SEBASE and ISEBASE Audit Explanation



SEBASE

& ISEBASE

Explanation

Version 3

Do NOT use this form to

Submit an audit – use the

Submission form

Designed for 1-person employers that hire contractors

SEBASE - Designed for small employers with 6-19 employees or dependant contractors and their employees

ISEBASE - Designed for small employers with 2-5 employees or dependant contractors and their employees

Instructions

The SEBASE or ISEBASE Audit Submission Package is designed to help employers satisfy the submission requirements of the SAFE Companies audit. This document is a supplemental document designed to help explain the intent of the questions in the submission package for those wishing more explanation. The SEBASE and ISEBASE audits are very similar, so a common set of explanations has been developed.

The SEBASE submission document is intended for companies with

1. An average size in its operating* months for the year of 19.99 or less.

2. A peak size for any month of the year of 24 or less.

*an operating month is any month that the company is at least 25% of its peak size. Companies at 19.99 average and 24 peak may still use this package.

The ISEBASE submission document is intended for companies with 2-5 workers or one-person companies who hire contractors.

If your company has had any changes in ownership, business activities, name, WorkSafeBC account or classification(s), please contact the Council prior to your audit.

Completing the package

The person completing this package must be a small company internal auditor. This means the person must have attended the Small Employer Occupational Health and Safety (SEOHS) training course. To be eligible for WorkSafeBC’s 2015 Certificate of Recognition (COR) incentive cheque, your company’s internal auditor may need to take the COR refresher training or equivalency before submitting your 2015 audit if their Small Employer OHS course was taken before 2013. The WorkSafeBC COR program requires small employer auditors receive 7 hours of refresher training every 3 years.

Please carefully read every question. Each numbered question, plus the CAL and the training chart are worth one point each. For the ISEBASE audit, listing a company safety representative on the profile replaces the SEBASE question on worker safety representative. Questions 2A, 2B, 9A and 9B are worth half a point each. A successful score is 80% or 19/24 points. For further assistance contact the Council at 1-877-741-1060 and ask to speak to a Safety Advisor.

Audit Submission Package

Preferred: The audit report may be submitted by:

• e-mail to audit@ for files under 10MB

• online submission for large files:

Optional: Paper reports (DO NOT STAPLE) or CD or thumb drive should be sent by registered mail, courier or delivered by hand to:

BC Forest Safety Council

420 Albert Street, Nanaimo, BC V9R 2V7 1-877-741-1060

PLEASE DO NOT STAPLE

Complete All Fields

Type of Audit (check one):

| Certification Audit | |This is a Joint Audit (complete a separate Company Profile for each company included in this audit) |

| Maintenance Audit |Existing SAFE Certification # (if any) |

| Recertification Audit |Date this audit was performed |

A company starts with a certification audit and then has a maintenance audit in each of the next two years followed by a recertification audit in the 4th year.

However, if a company changes name, accounts, classifications, work activities, ownership, size, re-joins the program after a gap or was not eligible for COR in the previous year, an early recertification audit is likely required.

If there is any doubt that the company is eligible for a maintenance audit, please either contact the Council or select a recertification audit. A recertification audit only has 3 additional policies to submit compared to a maintenance audit. Otherwise, they are the same.

This form is provided in Microsoft Word. Double-clicking on any check-box brings up a pop-up window to check the box. Alternatively, this form can be printed and then filled out in ink.

Company Information

|Legal Company Name |Company Trade Name/dba |

| | |

|WorkSafeBC account |SAFE Certification # (if any) |

| | |

|Address |City |Province |Postal Code |

| | | | |

Please fill out the exact legal company name, exactly as it appears on any letters from WorkSafeBC.

The Council passes your company name to WorkSafeBC if the audit is recommended for a COR incentive, and errors can occur if the names do not exactly match.

Your address is requested each year to help update our database so that we keep in touch with companies that move.

List your WorkSafeBC account number.

