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Safety Group Name: by Y3NBqD


									Safety Group Sponsor Name:

Firm Name:                                             Date (dd/mmm/yyyy):

WSIB Account #:                                        Firm Number #:

Completed by:                                          Telephone:                                                  2012 Advantage Program
Position:                                              Email:                                                            Action Plan

                                              Program Requirements                                                  Assigned          Due Date(s)
     2012 SGAP Requirements                  (Refer to the 2012 Employer             Objectives for 2012
                                                                                                                 Responsibilities   (dd/mmm/yyyy)

(1) Set Standard for HSMS Audit            Write/review standard (policy &
                                           procedures) for HSMS Audit
                                                1. Audit schedule
                                                2. Auditor qualifications
                                                3. Roles & Responsibilities
                                                4. Continual Improvement

(2) Auditor Training                       Specify Auditor training
                                           qualifications in the written
(Refer to 2012 Employer Program
Requirements for qualification standard)   Train or verify Auditor(s) meet
                                           the specific qualifications of the
                                           written standard.

                                           Select and complete HSMS             HSMS Audit selected:
                                           Audit, by trained Auditor.

                                           Documented supporting
(3) Complete HSMS Audit                    evidence of all findings.            ________________________
                                                                                (selection deadline-Feb 29/12)
                                           Documented evidence of
                                           completed audit being reviewed
                                           by Senior Management.
                                         All audit non-conformities
                                         addressed on Continual
                                         Improvement Plan with assigned
                                         responsibilities and timelines

(4) Written HSMS Audit Continual         Documented evidence of
    Improvement Plan                     completed Continual
                                         Improvement Plan being
                                         reviewed by senior management.

                                         Continual Improvement Plan
                                         must be initiated in 2012

(5) Return to Work                       Include as part of your HSMS
                                         Audit a formal review of your
                                         Return-to-Work Standards
                                         against the six new WSIB Work
                                         Reintegration Operational

                                         Identified non-conformities
                                         included and initiated on 2012
                                         Continual Improvement Plan.

Senior Management Signature and Title:                                    Joint Health & Safety Representative (Optional):

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