

If it is necessary for the purposes of completing, carrying out or protecting the integrity
of an investigation, or if it is necessary to maintain a work environment that is safe and
free of violence and harassment, the Business may require a worker to remain out of
the workplace (with pay) while an investigation is being conducted.
The participation and cooperation of all workers is critical to the development and
implementation of this policy. The refusal or failure of any worker to cooperate with an
investigation is a serious form of misconduct for which a worker may be disciplined up
to and including immediate dismissal for cause.
9.5 CONFIDENTIALITY
The Business recognizes the difficulty of coming forward with a complaint of workplace
violence or harassment and a complainant’s interest in keeping the matter confidential.
To protect the interests of a complainant, a respondent, or any other person who may
be involved in incidents of workplace violence or harassment, including witnesses, and
to protect the integrity of the investigation process, confidentiality will be maintained
throughout any investigation. Information relating to the complaint will be disclosed
only to the extent necessary to carry out this policy, or where disclosure is required by
law.
All individuals involved in a workplace investigation are expected to keep the

substance of the investigation strictly confidential. Unless otherwise set out in this
policy, all records of complaints, including records of meetings, interviews, results of
investigations and other relevant material, will be maintained in a confidential file and
will be disclosed only to the extent necessary to carry out these procedures or where
disclosure is required by law.
All such records will be retained in accordance with any privacy policies and
procedures that are in effect, and as required by law.
9.6 REGULAR POLICY REVIEW

This policy shall be monitored and reviewed on an ongoing basis and shall be
amended and modified as management deems necessary, or as required by law.
10.0 HAZARD REPORTING
10.1 WHAT IS A “HAZARD”?

For the purposes of this policy, a “hazard” is any practice, behaviour, condition or
circumstance or combination of these that could cause injury or illness to people or
damage to property, such as completing dangerous work without adequate training,
defective machinery and defective safety equipment, or a near miss.
A “near miss” is any unplanned event or incident that has the potential to cause, but
does not actually result in an injury to a worker, or that does not actually cause
environmental or equipment damage, or an interruption to normal operations.
10.2 PROCEDURE FOR REPORTING HAZARDS AND UNSAFE CONDITIONS

10.2.1 Workers
All hazards encountered by a worker must be reported to a supervisor or to a member

of management immediately. The worker must then:
1. Fill out the hazard reporting Form D found in Section 19.0, “Forms”,
along with a supervisor or a member of management; and
2. Immediately submit the completed hazard reporting form to
management.
10.2.2 Supervisors and Management
Upon receiving a completed hazard reporting form, or upon becoming aware of a

workplace hazard, whether reported or not, supervisors and members of management
must:
1. Complete the second part of the hazard reporting form within 24 hours
of receiving it;
2. Make recommendations regarding how to control the hazard and

establish an action plan for carrying out those recommendations;
3. Assign a member of management, or a supervisor, or both, to implement

the action plan and to ensure that the hazard is rectified;
4. Confirm completion and execution of the action plan;
5. File and maintain a record of the hazard report;
6. If applicable, submit the completed hazard report form and action plan to
human resources and to the JHSC or to a health and safety
representative, as the case may be (if applicable); and
7. Advise the worker who reported the hazard of the outcome of the report
and action plan.
10.2.3 Role of the JHSC and HSR (If Applicable)
If applicable, the Business’s joint health and safety committee or health and safety
representative, as the case may be, will monitor incidents of hazard reporting and
make any recommendations to management that are deemed necessary.
11.0 ACCIDENT AND INJURY REPORTING
11.1 REPORTING POLICY

All workers and staff must immediately report any workplace accident, injury or near
miss on a project site, to a supervisor and to management, as well as to any joint
health and safety committee member or to any health and safety representative, as
the case may be (if applicable), using the Workplace Accident, Injury or Near Miss
Reporting Form E found in Section 19.0, “Forms”.
11.2 ACCIDENT REPORTING PROCEDURES

11.2.1 Fatalities and Critical Injuries
Fatalities and critical injuries (such as an injury that places a person’s life in jeopardy,
involves a fracture to a limb, renders a worker unconscious, and other injuries of a
similarly serious nature) must be reported immediately and acted upon as follows:
Use Form E (Found

Worker/Supervisor in Section 19.0) Management
Must immediately:
Must immediately:
1. Dial “9-1-1” & seek 1. Notify the Ministry of
medical assistance for Labour and the JHSC
the injured person or HSR (if applicable)
2. Provide First Aid, if Report 2. Investigate & prepare
possible a written report of all
details of the incident
3. Report the incident to
a member of 3. Preserve the accident
management or a scene
JHSC member or HSR JHSC/HSR
(if applicable)
Will investigate the
incident, prepare a
report & make
recommendations to
management. HSR
must report findings
to the MOL in writing
Follow & Next
implement
action plan Steps
Implement Submit
preventative Use Form G written
action plan (Found in report to the
& explain to Section 19.0) MOL within
workers 48 hours
Submit Form
7 to the
WSIB within
3 days (if
applicable)
11.2.2 Non-Fatal Accidents and Injuries
Non-fatal accidents, injuries and near misses, including any incident as a result of
which a worker requires medical attention or is disabled, such as an explosion or a
fire, must be reported immediately and acted upon as follows:
Worker/Supervisor Use Form E (Found Management

in Section 19.0)
Must immediately: Must immediately:
1. Dial “9-1-1” & seek 1. Investigate & prepare a
medical assistance for written report of all
the injured person, if details of the incident
necessary
2. Notify the MOL if
2. Provide First Aid, if Report required (i.e., if ordered
possible to do so)
3. Report the incident to 3. Report the incident to
a member of the JHSC or HSR (if
management or a applicable)
JHSC member or HSR
(if applicable)
JHSC/HSR
incident, prepare a
report & make
recommendations to
management
Follow & Next
implement
action plan Steps
Implement Provide report

preventative Use Form G to JHSC or
action plan & (Found in HSR (if
explain to Section 19.0) applicable)
workers within 4 days
Submit Form
7 to the
WSIB within
3 days (if
applicable)
11.2.3 Occupational Illnesses
If a worker or former worker advises the Business, either directly or through another
person (such as the worker’s representative or lawyer), that he or she has an
occupational illness, or that a claim involving an occupational illness has been filed
with the WSIB by or on behalf of the worker, then it must be reported and acted upon
as follows:
Worker/Supervisor
Advise the Business of the Management

existence of an
occupational illness or a Must immediately prepare
WSIB claim involving an Report a report of the notice
occupational illness
JHSC/HSR
Can investigate the
incident, prepare a
report and make Next
recommendations to Steps
management, if
deemed necessary
Other Workers
Follow and
implement action
plan
Investigate and Provide full report

implement any to the MOL and to
preventative action the JHSC/HSR (if
plan if deemed applicable) within
necessary 4 days
Note: Workers should cross-reference this subsection with subsection

