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									                                One Page to Safety Program Success
                Do you have documentation to prove that these things have been done?
1. Policy Statement                                  8. Worker Orientation
The written policy statement has been:      Yes No   The checklist has been signed by the:   Yes No
 Distributed to all employees                            Worker
 Properly explained to all employees                     Supervisor who did the training

2. Responsibilities                                  9. Training
Health and safety responsibilities have
been communicated to:                       Yes No   Training records are kept for:          Yes No
 Managers                                                 WHMIS training
 Supervisors                                              New worker orientation
 Workers                                                  Site safety talks
 Subcontractors                                           First Aid training
New managers have received a health
                                                          All training sessions
and safety orientation

3. Enforcement                                       10. Reporting & Investigating Accidents
Disciplinary procedures are being           Yes No   Reports are kept for:                   Yes No
followed                                                  Critical injuries
                                                          Lost-time injuries
4. Health and Safety Rules                                Medical aid injuries
                                            Yes No        Property damage
The rules have been properly explained
                                                          Accident investigations
to all new employees
Action is taken when rules not followed              Standard forms are used

5. Safe Practices and Procedures                     11. Inspections and Hazard Assessments
The written procedures have been
communicated to:                            Yes No                                           Yes No
 Employees                                          Standard checklists are used
 Subcontractors                                     Planned inspections are made
                                                     MOL inspection reports are kept
6. Emergency Procedures                              Deficiencies are corrected
The emergency procedures have been
communicated to:                            Yes No
                                                     12. Health & Safety Representative or
    Employees
                                                         Joint Health & Safety Committee
    Subcontractors                                  The monthly inspections are made        Yes No
                                                     The recommendations are answered
7. First Aid and Medical Care
                                            Yes No   13. WHMIS
The First Aider certificate(s) is on file                                                    Yes No
There is a re-certification program                  Worker training records are kept
                                                     There is an MSDS binder

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