ࡱ>  @ bjbj5*5* 4tW@W@?(((((((<`J`J`J8JlK<irKKLLLL.M/M qqqqqqq$ uR_wr(NLLNNr((LL#rPPPNX(L(LqPNqPPR((RLK Lue>`JwNXRo9r0irR,xNxR<<((((x(R;M"]MPuMM;M;M;Mrr<<$7`JO<<`JAlberta Municipal Health and Safety Association Health and Safety Audit Executive Report BACKGROUND INFORMATION Audit Type: ___ External (COR Certification/Recertification) ___ Internal (COR Maintenance) ___ Auditor Certification and Internal (COR Maintenance) ___ Auditor Certification ___ Departmental / Baseline (Municipal Internal Use) Municipality Audited: Name Address WCB Account # and Industry Code Contact Person Telephone Fax Email Onsite Dates: Start End Operations Active at Time of Audit? ( Yes Overall Score Achieved: XX% PURPOSE An audit is an opportunity to identify the strengths of the existing health and safety management system, and to make recommendations so the program can continue to develop and improve. SCOPE Brief Description of Operations: * Brief Description of Organizational Structure: * Attach an organizational chart (no employee names). Work Sites Sampled: (attach an additional page if necessary) DepartmentSite / LocationIncluded in Audit?Finances and AdministrationPublic Works FCSS Parks and Recreation Fire / Emergency Services Police / By-law Human Resources Engineering Planning Transportation Other Other Other Other  Site Sampling Justification: * Interview Sample: Total # of permanent, part-time, casual and temporary employees at time of audit: XX Minimum number of interviews from Table 1: XX Number of interviews conducted: XX *Attach Completed Table 2 Organizational Structure for Determining Interviews, Table 3 Interview Selection Sheet, and Interview Summary Sheet. AUDITORS Lead Auditor: Name Municipality Address Certification Number and Expiry Telephone Number Email Address Team Auditors: (Describe each auditors role in the audit process must be involved in all aspects for credit towards auditor certification maintenance.) Name Municipality Certification Number and Expiry Telephone Number Email Address Role Name Municipality Certification Number and Expiry Telephone Number Email Address Role Name Municipality Certification Number and Expiry Telephone Number Email Address Role Name Municipality Certification Number and Expiry Telephone Number Email Address Role (Attach separate sheet if more than 5 auditors on audit team.) ELEMENT SUMMARY Score, strengths, and recommendations follow for each element. 1. Organizational Commitment Score: XXX (XX%) Organizational Commitment addresses the overall system within which a municipalitys health and safety management system must operate. Management must be committed to creating a healthy and safe environment for the municipalitys workforce, must demonstrate its support by actively promoting the values it has developed, and be actively involved. Strengths: Suggestions for Improvement: 2. Hazard Identification and Assessment Score: XXX (XX%) Hazard Identification and Assessment is a formal approach to proactively recognizing and ranking (assessing) all hazards faced by municipal employees. This intensive process is crucial to ensuring workers are protected. Strengths: Suggestions for Improvement: 3. Hazard Control Score: XXX (XX%) Hazard Control is a systematic approach to determine how to eliminate or the best way to control the hazards identified in Element 2. This includes making recommendations; identifying who is responsible for implementation; setting target dates; and follow-up. Strengths: Suggestions for Improvement: 4. Formal Workplace Inspections Score: XXX (XX%) The Formal Workplace Inspections process ensures that the hazard controls from Element 3 are adequate, and to identify any new hazards. Inspections are a great opportunity for management to speak with staff about their health and safety-related concerns. Strengths: Suggestions for Improvement: 5. Orientation and Training Score: XXX (XX%) Orientation and Training includes the identification of competency and training needs based on the hazards of the work, and that workers have the needed competence to do the work safely. Strengths: Suggestions for Improvement: 6. Emergency Response Planning Score: XXX (XX%) Emergency Response Planning establishes procedures related to on-the-job emergencies. This is different from the municipalitys system for large-scale municipal disasters involving the general public. Strengths: Suggestions for Improvement: 7. Incident Investigation Score: XXX (XX%) An Incident Investigation system must be developed for the reporting and investigation of occupational health and safety incidents and near-misses. It is critical to analyze incidents and near-misses, so that the direct and indirect causes can be found. Strengths: Suggestions for Improvement: 8. Program Administration Score: XXX (XX%) Program Administration addresses three critical components: record keeping, communication, and worker participation. Strengths: Suggestions for Improvement: NEXT STEPS The municipality should develop an action plan based on the recommendations provided in this report. This helps improve the program in an orderly way, with emphasis placed on priority items. CONCLUSION Please contact the auditors if you require more information or have any questions. 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