If you are a new business that does not have a number yet, please write ‘pending’.

|What does your company do? |

| |

|WSBC Classification Unit(s) that the company | | | | |

|has (list all) | | | | |

|WSBC CU(s) that this audit applies to (list | | | | |

|all) | | | | |

|Operating Location(s) this audit applies to |

| |

Please describe what your company does. Examples can be ‘log hauling’, ‘stump to dump contractor’, ‘ranch with a woodlot and 3 trucks that haul for Tolko, 4 fishing boats in a guide business and a small mining construction operation’.

If your company has activities outside of forestry, they need to be listed as well.

List all your WorkSafeBC classification unit numbers in the top row. You can find these on your annual assessment letter. Most companies only have one. During QA, Council will check what WorkSafeBC has on file and contact you if there is a mis-match.

List all the classification units that this audit is about in the bottom row. Most companies list all their classifications, but some wish to exclude some business activities.

List the cities/towns that you have permanent offices in. This should be a match with your WorkSafeBC account. During QA, Council will check what WorkSafeBC has on file and contact you if there is a mis-match.

Contact Information

|Company Safety Contact Person |Job Title |

| | |

|Office Telephone: |Cell Phone |Email address |

| | | |

|Person Preparing Audit Check if same as contact person above |Job Title |

| | |

|Office Tel. (if different than above) |Cell Phone |Email address |

| | | |

List the company contact and the person preparing the audit. These are who we will phone if there is a problem with the audit, so please give current phone numbers. If the person does not have an email address that they at least check every business day, please put ‘none’ for e-mail address.

ISEBASE only:

Listing the safety contact person is worth one point in the ISEBASE audit. This is because the SEBASE audit has a question about Worker Safety Representative that is not applicable to an ISEBASE company.

Injury Management Election

|Does the company have an implemented Injury Management / Return to Work program that they wish | |Yes - complete Element I |

|to include in the audit? | | |

|This element is optional and does not affect SAFE certification. | | |

| | |No - do NOT complete element I |

If your audit is intended to include Element I (Injury Management / return to work) please select ‘yes’. If you are not including this optional element, select ‘no’. Selecting ‘no’ does not impact SAFE-certification.

|Type of Work Activities: (Check all activities that this audit applies to) |

| Mechanical Harvesting | Custom Wood Kiln / Co-Generation |

|Hand Falling / Bucking |Laminated Wood Structural Support Products |

|Scaling / Sorting |OSB manufacture |

|Yarding / Loading |Sawmill or Planing Mill |

|Integrated Forest Management |Portable Wood Mill |

|Forestry Consulting |Pressed Board Manufacture / Pellet Mill |

|Silviculture |Shake or Shingle Mill |

|Water Operations |Veneer or Plywood Manufacturing |

|Log Hauling / Trucking |Wood Chip Mill |

|Heli-Logging |Wood Preserving |

|Road Building / Deactivation / Site Prep |Wooden Components (not elsewhere specified) |

|Forest / Road Engineering |Wooden Post or Pole |

|Fire Fighting |Other (Specify): |

|Total Personnel Count per Month for past 12 months: |

|(Total = owners + management + office + supervisors + workers +workers of dependent contractors) |

|(Maximum peak = 24 per month) (Maximum average permitted is 19.99) |

|Year |

| Name |Signature |Date |

| | | |

|Person Preparing Audit |

|Note that the auditor MUST be an owner or permanent employee of the company being audited unless a certified BASE external auditor performs the audit. |

|I hereby acknowledge that I have reviewed the submission to the best of my abilities and that the audit provides a representative sample of the |

|company. I am (select at least one): |

|A permanent employee of the company and a holder of an SEOHS course certificate. |

|An owner of the company and a holder of an SEOHS course certificate. |

|A certified BASE external auditor and have read, understood, and followed the terms and conditions of the British Columbia Forest Safety Council |

|Auditor Code of Ethics, Auditor Manual and COR Standards and Guidelines. |

|An attendee of an SEOHS course (or refresher training) within the last 3 years |

|Authorizing the Council to send my success letter and/or certification only by e-mail |

|Authorizing the Council NOT to return my audit package (safety minutes, etc.) to me. |

|An owner or a permanent employee who is scheduled for initial SEOHS training within 6 months. |

|Name |Name |Name |

| | | |

|Training Certificate Number |Training Certificate Number |

| | |

Please sign the submission. This is a legal document. The ‘Person Authorizing Audit’ must be a person who can tick at least one of the first 3 tick boxes. Another person, such as a clerk or contractor can prepare the audit, but the person authorizing the audit must review it for technical accuracy and sign off. In many cases, the management representative and the person authorizing the audit are the same person. In this case, please print and sign twice. If you have a training certificate number available, please enter that.