13.0 (Early and Safe Return to Work Policy) below, which explains a
worker’s reporting obligations in the context of the Business’s
return to work policy.
11.2.4 Accidents and Near Misses at Project Sites
If at any time the Business is operating as a constructor of a project(s) (see the

definitions of these terms in Section 3.0, “Roles and Responsibilities”, above) and an
accident or unexpected event occurs at the project site(s) that could have caused an
injury, then the accident or event must be reported immediately and acted upon as
follows, even if no workers have been hurt:
Use Form E (Found

Worker/Supervisor in Section 19.0)
Advise the Business of the Management

occurrence of an accident
or unexpected event that Must immediately prepare
could have caused an Report a report of the notice
injury to a worker
JHSC/HSR
incident, prepare a
report and make Next
recommendations to Steps
management, if
deemed necessary
Other Workers
Follow and
implement action
plan
Investigate and Provide full report

implement any to the MOL and to
preventative action the JHSC/HSR (if
plan if deemed applicable)
necessary within 2 days
11.2.5 Witnesses
In each case, witnesses should complete the Workplace Accident, Injury or Near Miss
Witness Statement Form F found in Section 19.0, “Forms”.
11.3 ACCIDENTS AND INJURIES INVESTIGATION PROCEDURE
11.3.1 Overview of Roles and Responsibilities
Occupational
Project Sites
Accidents at
Accidents
Accidents
Business
Non-fatal
Illnesses
Fatal or
Critical
Member
Workers Seek immediate medical Seek immediate medical Report the Report the
assistance & report the assistance & report the illness to incident to a
incident to a supervisor, incident to a supervisor, management supervisor,
management or to a JHSC management or to a JHSC management or
member or HSR (if member or HSR (if to a JHSC
applicable) applicable) member or HSR
(if applicable)
Supervisors Seek immediate medical Seek immediate medical Report the Notify
assistance, report the assistance; notify illness to management
incident to management & management & preserve management if and preserve the
preserve the accident the accident scene for made aware incident scene
scene for investigation investigation for inspection
Management Immediately notify the MOL Prepare a detailed written Notify the MOL Prepare detailed
and the JHSC or HSR (if report of the incident; notify and the JHSC or written report of
applicable); secure the the MOL if required (i.e., if HSR (if the incident;
accident scene; conduct a ordered to do so); report the applicable) investigate the
full investigation of the incident to the JHSC or within 4 days of incident; provide
accident; prepare a detailed HSR (if applicable); conduct being advised of written notice of
written report and submit it an investigation; provide a the illness the incident to
to the MOL within the next report to the JHSC or HSR the MOL within
48 hours; submit a Form 7 (if applicable) within the 2 days; &
to the WSIB within the next 4 (if applicable); implement a
next 3 days (if applicable) submit Form 7 to WSIB preventative
& implement a preventative within 3 days (if applicable) action plan
action plan & implement a preventative
action plan
JHSC Attend the accident scene; Investigate; prepare a report & make recommendations to
investigate the accident; management
(if prepare a report & make
applicable) recommendations to
management
HSR Attend the accident scene, Investigate; prepare a report & make recommendations to
investigate, prepare a management
(if report & submit it to the
applicable) MOL in writing & make
recommendations to
management
Form to Use Form E, Form F & Form G Form E, Form F & Form G Form E Form E
(See Section 19.0, “Forms”) (See Section 19.0, “Forms)
11.3.2 Workers
In the event of a workplace accident, injury or near miss, a worker must:
1. If a worker has been injured, seek out, or assist with seeking out,
immediate medical assistance, such as by dialling “9-1-1”;
2. Immediately notify, or help notify, a supervisor, a member of

management or a JHSC member or HSR (if applicable);
3. Cooperate fully with and assist in securing the incident scene;
4. Cooperate fully and assist with any investigation into the incident;
5. Refrain from in any way tampering with any evidence or other items at
the incident scene, including any tools, equipment; and
6. Complete the Accident, Injury or Near Miss Reporting Form E found in

Section 19.0, “Forms”.
11.3.3 Supervisors
In the event of a workplace accident, injury or near miss, a supervisor shall:
1. Seek, or assist with seeking out, immediate medical assistance, such as

by dialling “9-1-1”;
2. Immediately notify, or help notify, a member of management or a JHSC

member or HSR (if applicable);
3. Cooperate fully with and assist in securing the incident scene;
4. Cooperate fully and assist with any investigation into the incident;
5. Refrain from in any way tampering with any evidence or other items at
the incident scene, including any tools or equipment; and
6. Complete the Workplace Accident, Injury or Near Miss Reporting Form

E in found in Section 19.0, “Forms”.
11.3.4 Management
In the event of a workplace accident, injury or near miss, management shall:
1. In the case of a fatality or a critical injury to a worker:
a. Notify emergency response personnel (i.e., police and paramedics)

if they have not been notified already;
b. Immediately notify the Ministry of Labour and the JHSC or HSR (if
applicable);
c. Assume control of and preserve the incident scene as soon as
possible;
d. Carry out a detailed investigation as soon as possible;
e. Obtain the names of and obtain statements from any and all
relevant witnesses by having them complete the Workplace
Accident, Injury or Near Miss Witness Statement Form F found in
Section 19.0, “Forms”;
f. Take photographs of the incident scene;
g. Collect all relevant records and other information, such as

maintenance reports and equipment inspection records;
h. Attempt to identify the cause(s) of the incident;
i. Prepare a written investigation report and submit it to the Ministry

of Labour within 48 hours of the incident occurring;
j. If applicable, file a completed WSIB Form 7, being Form G found

in Section 19.0, “Forms”, with the WSIB within three (3) days of
the incident occurring; and
k. Prepare and implement a preventative action plan;
2. In the case of a non-fatal accident or injury to a worker:
a. Notify emergency response personnel (i.e., police and paramedics)

if they have not been notified already;
b. Immediately notify the Ministry of Labour (if applicable – i.e., if the

business is subject to an order requiring it to do so) and the JHSC
or HSR (if applicable);
c. Assume control of and preserve the incident scene as soon as

possible;
d. Carry out an investigation;
e. Obtain the names of and obtain statements from any and all
f. Take photographs of the incident scene;
g. Collect all relevant records and other information, such as

h. Attempt to identify the cause(s) of the incident;
i. If applicable, prepare a written investigation report and submit it to
the JHSC or HSR within four (4) days of the incident occurring;
j. If applicable (i.e., if the business has been ordered to do so by the

