Safety Groups Five Steps Worksheet

Safety Groups – Five Steps Worksheet

Company Name: ______

Element Name: ______Date:______

Step 1 - Set Standard

 I have a written standard for the above element  The standard is current (date of standard______)  The standard is signed / approved by senior management (name on the document______title______)  The standard describes exactly how the element will be implemented in the workplace  The standard clearly describes the specific responsibilities of everyone in the workplace (e.g., management, supervisors, workers, JHSC, Safety Group contact, etc.)  It outlines exactly how the standard will be communicated  It outlines exactly what health and safety training is necessary to meet the standard  It outlines exactly how the standard will be evaluated at the end of the year  The requirements of the standard are realistic  The standard meets minimum legislative requirements.

Step 2 - Communication

 The standard has been communicated to o All those responsible for implementing the standard o All those who will be affected by the standard.

Name Means of Communication Date of Communication (e.g., bulletin boards, emails, memos, meetings, etc.)

1 of 2 Step 3 – Training

 The training requirements outlined in the standard have been fulfilled  Training records are available showing the following information

Name of Person Trained Job Title Training Content Date of Training

Step 4 – Evaluation:

 Proposed date of evaluation of the standard: ______ Means of evaluation (e.g., quizzes, surveys, workplace inspection observations, accident statistical review, etc.): ______ Persons responsible for conducting the evaluation: ______ Actual date of evaluation: ______ Summary of the evaluation results/findings (be specific):

Evaluation Results/Findings:

Step 5 – Acknowledge Success/ Make Improvements:

 The standard was successfully implemented. o Who will formally acknowledge / recognize this success? ______o How will success be formally acknowledged? ______o Date of acknowledgement: ______

 Improvements recommended as a result of the above evaluation:

Recommended Improvements (be specific) Date Completed Signature

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