If you do not have a number available, please enter the town, year and approximate month of training and we will look up your number for you.

|Company Name |Audit Year |

| | |

|# |Identified Item |Required Corrective Action |Person Responsible|By When |Date Completed |

| | | | |dd/mm/yyyy |dd/mm/yyyy |

| | | | | | |

| | |

| |Minimum: |

| |The company needs to submit a reasonable (generally supports safety in a way appropriate to the size, scope and complexity of the company) safety |

| |policy. |

| |If this is a maintenance year, nothing needs to be submitted and the point will be awarded automatically, PROVIDED THE POINT WAS AWARDED IN THE LAST |

| |AUDIT FOR THE SAFETY POLICY and that there was no change to company name, operations, etc. as described in the explanation in the company profile |

| |page. |

| | |

| |Preferred: |

| |The safety policy is signed by management/ownership within the last 2 years |

| | |

| |Best practices: |

| |Contains responsibilities for management, supervision and workers, a commitment to legal and regulatory compliance as a minimum standard, commits to |

| |continual improvement and cooperation between all parties for the improvement of safety and health across the industry. |

| |The policy is reviewed, re-signed, re-dated and re-submitted every year. |

| | |

| | |

|2 |2A |Submit the progressive discipline policy (for certification and recertification audits only) |

| |2B |Submit the Personal Protective Equipment (PPE) policy (for certification and recertification audits only) |

| | |

| |Each of 2A and 2B is worth half a point. The half-point weighting is to stop the audit points being too heavy on policy. |

| | |

| |Minimum: |

| |The company needs to submit a reasonable progressive discipline and a reasonable PPE policy. |

| |If this is a maintenance year, nothing needs to be submitted and the point will be awarded automatically, PROVIDED THE POINT WAS AWARDED IN THE LAST |

| |AUDIT FOR THE DISCIPLINE AND PPE POLICIES and that there was no change to company name, operations, etc. as described in the explanation in the |

| |company profile page. |

| | |

| |ISEBASE only: The company has an option to explain how discipline works, instead of submitting a formal policy. |

| | |

| |Preferred: |

| |The discipline policy is appropriate to the size of the company. A six-step process with appeals is not usually an efficient choice for a 3-person |

| |company where everyone on the training list has the same last name. |

| |The PPE policy should cover PPE appropriate for the work activities. |

| | |

| |Best practices: |

| |The policies are re-evaluated and re-dated every year. |

| |The policies are re-submitted every year if only because the date of review has been updated. |

| | |

|3 |Submit one Emergency Response Plan (ERP) for the largest project of the year. |

| | |

| |OR |

| |Tick here if the company did not work during the past 12 months and submit one ERP for the home/office location. |

| |Minimum: |

| |The ERP for the largest project of the year is a combination of the general ERP and the site-specific ERP. |

| |It needs to cover injuries, fire, fatalities and natural disasters. |

| |It may include large portions from a licensee or Prime, but needs to include specific details for the site/project (i.e. where is the ETV and what |

| |frequency / phone is being used) and be customized for the company. |

| | |

| |Preferred: |

| |The ERP is very clearly written to workers, and directs them what to do, where to go and who to contact in case of emergencies and how to make |

| |contact. |

| |The ERP contains other scenarios such as wildlife encounter, violence from non-workers, spills, etc. Maps are included where applicable. |

| | |

| |Best practices: |

| |Sample of a laminated ERP card given to all workers, vehicles or machines is included. |

| |Photographs of instruction boards are included. |

| |ERP fully manages all workers and activities on the site/project for all reasonably expected scenarios with drills involving all personnel at least |

| |annually. |

| | |

|4 |Submit one completed first aid assessment. |

| |This may be for the company’s home/office if the company did not work during the past 12 months. |

| |Minimum: |

| |Include one assessment, correctly completed. |

|5 |Submit a list of first aid equipment locations. The following format is suggested but not required. |

