Safety Group Sponsor Name: Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Telephone: Job Title: Email: Optional 2016 SGAP Requirements Program Requirements Completed Yes or No – Standard for HSMS Audit Program written Standard written Written standard meeting all and implemented Current date program requirements Roles & Responsibilities completed and implemented: Auditor qualifications Audit Plan Yes Continual Improvement Plan (CIP) No process. Auditor Training Specify Auditor training Auditor training completed or qualifications in the written verified prior to Refer to pages 4 & 8 of 2016 Employer standard commencement of audit: Requirements for qualification standard Train or verify Auditor(s) meet the Yes specific qualifications of the written No standard. Review 2015 or most recent HSMS Audit Previous HSMS Audit and CIP Auditor formally reviewed and Continual Improvement Plan (CIP) reviewed by trained Auditor most recent HSMS Audit and Verified all non-conformities on CIP as outlined on page 4 1st year SGAP participants review their CIP and 5 of 2016 Employer 2015, or most recent, Safety Group Verified CIP implementation Requirements: Evaluation, and Making Improvements progressing as planned steps. Reviewed CIP action items for Yes effectiveness. No
Safety Group Sponsor Name: Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Job Title: Telephone: Email: 2016 SGAP Requirements Program Requirements Completed – Yes or No Optional Standard for HSMS Audit Program written and implemented Standard written Current date Roles & Responsibilities Auditor qualifications Audit Plan Continual Improvement Plan (CIP) process. Written standard meeting all program requirements completed and implemented: Yes No Auditor Training Refer to pages 4 & 8 of 2016 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 commencement of audit: Yes No Review 2015 or most recent HSMS Audit and Continual Improvement Plan (CIP) 1st year SGAP participants review their 2015, 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 and 5 of 2016 Employer Requirements: Yes No
2016%20SGAP%20Yearend%20Report%20Checklist%20version%202.docx