Ministry of Labour) prepare a written investigation report and
submit it to the Ministry within four (4) days of the incident
occurring;
k. If applicable, file a completed WSIB Form 7, being Form G found

in Section 19.0, “Forms”, with the WSIB within three (3) days of
the incident occurring; and
l. Prepare and implement a preventative action plan.
3. In the case of an occupational illness:
a. Upon receiving notice of an occupational illness from a current or

former worker, either directly or indirectly, keeping a record of
same; and
b. Notifying the Ministry of Labour, and the JHSC or HSR (if

applicable) in writing of the notice of occupational illness within
four (4) days of receiving it;
4. In the case of a non-fatal and non-critical accident or near miss at a

project site:
a. Assume control of and preserve the incident scene as soon as

possible;
b. Carry out an investigation;
c. Obtain the names of and obtain statements from any and all
d. Take photographs of the incident scene;
e. Collect all relevant records and other information, such as

f. Attempt to identify the cause(s) of the incident;
g. Prepare a written investigation report and submit it to the Ministry

of Labour and to the JHSC or HSR (if applicable), within two (2)
days of the incident occurring; and
h. Prepare and implement a preventative action plan.
11.3.5 JHSC or HSR Investigation (If Applicable)
In the event of a workplace accident, injury or near miss on a project site, a joint health
and safety committee worker member or health and safety representative, as the case
may be, shall:
1. In the case of a critical injury to a worker or a fatality:
a. Attend the incident scene and notify emergency response

personnel (i.e., police and paramedics) if they have not been
notified already;
b. Conduct an investigation into the incident;
c. Prepare a written report of his or her investigation;
d. Provide a copy of his or her written investigation report to the

Ministry of Labour and to the joint health and safety committee; and
e. In the case of a health and safety representative, report his or her

findings to the Ministry of Labour in writing;
2. In the case of a non-fatal accident or injury to a worker:
a. Obtain a report of the incident from management; and
b. If necessary, investigate the incident and make recommendations

to management;
3. In the case of an occupational illness that has been reported to

management:
a. Obtain particulars of the report from management; and

to management; and
4. In the case of a non-fatal and non-critical accident or near miss at a

project site:
a. Obtain a report of the incident from management; and

to management.
12.0 REFUSAL TO WORK
12.1 POLICY AND APPLICATION

It is the policy of the Business to follow the rules and provisions contained in the OHSA
regarding a worker’s right to refuse work, including all of the exemptions set out in the
Act.
All of the policies and procedures set out in this section shall apply to all workers who
are not exempt according to the applicable provisions of the OHSA. In addition, this
policy does not bestow rights upon workers regarding refusal rights over and above
those specifically set out in the Act.
Whatever the case, given the Business’s commitment to health and safety, and as a
result of the implementation of its health and safety program, including the creation
and dissemination of this policy manual, the Business expects that there will be few
occasions on which its workers will be required to refuse to work on the grounds that
it is unsafe.
12.2 WORK REFUSALS

Subject to the provisions of the OHSA (including the exemptions contained therein), a
worker may refuse to work, or refuse do particular work if he or she has reason to
believe that:
1. Any equipment, machine device or thing the worker is to use or operate

is likely to endanger himself, herself or another worker;
2. The physical condition of the workplace or the part thereof in which the
worker works, or is to work, is likely to endanger himself or herself;
3. Workplace violence is likely to endanger himself, herself; or
4. Any equipment, machine, device or thing he or she is to use or operate,

or the physical condition of the workplace or the part thereof in which he
or she works or is to work, is in contravention of the OHSA and the
contravention is likely to endanger the worker or another worker.
12.3 REPORTING AND INVESTIGATION PROCEDURE

If a worker has refused to work or refused to do particular work, he or she must
immediately report the circumstances of the refusal to his or her supervisor or to a
member of management by completing the Work Refusal Reporting Form H found in
Section 19.0, “Forms”. Management will then promptly investigate those
circumstances in the presence of the worker and, if applicable, in the presence of a
joint health and safety committee worker member or a health and safety
representative, as the case may be.
During the investigation, the worker shall remain in a safe location and must be
available to the Business to answer any questions and to provide any information
necessary for a proper investigation.
Following the completion of the investigation, the Business will notify the worker and,
if applicable, the joint health and safety committee worker member or health and safety
representative, as the case may be, of its findings.
12.4 OUTCOME
If after receiving the results of the Business’s investigation the worker feels that he or
she still has reasonable grounds to believe that his or her work is unsafe, then the
worker may refuse to work and must notify the Ministry of Labour.
13.0 EARLY AND SAFE RETURN TO WORK POLICY
13.1 OVERVIEW
The Business will make every effort to provide modified or suitable alternative work or
duties to a worker who is unable to perform his or her regular duties as a result of a
work-related injury or illness. In every such case, it is the goal of the Business to return
a worker to his or her regular pre-injury or pre-illness duties as quickly as possible,
provided that it is safe to do so.
13.2 WORKER DUTIES

If worker suffers a work-related injury or illness, the worker must:
1. Immediately report his or her injury or illness to their supervisor or to a

member of management by completing the WSIB Form 6/Workplace
Injury or Occupational Illness Reporting Form I found in Section 19.0,
“Forms”1;
2. If applicable and if required by law, submit a completed Form I to the

WSIB;
3. Comply with all of the Business’s early and safe return to work
(“ESRTW”) programs, policies and procedures that are in place from
time to time, including this policy;
4. Complete, along with his or her doctor or health care provider, the
Business’s ESRTW package contained in Form J found in Section 19.0,
“Forms”, which consists of:
a. A WSIB Functional Abilities Form2;
b. A draft employer letter to the worker’s doctor or health care provider;

and
c. A Modified/Alternative Work Journal;
5. If applicable and if required by law, all other forms and documents that
the worker must complete and submit to the WSIB;
6. Return a completed ESRTW package to management as soon as

possible and prior to the worker’s next scheduled day of work;
1 Not every business is subject to the specific injury reporting requirements set out in the Ontario
Workplace Safety and Insurance Act. However, for the sake of simplicity and consistency, the Business
has elected to use WSIB Form 6 for reporting all work-related injuries and illnesses.
2 Again, for the sake of simplicity and consistency, the Business has elected to use the WSIB’s
Functional Abilities Form for managing all work-related injuries and illnesses regardless of whether the
Business is actually subject to the specific reporting requirements set out in the Ontario Workplace
Safety and Insurance Act.
7. Participate in good faith in reintegrating him or herself back into the
workplace, including by cooperating with any reasonable modified
working arrangements; and
8. Cooperating with management by, among other things, and not limited
to, maintaining regular communication and sharing necessary
information regarding his or her ability to work, physical capabilities and
limitations and treatment plans and sharing any concerns that the worker
may have regarding his or her health or current work arrangements.
13.3 MANAGEMENT’S DUTIES

If a worker suffers a work-related injury or illness, management shall:
1. Ensure that the worker is informed of and complies with all of the
Business’s ESRTW programs, policies and procedures that are in place
from time to time, including this policy;
2. Participate in the promotion and provision of reasonable modified or

alternative work arrangements;
3. Offer the worker suitable alternative or modified work using the

Modified/Alternative Work Offer Form K found in Section 19.0, “Forms”.
4. Provide support and encouragement to a worker participating in the