| |Level |Location (i.e. in each machine, in the ETV, in the shop, etc.) |

| |Personal | |

| |Basic | |

| |Level 1 | |

| |Level 2 | |

| |ETV | |

| |other | |

| |Minimum: |

| |Complete the above table. Do not forget the office and/or shop. |

| | |

| |Best practices: |

| |The company has a regular inventory process for all their first aid and emergency equipment and submits a completed copy of that. |

|6 |Submit one page out of a supervisor journal (or electronic equivalent) or other documentation showing that the supervisor is supervising workers |

| |and/or contractors. |

| |e.g. a days’ collection of worker assessments, inspections and hazard assessments, etc. |

| |Minimum: |

| |Submit evidence that the supervisor is actively supervising workers. |

| |This can include a day’s worth of assessments, inspections and pre-works, etc. provided it can be shown that the supervisor is doing the work. Site |

| |inspections by a third party are not sufficient. |

| | |

| |Preferred: |

| |Send in a page out of a supervisor journal showing daily supervision activities, or electronic equivalent. |

|7 |Submit one new worker orientation form that meets current regulatory requirements. |

| |If no new workers were hired, submit a compliant blank form that the company would use for the next new worker. |

| |Including the topic of Injury Management will also satisfy question I-8 of the optional Injury Management Audit |

| |Minimum: |

| |Submit a safety orientation that meets regulatory requirements (all of WSBC Regulation 3.23). |

| | |

| |Best practices: |

| |The orientation is part of a new hire covering safety, training, and business items. |

| |Please black out any private information (SIN, BC medical, pay rate, bank information, etc.). |

| |The process starts with orientation and moves on through competency assessment. |

|8 |Submit one worker assessment. |

| |If the company has a new worker, the assessment must be for the new worker. |

| | |

| |OR |

| |Tick here if the company did not work during the past 12 months and submit a blank form that the company would use for the next worker assessed. |

Minimum:

The assessment is of any worker except if there is a new worker, as shown by a completed orientation in the previous question, then the worker selected must be a new worker.

A faller assessment should be used for a manual falling company.

Assessments include name and date (at least year and month)

Preferred:

The assessment is of the exact new worker from the orientation form in the previous question if there was a new worker in question 7.

The assessment is dated and signed by both the worker and supervisor (or other qualified person assessing the worker).

Assessments contain more content than just tick boxes

Best practices:

The assessment for a new worker flows from the orientation and includes a statement that the worker is now competent and is released to normal levels of supervision.

The routine assessments of existing workers use the same parameters and lead towards continual skill development.

|9 |9A |Provide a list of the company’s Safe Work Procedures (SWPs) that the company uses. |

| | |1. |7. |

| | |2. |8. |

| | |3. |9. |

| | |4. |10. |

| | |5. |11. |

| | |6. |12. |

| |9B |Submit two Safe Work Procedures (SWPs) of your choice for evaluation |

| | |These must be different than last year if this is not your first submission. |

| | |Lockout must be included in equipment or commercial vehicle SWPs or a separate lockout procedure specific for that equipment provided. |

| |Minimum: |

| |Complete the table, adding additional pages or lines as necessary and submit the best 2 safe work procedures that have not already been submitted in |

| |a previous year. |

| |If the safe work procedure is about machinery or commercial vehicles, it needs to include lockout, or have a separate lockout procedure applicable to|

| |that machinery or vehicle attached. |

| | |

| |ISEBASE only: Only one safe work procedure needs to be included. |

| | |

| |Preferred: |

| |Submit the page(s) from the safety manual table of contents that lists all the safe work procedures. Safe Work Procedures submitted include ergonomic|

| |considerations. |

| | |

| |Best practices: |

| |All activities have a safe work procedure. |

| |The procedures are clear, simple and supported by graphics or pictures. |

| |Procedures were developed through a risk assessment process, cooperatively with workers and are reviewed annually and when there are significant |

| |changes in operations. |

| | |

| | |

|10 |Submit one completed investigation form showing recognized investigation technique. |

| |(investigate a close call, near miss or property damage or use a training example if the company had no injuries) |

