Safety Group Sponsor Name: Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Telephone: Job Title: Email: Required supporting Optional 2017 SGAP Requirements Completed Yes or No – Program Requirements documentation attached Standard for HSMS Audit Program Standard written Copy of 2017 Written standard meeting all program Current date Written HSMS Audit written and implemented requirements completed and & Responsibilities Standard attached: implemented: Auditor qualifications Audit Plan Yes Yes Continual Improvement Plan No No (CIP) process Auditor Training Specify Auditor training Auditor training completed or verified Copy of Training qualifications in the written Record(s) attached: to commencement of audit: Refer to pages 4 & 8 of 2017 Employer standard Yes Requirements for qualification standard Yes Train or verify Auditor(s) No No meet the specific qualifications of the written standard. Review 2016 or most recent HSMS Previous HSMS Audit and Auditor formally reviewed most Copy of Review CIP reviewed by trained included in Audit Audit and Continual Improvement recent HSMS Audit and CIP as Auditor Report and is Plan (CIP) outlined on page 4 and 5 of 2017 Verified all non-conformities attached: Employer Requirements: on CIP 1st year SGAP participants review Verified CIP implementation Yes their 2016, or most recent, Safety Yes progressing as planned No Group Evaluation, and Making No Reviewed CIP action items Improvements steps. for effectiveness.
Safety Group Sponsor Name: Firm Name: Date (dd/mmm/yyyy): WSIB Account #: WSIB Firm #: Completed by: Job Title: Telephone: Email: 2017 SGAP Requirements Program Requirements Completed – Yes or No Required supporting documentation attached Optional Standard for HSMS Audit Program written and implemented Standard written Current date & Responsibilities Auditor qualifications Audit Plan Continual Improvement Plan (CIP) process Written standard meeting all program requirements completed and implemented: Yes No Copy of 2017 Written HSMS Audit Standard attached: Yes No Auditor Training Refer to pages 4 & 8 of 2017 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 to commencement of audit: Yes No Copy of Training Record(s) attached: Yes No Review 2016 or most recent HSMS Audit and Continual Improvement Plan (CIP) 1st year SGAP participants review their 2016, 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 2017 Employer Requirements: Yes No Copy of Review included in Audit Report and is attached: Yes No
2017_Advantage_Program_Year_End_Report_Checklist.docx