Business’s ESRTW programs, policies and procedures;
5. Cooperate with a worker by, among other things, maintaining regular

communication and sharing necessary information regarding the
worker’s ability to work, his or her physical capabilities and limitations
and treatment plans and sharing any concerns that management may
have regarding the worker’s health or current work arrangements;
6. Ensure that the worker, or any other worker, is not subjected to unsafe
conditions, such as by allowing a worker to perform duties for which he
or she is not medically fit or providing modified duties that are unsuitable
having regard for the worker’s limitations; and
7. Making reasonable efforts to help the worker return to his or her regular
duties as quickly and safely as possible.
14.0 EMERGENCY PROCEDURES
14.1 GENERAL
Emergency preparedness shall be maintained at all times within the workplace in order
to handle any emergency situation promptly. The necessary degree of emergency
preparedness shall be ensured through training, emergency drills, personnel
qualifications, instructions and procedures.
The Business will take steps to ensure that emergency exits and escape routes are free
from obstructions and that all workers are familiar with their surroundings and aware of
all available exits and escape routes. The Business will also conduct and keep logs of
annual emergency fire and evacuation drills.
The Business will maintain and post in a conspicuous location in the workplace a
completed Emergency Response Information Form L found in Section 19.0, “Forms”,
which will set out, among other things:
1. Key personnel names and contact details;
2. The names, contact details and work location(s) for the first aid
personnel;
3. The location of first aid equipment;
4. The contact details for the nearest emergency services;
5. The address of contact information for the nearest medical facility; and
6. The Business’s emergency evacuation procedure.
14.2 APPLICATION
The Business’s emergency protocols, policies and procedures shall apply to any
emergency situation, including, but not limited to:
1. Fires;
2. Bomb threats;
3. Chemical spills or leaks;
4. Severe weather incidents;
5. Natural disasters; and
6. Acute medical events (such as a heart attack or a stroke).
Each emergency occurrence shall be formally reported using the Emergency Incident
Report Form M found in Section 19.0, “Forms”, and if necessary, investigated in line
with applicable procedures.
14.3 COMMUNICATION
If an emergency situation occurs, management shall notify all workers of the
circumstances of the emergency, and to the extent possible, in a manner that does not
further endanger the safety of any worker or person, such as by inciting mass panic.
The Business shall ensure that it has in place at all times a global communication system
(such as an alarm) capable of carrying out an immediate business-wide evacuation,
such as in the event of a fire or gas leak.
Depending on the nature of the emergency, management shall contact the appropriate
emergency service, such as the police, fire services, paramedics, hazard control
services or hydro or gas line repair services.
14.4 EMERGENCY EVACUATIONS

The Business shall have in place emergency evacuation protocols, policies and
procedures to be applied in an emergency that requires an immediate business-wide
evacuation, including the following evacuation procedures:
1. Activating the appropriate alarm system;
2. Exiting the workplace or building using the emergency exit;
3. Refraining from using elevators;
4. Exiting the workplace or building in an orderly fashion;
5. Heading directly to the nearest predetermined assembly point, or if one

does not exist, to the nearest safe location;
6. Refraining from returning to the workplace under any circumstances; and
7. Waiting at the designated assembly point or safe spot until instructed

otherwise or unless it is unsafe to do so (for example, if there is severe
weather or falling glass, debris or flames).
Each emergency situation occurrence shall be formally reported and investigated in

accordance with applicable procedures.
15.0 HAZARDOUS MATERIALS IN THE WORKPLACE AND WHMIS
The Business will implement programs, policies, procedures and protocols to ensure
compliance with the OHSA as it applies to hazardous products and materials in the
workplace, and in particular, Ontario Regulation 490/09 (Designated Substances),
Ontario Regulation 278/05 (Asbestos on Construction Projects and in Buildings and
Repair Operations), Ontario Regulation 860 (Workplace Hazardous Materials
Information System) and Ontario Regulation 833 (Control of Exposure to Biological or
Chemical Agents), and any successor legislation, as they are all or may be amended
from time to time.
Without limiting the generality of the foregoing, the Business shall take steps to ensure
that:
1. All workers are properly trained regarding how to recognize, monitor,

handle and limit their exposure to hazardous substances in the
workplace;
2. Hazardous products and materials are used, handled and stored in the
manner prescribed by law;
3. All hazardous products and materials are identified and labelled in the
manner prescribed by law; and
4. Proper policies, procedures and protocols are in place to ensure that

proper records and data concerning hazardous materials and products
in the workplace are maintained and not tampered with.
16.0 DRUG AND ALCOHOL POLICY
16.1 GENERAL
Workers are strictly prohibited from reporting to work and engaging in work while
impaired by drugs, alcohol or other substances (legal or illegal) which may cause
impairment, including cannabis.
In addition, the use, possession, transfer, or sale of any illegal substance on the
Business’s premises or in any parking lot or work site is strictly prohibited.
However, if any worker requires accommodation due to a disability (such as a

substance abuse issue) or as a result of being prescribed medically required drugs
(including cannabis), then the worker should immediately report his or her condition
to management in confidence.
16.2 DEFINITIONS
“Impairment” or “being impaired” means that a worker’s normal physical or mental
abilities, or faculties, while at work have been detrimentally affected by the use of
substances (legal or illegal, including cannabis), as determined by the Business in
its sole discretion. Without limiting the generality of the foregoing, “impairment”
includes the inability to safely, competently or efficiently perform work duties.
16.3 APPLICATION
Any worker who reports to work impaired will not be allowed to work and any worker
who is found to be impaired while working will not be allowed to continue working.
If, in the sole opinion of the Business, a worker is deemed seriously impaired, the
worker shall be sent home (with pay, pending an investigation, if the Business deems
it appropriate in the circumstances), and if it is necessary to ensure the worker’s
safety, as determined by the Business, he or she will be sent home by taxi or another
safe means of transportation. An impaired worker will not be allowed to drive or
operate any equipment or machinery under any circumstances.
Subject to any overriding obligations at law (such as a duty to accommodate a

disability), any worker who violates this policy by either reporting to work impaired,
becoming impaired at work or working while impaired is guilty of serious workplace
misconduct and can be subject to severe disciplinary action including immediate
dismissal for cause.
If a worker is involved in the use, possession, transfer, or sale of an illegal substance

in the workplace, management may notify the appropriate authorities.
Management may also deem it necessary to report a worker’s illicit conduct outside
of work if it presents the potential to cause a risk of harm to workers within the
workplace.
17.0 PROGRESSIVE DISCIPLINE POLICY
The following progressive discipline process will, where appropriate, be carried out
with the intent of promoting a safe and healthy workplace.
17.1 IDENTIFICATION OF PERFORMANCE ISSUES

A worker’s supervisor, or alternatively, the Business’s management, shall be
responsible for promptly identifying and promptly responding to any unsafe conduct
by the worker, including, but not limited to, any violations of the Business’s health and
safety program, policies, procedures and protocols, including this policy.
Before initiating this progressive discipline process, the worker’s supervisor or

management, as the case may be, shall first communicate the Business’s
expectations to the worker – and in particular, the importance of health and safety
compliance – both verbally and in writing so that: (i) the worker is fully aware of the
health and safety standards expected of him or her; and (ii) that failure to comply with
those standards will result in discipline.
17.2 PROGRESSIVE DISCIPLINE