| |OR |

| |Tick here if the company did not work during the past 12 months and submit a blank form that the company would use for the next investigation. |

| |Minimum: |

| |Submit a completed investigation. A blank form is not acceptable unless the company had no work in the past 12 months (or since the company existed, |

| |if the company is newer than 12 months old). |

| |If the company did not have an injury, an investigation of a close call, near miss or property damage or other loss is acceptable. Investigating the |

| |mock event that was used for the annual ERP drill is acceptable. Presenting a training example is acceptable. The investigation will be evaluated for|

| |completion, consistency and reasonableness. |

|11 |Submit completed monthly safety (or pre-work) meeting documentation for all operating months within the past 12 months. |

| |One meeting per operating month is required. Please submit only one per month. |

| |For a one person company, these may be meetings with clients or with contractors. |

| |Please mark which attendees are contractors, if any, or submit separate contractor meeting minutes. |

| |Minimum: |

| |For every operating month (as indicated in the company profile month-by-month grid), submit one legible safety meeting. |

| |The safety meeting could be a pre-work meeting for companies that have many projects per month. If the company has weekly safety meetings, please |

| |only submit one per month. |

| |Meeting content needs to include: |

| |• Inspections, |

| |• assessments; |

| |• industry alerts (from industry); |

| |• close calls / near misses; and |

| |• incidents (and alerts sent out to industry if applicable) |

| |The format for the minutes can be journal notes, annotated maps or any other method that works for the company, including electronic methods. |

| |Attendees and absent people are listed. |

| | |

| |Preferred: |

| |The company uses a standard template. |

| |Minutes are signed by participants and proof of circulation/distribution to absent workers is available. Minutes contain sufficient detail and |

| |contents that QA understands the company activities. |

| |Items in the minutes obviously relate to company geography, season and company profile. |

| |Minutes do not exclude office staff. Minutes include statistics such as current injury count or rate compared to a previous month or year. |

| | |

| |Best practices: |

| |Minutes clearly assign and track open items, feeding into a company CAL. |

| |Items do not reappear on the minutes month after month. |

| |Minutes include safety, productivity, quality, environmental and other business issues in a single balanced presentation. |

| |Minutes include planned presentations by management, including safety and operational statistics in some months. |

| |Minutes included planned talks by workers. |

| |Company has a major annual meeting with more depth and detail than the regular monthly meeting, covering an annual review and planning process. |

|12 |Submit one close call / hazard report. This may be a combined form or one form for each purpose. |

| | |

| |OR |

| |Tick here if the company did not work during the past 12 months and submit (a) blank form(s) that the company would use for the next close call / |

| |hazard report. |

| |Minimum: |

| |Submit proof that hazards and close calls are reported in any way faster than saving them up for monthly safety meetings. |

| |This can be journal notes from a supervisor recording a verbal report from a worker or email transcripts. |

| |This can include daily pre-use inspection reports on machinery where something is reported. |

| |A ‘form’ is not necessary. |

| |It is not acceptable to submit a blank unless the company has not worked in the last 12 months. For one-person companies, communications to clients |

| |or other companies is acceptable. |

| | |

| |Best Practices |

| |The reports have a documented feedback mechanism to the worker to give information on when and how their issue will be (or was) addressed, including |

| |for cases where the issue will be managed, but not fully closed. |

|13 |What is the most important hazard in your company? Why? (attach additional pages if necessary) |

| | |

| | |

| |Minimum: |

| |Respond to the question in your own words. |

| | |

| |Best Practices |

| |Attach the company-wide hazard assessment matrix, including assessment parameters for frequency, probability and severity. The matrix is updated |

| |annually in a cooperative effort including workers. |

|14 |What could your company be doing to help further reduce fatalities and serious injuries? |

| |(attach additional pages if necessary) |

| | |

| | |

| | |

| | |

Minimum:

Respond to the question in your own words.

The topic may or may not relate to the previous question.

Best Practices:

Attach your annual safety review and improvement plan, developed in cooperation with workers.

Select one choice in each of the following questions 15-22

|15 - Pre-work planning |

| |Submit one pre-work or block plan. |

| | |

| |OR |

| |Submit a blank pre-work if the company usually uses pre-work plans, but did not work during the past 12 months. |

| | |

| |OR |

| |The company is not directly involved in an activity requiring formal pre-works. |

Minimum:

Every company must select one tick box in order to receive a point.

