Safety Sponsor Name: Northern Ontario Safety Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Telephone: Job Title: Email: 2015 SGAP Requirements Completed Yes or No Optional – Program Requirements Written Standard for HSMS Audit Standard written Written standard meeting all Program Current date program requirements Roles & Responsibilities completed: Auditor qualifications Audit Plan Yes Continual Improvement Plan No (CIP) process. Auditor Training Specify Auditor training Auditor training completed or qualifications in the written verified prior to audit Refer to pages 4 & 7 of 2015 Employer standard Requirements for qualification standard Yes Train or verify Auditor(s) meet the No specific qualifications of the written standard. Previous HSMS Audit and CIP Auditor formally reviewed Review 2014 or most recent HSMS Audit reviewed by trained Auditor most recent HSMS Audit and and Continual Improvement Plan (CIP) Verified all non-conformities on CIP as outlined on page 4 of CIP 2015 Employer (1st year SGAP participants review 2014 Verified CIP implementation Requirements: or most recent, Safety Group Evaluation, progressing as planned and Making Improvements steps. Reviewed CIP action items for Yes effectiveness. No
Safety Sponsor Name: Northern Ontario Safety Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Job Title: Telephone: Email: 2015 SGAP Requirements Program Requirements Completed – Yes or No Optional Written Standard for HSMS Audit Program Standard written Current date Roles & Responsibilities Auditor qualifications Audit Plan Continual Improvement Plan (CIP) process. Written standard meeting all program requirements completed: Yes No Auditor Training Refer to pages 4 & 7 of 2015 Employer Requirements for qualification standard Specify Auditor training qualifications in the written standard Train or verify Auditor(s) meet the specific qualifications of the written standard. Auditor training completed or verified prior to audit Yes No Review 2014 or most recent HSMS Audit and Continual Improvement Plan (CIP) (1st year SGAP participants review 2014 or most recent, Safety Group Evaluation, and Making Improvements steps. Previous HSMS Audit and CIP reviewed by trained Auditor Verified all non-conformities on CIP Verified CIP implementation progressing as planned Reviewed CIP action items for effectiveness. Auditor formally reviewed most recent HSMS Audit and CIP as outlined on page 4 of 2015 Employer Requirements: Yes No
2015%20SGAP%20Yearend%20Report%20Checklist.docx