If a worker’s conduct continues to fall short of acceptable standards, or if the worker
commits a serious initial violation of the Business’s health and safety program,
policies, procedures and protocols, including this policy, as determined by the
Business in its sole discretion, then management will initiate the Business’s
progressive discipline process, as explained in detail below.
17.2.1 Step One: Verbal Warning
The worker’s supervisor or a member of management shall meet privately with the
worker to discuss his or her conduct and warn the worker that failure to correct his or
her conduct could lead to further discipline up to and including immediate dismissal
for cause. The supervisor or management representative shall discuss with the worker
ways to bring about improvements in the worker’s conduct and health and safety
compliance and schedule a follow-up interview date.
If management determines that it is appropriate, the worker will be placed on a

performance improvement plan with the aim of helping the worker correct his or her
conduct.
17.2.2 Step Two: Written Warning
If a worker’s performance does not improve following Step 1, then the worker will
receive a written warning that his or her continued misconduct could lead to further
disciplinary action up to and including dismissal for cause. The worker’s supervisor or
a member of management will again discuss with the worker ways to bring about
improvements in the worker’s conduct and schedule a second follow-up interview
date.
If management determines that it is appropriate, the worker will be placed on a new or
updated performance improvement plan with the aim of helping the worker correct his
or her behaviour.
17.2.3 Step Three: Dismissal
If the worker’s misconduct continues after Step 2, then the worker will be dismissed
for cause.
17.3 EXCEPTION FOR SERIOUS MISCONDUCT

The Business may elect to dismiss a worker prior to carrying out any or all of the steps
set out in subsection 17.2 (Progressive Discipline) above if the Business determines,
in its sole discretion, that a worker has engaged in serious misconduct, including
engaging in conduct that presents a serious risk to the health and safety of other
workers.
18.0 INDEX
A
Duties of supervisors .............................................. 8
Accident (project site)........................................... 43 Duties of visitors ................................................... 15
Accident reporting ................................................ 40
Accidents (reporting procedure) ........................... 40 E
Accommodation ................................................... 56
Accommodation of disability ................................. 56 Early and safe return to work
Affected workers .................................................. 10 (management's duties) ......................................... 52
Agent.................................................................... 10 Early and safe return to work forms ...................... 51
Alternative Work Offer Form ................................ 52 Early and safe return to work package ................. 51
Annual review......................................................... 9 Early and safe return to work policy...................... 51
Apprentice .............................................................. 6 Education and Training......................................... 16
Asbestos .............................................................. 55 Education and training policy................................ 16
Elevated heel.......................................................... 9
B Emergency contact list ......................................... 16
Emergency evacuations ....................................... 54
Basic awareness training ..................................... 16 Emergency notification procedure ........................ 54
Biological agents .................................................. 55 Emergency procedures ........................................ 53
Emergency response plan .................................... 53
C Enforcement orders .............................................. 10
Entertainment and advertising industry .................. 9
Cabinet drawers ................................................... 19
Equipment .............................................................. 8
Cannabis .............................................................. 56
Equipment defect ................................................. 14
Cannabis in the workplace ................................... 56
ESRTW ................................................................ 51
Cellphones ........................................................... 13
Certified training ................................................... 16
Chairs................................................................... 19 F
Chemical agents .................................................. 55 Fall protection ....................................................... 19
Committee members ............................................ 16 Fall protection equipment ..................................... 20
Competent person.................................................. 9 Fatalities ............................................................... 40
Conspicuous location ............................................. 9 Filing cabinet ........................................................ 19
Construction (definition) ....................................... 11 Fire alarms ........................................................... 20
Construction project ............................................. 11 Fire extinguishers ........................................... 19, 20
Constructor (definition) ......................................... 12 First aid................................................................. 24
Constructor duties ................................................ 12 First aid kits .......................................................... 19
Constructors ......................................................... 10 First Aid kits .......................................................... 20
Contractors .......................................................... 14 Footwear ................................................................ 9
Court orders ......................................................... 10
Critical injuries ...................................................... 40 G
D General training .................................................... 16