Submit the completed plan or blank if that is what is ticked.

Preferred:

Companies that are not directly involved in harvesting but are involved in similar type activities (i.e. silviculture) have a pre-work or block plan and submit it.

Best practices:

Any company has a pre-work planning process and submits an example or range of examples.

Possible examples include contract scoping, maps, e-mails, check-in plans for travelling or working alone.

The company has a policy and procedure defining pre-work planning.

|16 - Inspections |

| |Submit one site inspection for the company’s field site, shop, office or home/office. |

| | |

| |OR |

| |The company did not manage any work sites for 30 or more days in the past 12 months, including a shop, office or home/office. |

Minimum:

Every company must select one tick box in order to receive a point.

Submit the completed inspection if that is what is ticked.

3rd party inspections are acceptable as long as the site supervision participated in the inspection.

|17 - Pickups, ATV’s, snowmobiles, boats or other non-commercial vehicles |

| |Submit one current page from a maintenance log or maintenance invoices/records for one vehicle. |

| | |

| |OR |

| |The company did not use any pickups, ATV’s, snowmobiles, boats or other non-commercial vehicles for any work activities in the past 12 months. |

Minimum:

Every company must select one tick box in order to receive a point, even if the company does not have vehicles.

Submit the maintenance-related invoices/records or log if that is what is ticked.

Oil changes, tires, exhaust work would be acceptable.

Fuel and other consumable (washer fluid, etc.) invoices are not acceptable.

Electronic records are acceptable (i.e. On-Star printouts for new GM trucks)

Submit only for one vehicle, even in the company has many.

Select a different vehicle each year if the company has multiple vehicles.

If the company is claiming business tax deductions related to a vehicle, it is in the scope of this question.

If the company only uses vehicles belonging to other companies, select the second tick box.

Best practices

The company has an electronic filing system by vehicle, tracking all maintenance, fuel, mileage/hours, warrantee, insurance, damages and other parameters (billable project and/or client kilometers/hours, driver/operator, etc.) from vehicle purchase through to sale/disposal/retirement. An extract for the past 12 months for one vehicle would be an acceptable sample.

|18 - Heavy Equipment and Commercial Vessels (not including commercial vehicles) |

| |Submit one current page from a maintenance log or maintenance invoices/records for one piece of heavy equipment or commercial vessel (large boat / ship).|

| |OR |

| |The company did not have any heavy equipment in the past 12 months. Commercial vehicles do not count as heavy equipment for the purposes of this |

| |question. |

Minimum:

Every company must select one tick box in order to receive a point, even if the company does not have heavy equipment.

Submit the maintenance-related invoices/records or log if that is what is ticked.

Oil changes, tires, exhaust work would be acceptable.

Fuel and other consumable (washer fluid, etc.) invoices are not acceptable.

Electronic records are acceptable.

Submit only for one piece of equipment, even in the company has many.

Select a different piece of equipment each year if the company has multiple pieces.

If the company only uses equipment belonging to other companies, select the second tick box.

Best practices

The company has an electronic filing system by piece of equipment, tracking all maintenance, fuel, mileage/hours, warrantee, insurance, damages and other parameters (billable project and/or client kilometers/hours, driver/operator, etc.) from vehicle purchase through to sale/disposal/retirement. An extract for the past 12 months for one piece would be an acceptable sample.

|19 - Commercial Vehicles |

| |Submit one Commercial Vehicle Inspection (CVI) page or include CVI report number here: |

| | |

| | |

| |OR |

| |Submit one page of a maintenance log or maintenance invoices/records for one commercial vehicle from the past 12 months. |

| |OR |

| |The company did not own or operate any commercial vehicles in the past 12 months. |

Minimum:

Every company must select one tick box in order to receive a point, even if the company does not have trucks.

Submit the CVI number or page if that is what is ticked.

A photograph of the CVI sticker is acceptable.

Submit the maintenance-related invoices/records or log if that is what is ticked.

Oil changes, tires, exhaust work would be acceptable.

