Safety Group Sponsor Name: Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Telephone: Job Title: 2018 SGAP Requirements Completed Yes or No Optional Self-Score – Program Requirements 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 No (CIP) process. Auditor Training Specify Auditor training Auditor training completed or qualifications in the written verified prior to Refer to pages 4 & 8 of 2018 Employer standard commencement of audit: Requirements for qualification standard Train or verify Auditor(s) meet the Yes specific qualifications of the No written standard. Previous HSMS Audit and CIP Auditor formally reviewed Review 2017 or most recent HSMS Audit reviewed by trained Auditor most recent HSMS and and Continual Improvement Plan (CIP) Verified all non-conformities on CIP as outlined on page 4 CIP 1st year SGAP participants review their and 5 of 2018 Employer Verified CIP implementation 2017, or most recent, Safety Group Requirements: progressing as planned Evaluation, and Making Improvements Reviewed CIP action items for steps. Yes effectiveness. No
Safety Group Sponsor Name: Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Job Title: Telephone: 2018 SGAP Requirements Program Requirements Completed – Yes or No Optional Self-Score 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 2018 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 2017 or most recent HSMS Audit and Continual Improvement Plan (CIP) 1st year SGAP participants review their 2017, 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 and CIP as outlined on page 4 and 5 of 2018 Employer Requirements: Yes No
2018_SGAP%20Yearend_Report_Checklist_version_2.docx