Government authorities ........................................ 11
Dangerous Substances ........................................ 12 Gross misconduct ................................................. 58
Defective equipment ............................................ 20
Delegate ............................................................... 10 H
Designated substances ........................................ 55
Desk drawers ....................................................... 19 Harassment .......................................................... 29
Detection system.................................................. 10 Hazard (definition) ................................................ 38
Directors and officers ........................................... 10 Hazard reporting ................................................... 38
Disability............................................................... 56 Hazard reporting form........................................... 38
Discipline policy.................................................... 57 Hazard reporting procedure .................................. 38
Dismissal for cause .............................................. 58 Hazardous materials............................................. 55
Drawings .............................................................. 11 Hazardous materials handling .............................. 55
Drug use outside of work ..................................... 56 Hazardous materials training ................................ 55
Drugs ................................................................... 13 Hazardous substances ......................................... 11
Drugs and alcohol policy ...................................... 56 Hazardous substances ......................................... 55
Drugs at work ....................................................... 56 Hazards (duties of management) ......................... 38
Drunk at work ....................................................... 56 Hazards (duties of workers).................................. 38
Duties of contractors ............................................ 14 Health and safety literature ..................................... 9
Duties of directors and officers ............................. 10 Health and safety literature ................................... 16
Duties of managers ................................................ 8 Health and safety paperwork ................................ 10
Duties of owners .................................................. 10 Health and safety report ......................................... 8
Duties of project owners ....................................... 11 Health and safety representative .......................... 18
Duties of subcontractors ...................................... 14 Health and safety representative
(duties regarding fatalities and critical injuries) .... 47 Owner of a workplace ........................................... 10
Health and safety representative Owners ................................................................. 10
(duties regarding fatalties and critical injuries) ..... 47
Health and safety training .................................... 13 P
Housekeeping ...................................................... 19
Performance improvement plan ........................... 57
I Performance issues .............................................. 57
Personal protective equipment ....................... 19, 20
Illegal substances at work .................................... 56 Posting ................................................................. 16
Impairment at work............................................... 56 pot at work ............................................................ 56
Impairment policy ................................................. 56 Prevention Starts Here (poster) ............................ 16
Industrial establishment ....................................... 11 Progressive discipline ........................................... 57
Information ............................................................. 8 Progressive discipline policy ................................. 57
Injuries (reporting procedure) ............................... 40 Progressive discipline process ............................. 57
Injury reporting ..................................................... 40 project owner (definition) ...................................... 11
Inspection and maintenance ................................ 19 Project owners ................................................ 10, 11
Inspection Routine ............................................... 20 Project site (accident) ........................................... 43
Investigation (workplace violence) ....................... 25 Project site (near miss) ......................................... 43
Investigation procedure ........................................ 35
Investigation procedure (work refusals)+ ............. 49 R
Investigation procedure (workplace accidents) .... 44
Investigation procedure (workplace injuries) ........ 44 receiver................................................................. 10
Investigations ....................................................... 35 Regular review ..................................................... 10
rental .................................................................... 13
J Reporting accidents and injuries .......................... 40
Reporting form (workplace accident or injury) ...... 40
JHSC.................................................................... 18 Reporting form (workplace harassment)............... 32
Joint health and safety committee ........................ 18 Reporting form (workplace illness) ....................... 51
Joint health and safety committee Reporting form (workplace injury) ......................... 51
(duties regarding fatalities and critical injuries) .... 47 Reporting form (workplace violence) .................... 26
Reporting workplace violence ............................... 26
L Rescue equipment................................................ 20
Return to work (management's duties) ................. 52
Ladder .................................................................. 19 Return to work (worker duties) ............................. 51
Leasing ................................................................ 13 Return to work policy ............................................ 51
Legal working age .................................................. 8 Risk assessment (working alone) ......................... 21
Lessee ................................................................. 10 Risk assessments................................................. 10
Lone working ........................................................ 21
S
M
Safety equipment ................................................. 19
Management .......................................................... 8 Dafety sensitive work............................................ 13
Marijuana ............................................................. 56 Serious misconduct .............................................. 58
Medical condition ................................................. 14 Sexual harassment ............................................... 29
Medical surveillance program............................... 10 Specifications ....................................................... 11
Ministry of Labour Subcontractor ....................................................... 12
(reporting fatalities and critical injuries) ................ 45 Subcontractors ..................................................... 14
Ministry of Labour Supervision............................................................. 8
(reporting occupational illnesses) ......................... 47 Supervisor training................................................ 16
Modified Work Offer Form .................................... 52 Supervisory Personnel ........................................... 8
Mortgagee ............................................................ 10 Supplier (definition)............................................... 12
Supplier duties ...................................................... 12
N Suppliers ........................................................ 10, 12
Near miss (definition) ........................................... 38
Near miss (management duties) .......................... 45 T
Near miss (project site) ........................................ 43 Tenant .................................................................. 10
Near miss (worker duties) .................................... 44 Tender .................................................................. 12
Near misses ................................................... 14, 38 Trainee ................................................................... 6
Non-fatal accidents .............................................. 41 Training .................................................................. 8
Non-fatal injuries .................................................. 41 Training records ................................................... 17
Tripping hazard .................................................... 19
O Trustee ................................................................. 10
Occupational illnesses ......................................... 42
occupier of lands .................................................. 10 U
Occuptional Health and Safety Act......................... 6 Underage workers .................................................. 9
OHSA. .................................................................... 6 Unsafe work ......................................................... 49
V Workplace harassment (investigation procedure) 35
Workplace harassment (investigation).................. 32
Verbal warnings ................................................... 57 Workplace harassment (reporting procedure) ...... 32
Visitors ................................................................. 15 Workplace harassment (risk assessments) .......... 33
Volunteer ................................................................ 6 Workplace Hazardous Materials
Information System............................................... 55
W Workplace injuries (worker duties) ....................... 44
WHMIS........................................................... 16, 55 Workplace injury (management duties) ................ 45
Work equipment ................................................... 19 Workplace injury reporting form ............................ 51
Work refusal reporting form .................................. 49 Workplace inspections.......................................... 10
Worker ................................................................... 6 Workplace inspections and evaluations................ 20
Worker dismissal .................................................. 58 Workplace investigation (confidentiality)............... 37
Worker duties ....................................................... 13 Workplace investigation (employee cooperation) . 37
Worker orientation ................................................ 17 Workplace investigations ...................................... 35
Worker reporting obligations ................................ 14 Workplace Safety and Insurance Act.................... 24
Worker Representation ........................................ 18 Workplace sexual harassment ............................. 29
Workers ................................................................ 13 Workplace sexual harassment
Working alone ...................................................... 21 (investigation procedure) ...................................... 35
Working at heights training ................................... 16 Workplace violence .............................................. 25
Working conditions ............................................... 19 Workplace violence (investigation procedure) ...... 35
Worklpace injury reporting form ........................... 40 Workplace violence (reporting to the police)......... 27
Workplace accident (management duties) ........... 45 Workplace violence (training) ............................... 28
Workplace accident (worker duties) ..................... 44 Workplace violence and prevention policy............ 25
Workplace accident reporting form....................... 40 Workplace violence, duties of management) ........ 26
Workplace harassment ........................................ 29 Written warnings ................................................... 57
Workplace harassment (definition) ....................... 30 WSIA .................................................................... 24
Workplace harassment (duties of management) .. 32 WSIB Form 6 ........................................................ 51
Workplace harassment (examples) ...................... 30 WSIB Form 7 .................................................. 46, 47
19.0 FORMS
Title Description
Form A Training/Certified Training Record
Form B Equipment Inspection Log Form
Form C Workplace Violence and Harassment Incident Reporting Form
Form D Hazard Reporting Form
Form E Workplace Accident, Injury or Near Miss Reporting Form
Form F Workplace Accident, Injury or Near Miss Witness Statement Form
Form G WSIB Form 7
Form H Work Refusal Reporting Form
Form I WSIB Form 6/Workplace Injury or Occupational Illness Reporting Form
Form J Early and Safety Return to Work Package
Form K Modified/Alternative Work Offer
Form L Emergency Response Information
Form M Emergency Incident Report
Form A
Training/Certification Training Record
NAME TRAINING TYPE COMPLETION CERTIFICATE EXPIRY WORKER

(print clearly) (print clearly) DATE OR TICKET # DATE: SIGNATURE
(dd/mm/yyyy) (initial)
(dd/mm/yyyy)
Form B
Equipment Inspection Log Form
TYPE OF HEAVY EQUIPMENT AND RELEVANT DETAILS
Type of Equipment Crane ☐ Truck ☐ Car ☐ Forklift ☐ Excavator ☐
Loader ☐ Tractor ☐ Light Truck ☐ Other (specify): ☐
Equipment Details Manufacturer Model No.
Serial No. Month
Items to be inspected Day of the month
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Engine oil level
Brakes
Mirrors
Hydraulic system
Coolant level
Wheel condition
Condition of tires
Other:
Form B
Equipment Inspection Log Form
CORRECTIVE MAINTENANCE ACTION
No. Date Description of failed inspection Corrective action Repair completed Repaired by
item taken
(dd/mm/yyyy) (dd/mm/yyyy)
Name Signature
1.
2.
3.
4.
5.
Form C
Workplace Violence and Harassment
Reporting Form
INCIDENT REPORTING DETAILS
Report date (dd/mm/yyyy) Incident date (dd/mm/yyyy)
Name of person reporting the incident Location of the incident
Time of the incident (hh:mm) Reporting person’s phone number
Alleged victim’s name Reporting person’s contact information
Names of witness Witness phone number/email address
Witness #1:
Witness #2:
Witness #3:
Witness #4:
Witness #5:
Form C
Reporting Form
Provide a detailed description of the incident.
(Explain what you personally witnessed and heard. Do not provide opinion or speculate).
Form C
Reporting Form
Was any property damaged? Yes ☐ No ☐ Don’t know ☐
If “yes”, then please provide a detailed description of the damage:
Did the alleged victim suffer an injury? Yes ☐ No ☐ Don’t know ☐
If “yes”, please provide details of the injury(ies) suffered:
Did the alleged victim receive medical or Yes ☐ No ☐ Don’t know ☐

first aid treatment?
If “yes”, please provide details of the treatment received:
Did the alleged victim miss any time Yes ☐ No ☐ Don’t know ☐
from work?
If “yes”, please provide details, including the dates on which the alleged victim was absent
from work:
DECLARATIONS
Name of reporting person Signature Date