Fuel and other consumable (washer fluid, etc.) invoices are not acceptable.

Electronic records are acceptable.

Submit only for one truck, even in the company has many.

Select a different truck each year if the company has multiple pieces.

If the company only uses trucks belonging to other companies, select the second tick box.

Best practices

The company has an electronic filing system by truck, tracking all maintenance, fuel, mileage/hours, warrantee, insurance, damages and other parameters (billable project and/or client kilometers/hours, driver/operator, etc.) from vehicle purchase through to sale/disposal/retirement. An extract for the past 12 months for one piece would be an acceptable sample.

|20 - Contractors |

| | |Submit the company’s contractor selection policy / criteria. This must include SAFE certification for direct hands-on forestry contractors. |

| | | |

| | |If contractors include fallers, this must include evaluation of the competency of the company to perform manual falling. |

| | |20A |Assigning Prime Contractor Status to another company |

| | | |Submit one completed inspection form where the company inspected the Prime Contractor. |

| | | |AND |

| | | |Submit one Prime Contractor agreement |

| | | |Only pages showing where Prime is assigned. |

| | | |Do not send financial details please. |

| | | |OR |

| | | |The company did not assign any Prime Contractors during the past 12 months |

| | | OR |

| | |The company did not hire any contractors during the past 12 months |

Minimum:

Every company must select one tick box in question 20 to be awarded a point, even if they did not hire contractors.

If the company selected the first tick box, they also have to select one tick box in question 20A.

This question only applies to the last 12 months; whether the company hired contractors in the past or intends to in the future does not matter.

“Competency of the company to perform manual falling” refers to ensuring competent falling supervision as well as competent fallers.

SAFE-certification is only a requirement for direct hands-on forestry contractors. The company can choose to require other contractors to be SAFE if they wish, but it is not an audit requirement.

This question only applies to contractors that the company hires.

Contractors assigned to work under the company by a Prime or licensee are not included.

Co-contractors on site that are not working under the company are not included.

Submit the required policy for contractors

Submit the required agreement and inspection form if you assigned Prime

|21 - Company was a Prime Contractor |

| |Submit one copy of a Notice of Project if the company was a Prime Contractor during the past 12 months. |

| | |

| |OR |

| |The company was not a Prime Contractor at any point during the past 12 months. |

| |Minimum: |

| |Every company must select one tick box to be awarded the point, even if they were not Prime during the past 12 months. |

| |Submit one N.O.P. if applicable. |

| |If the company was a Prime, but was not required to submit an N.O.P. during the past 12 months, please explain why. |

Question 22 only applies to the SEBASE audit. ISEBASE companies supply the name of the ‘company safety contact’ on the profile page instead.

|22 - Worker Safety Representative |

| |Print Name of Worker Safety Representative here: |

| | |

| |OR |

| |The company did not have more than 10 people at any point during the past 12 months. |

Minimum:

Every company must select one tick box in order to receive a point.

If the first box is selected, print the name of the worker safety representative. This person CANNOT be an owner or supervisor.

Best practices:

If the company at any time in the year is at or above 20 people, they should by regulation have a safety committee. Companies just under the 20 person mark have developed a safety committee in advance.

|Space for Notes from Company (optional) |

|Minimum: |

|Nothing required. |

| |

|Preferred: |

|Insert any notes that the company feels would help explain a question or the overall context of the audit. It is not required to write any notes here at all. |

|Suggestions to improve the audit form, process and/or SAFE Companies overall are welcome. |

Injury management / return-to-work is optional and does NOT affect a company’s SAFE-certification.

New IM/RTW certifications are no longer being accepted by WorkSafeBC for the additional 5% IM/RTW incentive but existing certificates will be honoured if the company continues to submit a passing IM/RTW audit annually.

|INJURY MANAGEMENT / RETURN-TO-WORK |

|I-1 |Submit the company’s Injury Management Policy or Letter of Intent. |

| | |

| | |

Minimum:

This document needs to outline the objectives of the IM/RTW program.

It may be a policy, signed commitment or other similar letter of intent or an agreement with a union.

Some companies may include their IM/RTW policy as part of their overall Safety Management Policy.

Preferred:

It should be signed by the current senior management and dated within the last 3 years.

|I-2 |Submit the company’s Injury Management / Return-to-Work (IM/RTW) program. |

| | |

| | |

Minimum:

The company needs to have a detailed planned process to manage the impact of work-related injury/illness from the time of injury until either the injured person returns to full capacity or a medical plateau is reached.

This may be developed by the company or managed by a third-party service provider.

Best Practices:

It needs to include a summarized step-by-step instruction for injury management. For example:

1. 1st response to injury;

2. Worker reporting requirements;

3. Medical assessment;

4. Contact with worker;

5. Employer reporting requirement to WSBC;

6. Claims management;

7. Identification of available alternate or modified duties; and

8. Process to develop IM/RTW plan.

9. Defined frequency of contact and progress review

10. Definition of how case files will be set up, tracked and stored.

|I-3 |State, highlight or mark in the Injury Management / Return-to-Work program where the light and/or modified duties section is found and include that |

| |text |

| | |

Minimum:

The company needs to identify types of meaningful, productive light or alternate duties in advance.

It is recognized that light duties may consist of regular duties with reduced physical capacity, extra assistance or increased breaks and that small companies are not required to have completely different jobs specifically reserved for injured workers.

The worker may need to be able to perform 100% of a job safely, but may not need to be at 100% of their pre-injury capacity.

Preferred:

The company has a ‘wish list’ of tasks that a worker could meaningfully perform for the benefit of the company. It is recognized that the injury or a lack of skill or aptitude may make some or all of the wish list inappropriate for any particular case.

|I-4 |State, highlight or mark in the Injury Management / Return-to-Work program where Stay-at-Work is found and include that text. |

| | |

| | |

Minimum:

The company program needs to include Stay-at-Work opportunities as well as Return-to-Work cases.

|I-5 |State, highlight or mark in the Injury Management / Return-to-Work program where initial and ongoing contact is found and include that text. |

| | |

Minimum:

The company needs to have a written commitment to contact the worker, or their emergency contact, on the first day of absence and then a commitment to keep in touch at regular intervals after that, as determined by the nature and severity of the injury.

Best Practices

The company needs to keep records of worker contact.

|I-6 | Describe how the Injury Management / Return-to-Work Coordinator is qualified. |

| | |

| |OR |

| | Attach proof of training. |

Minimum:

Explain how the person in the company who is running (or will run) the Injury Management program is qualified to do so. Extensive experience or certificate courses that include Claims Management or similar topics are acceptable.

Alternatively the IM/RTW Coordinator could have attended IM/RTW training. Minimum training would be a half-day course on Claims Management or IM/RTW if the company runs the program or an orientation briefing from the service provider if the company contracts out the IM/RTW service.

|I-7 | Submit the training summary or meeting minutes where the Injury Management / Return-to-Work procedures are communicated to ALL personnel. |

| |OR |

| | Submit other proof that the procedures are communicated to all personnel in the company. |

Minimum:

The company will have training records, meeting minutes or other sign-off methods to show that all workers have received the procedures.

Just showing that only one specific worker has received the information via an orientation form is insufficient (unless the company only has one worker).

Minimum:

Usually the company who is running (or will run) the Injury Management program is qualified to do so.

|I-8 | Submit a copy of the Injury Management / Return-to-Work orientation form. |

| |OR |

| | Tick here if the Injury Management / Return-to-Work topic is included on the form submitted for question 7 of the OHS audit (page 7 of this |

| |submission form). |

Minimum:

The company needs to list IM/RTW on the orientation form or have a separate IM/RTW orientation

Best Practices:

The company has a brochure or handout explaining the program and its benefits.

|I-9 | Submit a blank copy of the letter or package for the medical professional. |

| |OR |

| |State, highlight or mark in the Injury Management / Return-to-Work program where the letter or package is found and include that text. |

Minimum:

The company needs to have a letter or package ready for injured workers to take to their doctor. It needs to advise the doctor of the program and the availabilities of light and/or modified duties as applicable.

Best Practices:

The Company has held meetings with local doctors, explaining the company program and finding ways to work cooperatively for the benefit of the worker/patient.

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Council Received Stamp Here

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