(dd/mm/yyyy)
I confirm that the information in this report is true and accurate to the best of my knowledge.
Name of person accepting the report Signature Date

(dd/mm/yyyy)
Form D
Hazard Reporting Form
CONTACT INFORMATION
Business name Name of reporting person
Business address Address of reporting person
Business phone number Reporting person’s phone number
Business’s contact person Status (select one)
Employee ☐ Customer ☐ Contractor ☐

Visitor ☐ Other (specify):
Contact person’s phone number Job title (if applicable)
HAZARD DETAILS
Date on which the hazard was noticed Time
Was the hazard previously reported? If so, to whom?
☐ Yes ☐ No ☐ Supervisor ☐ JHSC/HSR

☐ Other (specify):
Names of witnesses Witness phone number/email address
Witness #1:
Witness #2:
Witness #3:
Witness #4:
Form D
HAZARD DESCRIPTION
Describe the hazard in detail. Include information about the specific location
of the hazard, equipment, machines, materials, tools, and the people involved
and what injury or damage could occur. Include/attach pictures if possible.
Form D
SUGGESTED CORRECTION
Please describe in detail how the hazard can be removed or the risk of injury
or damage can be reduced.
DECLARATIONS
Name of person reporting the hazard Signature Date

(dd/mm/yyyy)

(dd/mm/yyyy)
Form E
Workplace Accident, Injury or Near Miss
Reporting Form
GENERAL INFORMATION
Event title Date (dd/mm/yyyy)
Business name Name of reporting person
Business address Address of reporting person
Business phone number Reporting person’s phone number
Business’s contact person Status (select one)
Employee ☐ Customer ☐ Contractor ☐

Visitor ☐ Other (specify):
Contact person’s phone number Job title (if applicable)
Contact person’s email address Date of birth (dd/mm/yyyy)
Form E
Reporting Form
ACCIDENT DETAILS
Date of the incident (dd/mm/yyyy) Time of the incident (a.m./p.m.)
Date incident was reported (dd/mm/yyyy) Time incident was reported (a.m./p.m.)
Location of the incident Person incident was reported to
☐ Discipline Supervisor
☐ JHSC/Health Safety Rep.
Nature of the incident (please check one) Type of incident (please check one)
☐ Gradually occurring over time ☐ Struck/caught

☐ Sudden specific event/ occurrence ☐ Overexertion
☐ Occupational illness ☐ Repetition
☐ Fatality ☐ Assault
☐ No Injury/Hazard ☐ Slip/trip
☐ First Aid ☐ Other (specify):
☐ Lost Time
☐ Non-Lost Time
Witness #1:
Witness #2:
Witness #3:
Witness #4:
Witness #5
Form E
Reporting Form
REPORTING PERSON’S DESCRIPTION OF THE ACCIDENT/INCIDENT/INJURY
Describe the incident in detail, including details regarding any injuries that
were suffered. Include information about the specific location of the incident,
equipment, machines, materials, tools, and people involved. Include/attach
pictures if possible.
Form E
Reporting Form
INJURY DETAILS
If applicable, please indicate which area of your body was injured.
Additional Details:
MEDICAL AID DETAILS
Was first aid treatment given? Name of first aid attendant
Yes ☐ No ☐
Details of first aid treatment given
Form E
Reporting Form
PROFESSIONAL MEDICAL TREATMENT
Was the injured person taken to hospital? Was the person treated by a physician?
Yes ☐ No ☐ Yes ☐ No ☐
If your answer is “yes”, please provide If your answer is “yes”, please provide
the following information? the following information?
Name of hospital: Name of physician:
Hospital address: Address of physician:
Mode of transportation (e.g., ambulance, Treatment or care received:

own vehicle, etc.):
LOST TIME
Did you or the injured person miss work time due to the incident/accident? (check
one)
☐ Returned to regular duties with no time lost

☐ Returned to modified duties with no lost time
☐ Had lost time
If you or the injured person did miss work, please provide the following details
1. How many days of work did you or injured person miss?

2. When did you or the injured person first return to work (dd/mm/yyyy)?
Form E
Reporting Form
DECLARATIONS

(dd/mm/yyyy)

(dd/mm/yyyy)
Form F
Witness Statement Form
WITNESS STATEMENT FORM
Witness name Address
Date of Birth (dd/mm/yyyy) Job title/occupation
Phone number Email address
Name of employer Employer’s contact information
Details of the accident, incident or near miss (write on reverse if necessary)

(Explain what you personally witnessed and heard. Do not provide opinion or speculate).
DECLARATION

(dd/mm/yyyy)
Form G
WSIB Form 7 Page 1 of 4
Form G
Form G
Form G
WSIB Form 7
Page 4 of 4
Form H
Work Refusal Reporting Form
REPORTING DETAILS
Report date (dd/mm/yyyy) Full name of reporting person
Job title Reporting person’s phone number
Reporting person’s email address Reporting person’s work location
Work refusal date (dd/mm/yyyy) Time work was refused (hh:mm)
Provide details of your work refusal, including the reason(s) that you believe the work
you are required to perform is unsafe.
Have you previously performed this Have you ever reported this allegedly unsafe
work without refusing or making a work to your HSR or a JHSC (if applicable)?
complaint?
Yes ☐ No ☐ Yes ☐ No ☐
DECLARATIONS

(dd/mm/yyyy)
Name of person accepting the Signature Date

report (dd/mm/yyyy)
Form H
INVESTIGATION DETAILS
Name of investigator Date investigation started (dd/mm/yyyy)
Job title Date investigation completed (dd/mm/yyyy)
Please describe in detail the steps that you took to investigate the worker’s work
assignment, including the names and contact information or any other individuals or
witnesses.
Determination: Work is safe ☐ Work is unsafe ☐
Provide a detailed summary of your findings, including an explanation as to how you

determined that the work in question is safe or unsafe:
Form H
Investigation results were reported to If “no”, explain why not.

worker?
Yes ☐ No ☐
If the work was determined to be unsafe, please provide a detailed explanation of the
steps being taken to modify the work so that it is safe.
Did the worker accept the work as modified? If not, explain why.
DECLARATIONS
Name of investigating person Signature Date

(dd/mm/yyyy)
Form I
WSIB Form 6/Workplace Injury or
Occupational Illness Reporting Form
Page 1 of 4
Form I
Page 2 of 4
Form I
Page 3 of 4
Form I
Page 4 of 4
Form J
Early and Safe Return to Work Package
Page 1 of 2
Form J
Page 2 of 2
Form J
Date:
Worker name:
Dear Doctor:
Our business has an “Early and Safe Return to Work Policy”. Pursuant to the
program, our business provides temporary alternative work assignments for injured
workers until such time as they are medically fit to resume their regular work duties.
The ensure the safety of our workers, we require a medical assessment of an injured
worker’s present capabilities and limitations. In that regard, a Functional Abilities
Form is attached, which we kindly ask that you complete along with our worker and
return to us within 24 hours.
We look forward to working with you to assist our worker in returning to their regular
duties.
Yours truly,
Employer Name:
Employer Contact Person:
Contact Person’s Email Address:
Contact Person’s Phone No.:
Form J
MODIFIED/ALTERNATIVE WORK JOURNAL

(To be completed by the worker’s supervisor weekly)
Name of injured worker Duration of modified work plan
Number of days:
Number of weeks:
Number of months:
Injured worker’s pre-injury job Name of supervisor

title
Injured worker’s regular pre- Job title of supervisor

injury working hours
Injured worker’s modified work Modified work start date (dd/mm/yyyy)

title
Additional details or comments:
Form J
JOURNAL DETAILS
Day of the week Scheduled Hours Comments or concerns

hours worked
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total Hours Difference
Start Date End date
Employee’s Date
Signature
Supervisor’s Date
Signature
Form K
Modified/Alternative Work Offer
MODIFIED/ALTERNATIVE WORK OFFER
Name of worker Department
Position Work location
Date that suitable work is available Date on which Functional Abilities Form
(dd/mm/yyyy) was completed (attach a copy)
(dd/mm/yyyy)
Nature of the worker’s injury
Back ☐ Neck ☐ Shoulder ☐
Upper Extremity ☐ Lower Extremity ☐ Other ☐

(specify):
Describe the suitable alternative work (Provide a detailed description)
SIGN OFF
Employee’s signature Date
Supervisor’s signature Date
FOR HR/MANAGEMENT USE ONLY
Copy Faxed to the WSIB? Yes ☐ No ☐ If “no”, why?

(if applicable)
Copy Sent to Worker by Yes ☐ No ☐ If “no”, why?

Courier?
Form L
Emergency Response Information
EMERGENCY CONTACT INFORMATION
Services or organization Contact information
Local police department or division:
Local fire department:
Nearest hospital:
Landlord or property manager (if applicable):
Poison control:
Ontario Ministry of Labour:
Office team Contact information
Health and safety representative (if applicable):
JHSC worker member(s) (if applicable):
Trained first aid personnel:
Fire warden:
Address/location of designated meeting area Contact person and mobile number
Form M
Emergency Incident Report
INCIDENT REPORTING DETAILS
Report date (dd/mm/yyyy) Incident date (dd/mm/yyyy)
Name of person reporting the incident Location of the incident
Time of the incident (hh:mm) Reporting person’s phone number
Type of incident (check one)
Fire ☐ Bomb threat ☐
Chemical spill/hazardous leak ☐ Alarm activation ☐
Severe weather/natural disaster ☐ Theft/security breach ☐
Other (specify): ☐
Witness #1:
Witness #2:
Witness #3:
Witness #4:
Form M
Emergency Incident Report
Provide a detailed description of the incident.
DECLARATIONS

(dd/mm/yyyy)

(dd/mm/yyyy)

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WOODLAND GOURMET IMPORTS INC.

Health and Safety

1.0 OUR HEALTH AND SAFETY POLICY STATEMENT ...................................... 6

Woodland Gourmet Imports Inc. Operating as Antipastos (the “Business”) is

Signature ...........................................………… Date:

3.1 MANAGEMENT AND SUPERVISORY PERSONNEL

1. Equipment, materials and protective devices required by law are

2. Equipment, materials and protective devices provided by the Business

4. All equipment, materials and protective devices provided to workers are

Without limiting the generality of the foregoing, management shall also:

Information and Training for Workers

1. Provide workers, supervisors and health and safety committee members

2. Provide information, instruction and supervision to workers with a view

3. If required by law, provide workers with written instructions as to the

4. Acquaint a worker or a person with authority over a worker with any

5. Notify workers of the results of any occupational health and safety

6. Establish an occupational health and safety service for workers as

8. Not knowingly allow underage workers into the workplace;

9. Take every precaution reasonable in the circumstances to protect the

10. When appointing a supervisor, appoint a competent person;

12. Regularly monitor the levels of biological, chemical or physical agents in

13. Cooperate with third parties in the event of a medical emergency;

14. If required by law, only permit a worker to work or be in a workplace if he

18. Immediately inform a worker of the existence of any potential or actual

Administrative Health and Safety Duties

25. Establish a medical surveillance program for workers as required by law;

27. Conduct investigations into all workplace incidents, accidents, injuries

29. Regularly carry out workplace inspections and risk assessments as a

30. Implement a system for detecting and eliminating workplace hazards,

3.2 DIRECTORS AND OFFICERS

1. All applicable health and safety legislation;

2. Any enforcement orders; and

3. Any court orders.

1. Provide and maintain all facilities as required by law;

3. Ensure that its workplace is only constructed, developed, reconstructed,

4. If required by law, not begin any construction, development,

5. If required by law, keep copies of all Construction Documentation in a

3.3.2 Project Owners

1. The construction of a building, bridge, structure, industrial establishment,

2. The moving of a building or structure; and

3. Any work or undertaking, or any lands or appurtenances used in

1. Before beginning a project, determine whether any of the following

3. Ensure that a prospective constructor of a project on the owner’s

If the Business is ever a supplier, then it must:

1. Ensure that every machine, device, tool or item of equipment (including

2. If it is the responsibility of the supplier under the rental, leasing or similar

1. Complete all necessary health and safety training and orientation

2. Arrive at work on time and be prepared to undertake all of their assigned

5. Never remove, adjust, modify or in any way tamper with or alter

6. Never use substitute protective equipment, devices or clothing unless

7. Never perform work without using any required protective equipment,

8. Never operate any equipment, tools, machinery or thing or work in an

9. Never engage in any prank, contest, feat of strength or unnecessary

11. Never smoke or consume any alcohol, illicit drugs or impairing

Specific Reporting Obligations

15. Immediately report to a supervisor or to a member of management the

16. Immediately report to a supervisor or to a member of management any

17. Immediately report to a supervisor or to a member of management any

18. Immediately report any medical condition or medical prescription (in