6825 TOM KEN ROAD, MISSISSAUGA, ON, CANADA L5T 1N4

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1 tron f'):..-,_ aria Telephone: (905) TOM KEN ROAD, MISSISSAUGA, ON, CANADA L5T 1N4 JHSC Status: Inactive Work Force #: 1 Page 1 7 Completed %: Persons Contacted: Visit Purpose: Visit Location: Visit Summary: PATRICIABOUCHER- H&SCONSULTANT.JENNIFERROACH - ACTING PLATOONCOMMANDER. DAVE WAKELY- OPSEU PRESIDENTLOCAL277. MICHAEL SPEERS- JHSC WORKERCO-CHAIR ATIENDEDWITHCRAIG LAWRIE- MOL TO REVIEWTHEEMPLOYERSMEASURESAND PROCEDURESRELATEDTO INFECTIONPREVENTIONAND CONTROL 6825 TOMKENROAD. MISSISSAUGA PLEASESEEDETAILEDNARRATIVE Detailed Narrative: Comments from Craig Lawrie. MOL Infection Control Consultant At the time this inspection the provincial health system has been engaged in preparations for how to deal with cases (or suspected cases) Ebola Virus Disease (EVO)_ There have been no cases EVD in Ontario. however the health system must be vigilant and assess any patient that presents with symptoms and travel/contact history that may be suggestive concern for EVD_ MEASURES AND PROCEDURES FOR WORKER SAFETY With respect to the emerging issue EVD. information related to the precautions to be taken for Emergency services have been developed by Public Health Ontario (PHO) called "Initial assessment and management the returning traveller from countries/areas affected by Ebola virus disease for Emergency Medical Services". dated September _ Public Health Ontario has also prepared guidance entitled "Infection Prevention and Control Guidance for Patients With Suspected or Confirmed Ebola Virus Disease (EVD) in Ontario Health Care Settings. (published August revised August 29). which is referenced in the previously mentioned guidance_ These documents are located at: Workplace specific measures and procedures related to EVD have not been developed Information has been distributed by to workers however there have been no formal procedures developed that are specific to Ebola virus disease (EVD)_ The employer has created a working committee to plan and develop procedures related to Ebola virus diseose. Membership on the committee includes representation from management. resource staff and a worker member the JHSC. PROCEDURES RELATED TO EBOLA VIRUS DISEASE (EVD) REBECCAMCCREITH Leslie Street. Unit 102 Newmarket. ON. L3Y OA4 ~X:905-~ \) (', ((." '! ) J / w07prest;nlotive ( :,.: You are required u er the Act to post a copy this report in a conspicuous place at the workplace and provide copy to the health and safety representative or the joint health and safety committee if any. Failure to comply with an order. decision or requirement on inspector is on fence under Section 66 the Act. You have the right to appeal any order or decision within 30 days the date the order issued and to request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Relations Board, 505 University Ave.. 2nd Floor, Toronto, Ontario M5G 2Pl. You may also contact the Board by phone at (416) 32&7500 Of (toll free), mail or by website at for more information,

2 OHS Case 10: 03916HSKK038,...~ tron aria Workplace Identification: PEELREGIONAL PARAMEDIC SERVICES Notice 10: 6825 TOM KEN ROAD, MISSISSAUGA, ON, CANADA L5T 1N4 The employer has a written standard operating procedures for infection prevention and control, SOP HS-04 (revised June 2014) and procedures for waste management (SOP HS-l 0, revised June 2014). Page 2 7 It is recognized that basic infection prevention and control is important to the control infections related to EVD, however with the additional need for specific personal protective equipment, and issues related to cleaning and waste handling it is reasonable that the employer develops standard operating procedures related to the potential encounter with a patient confirmed or suspect for EVD. The procedure should address concerns such as (but not limited to) what type PPEto wear, the correct procedure for donning and dfing PPE, procedures for disposal waste and proper disinfection surfaces. Procedures that are developed may be guided by current guidance issued by Public Health Ontario as noted above. An order has been issued for the employer to take the reasonable precaution developing and putting into place procedures appropriate for workers when dealing with patients with or suspected with EVD. PERSONAL PROTECTIVEEQUIPMENT For patients that meet the screening criteria for EVD (or suspect EVD) based on symptoms and travel history it is important for workers to have available the appropriate PPE.Guidance on appropriate PPEhas been developed and is available. In response to preparations related to EVD, the more specialized personal protective equipment that may be required includes a supply fluid resistant and/or fluid impervious gowns, full face shield, N95 respirator (standard for EMS) and gloves. As a patient symptoms increase the level PPErequired may also change. Currently gowns are provided for PPE.These gowns are not clearly labelled as being fluid resistant nor fluid impervious, and no information was available to determine if the gowns were resistant or impervious. The full body protective suits are also not clearly identified as fluid resistant or impervious. An order has been issued for the employer to ensure that the gowns or protective suits provided are fluid resistant or fluid impervious as required. For EVD patients workers must wear PPEthat is fluid resistant (as a minimum) and fluid impervious if the symptoms the patient are such that there is a large quantity blood and body fluid. Guidance on protective gowns and PPEis available from standards setting agencies such as CSA, ANSI, AAMI etc. Both the CSA and the AAMI classify gowns in accordance to one 4 levels (levels 1 to 4). Specification fluid ~> ~~ / ;~: ~ REBECCA MCCREITH Worker Representative Newmarket, You are required under the Act to post a copy this report in a conspicuous place at the workplace and provide a copy to the health and safety representative or the joint health and safety committee if any. Failure to comply with on order. decision or requirement an inspector is an fence under Section 66 the Act. You have the right to appeal any order or decision within 30 days the date the order issued and to request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario labour Relations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may also contact the Board by phone at (416) 321r7500or (toll freel, mail or by website at for more information.

3 OHS Case 10: 03916HSKK038,...~t :> t»: On arlo Workplace Identification: PEEL REGIONAL PARAMEDIC SERVICES Notice 10: 6825 TOMKEN ROAD, MISSISSAUGA, ON, CANADA L5T 1N4 impervious (level 4) is based on testing to ASTM standards. The employer may wish to review standards related to fluid resistance and impervious. It was also observed that the white protective suits provided in the PPEbags that are on-board an ambulance may not always be the correct size for the worker. The employer must ensure that workers know and are provided the correct size PPE.An order has been issued. Page 3 7 Gloves available for workers on-board the ambulance are standard length nitrile gloves available in a number sizes. Of note however is that the use standard gloves with protective gowns or suits may leave a "gap" between the sleeve and the glove. The employer must ensure that the protective ensemble provides full coverage a worker's arm and hand and leaves no gap. Concerns were raised regarding the use disposable full face shield as a means providing eye protection as these protective devices may become dislodged while providing care. If this is the case, the employer must ensure that other protective equipment (such as safety goggles or safety glasses) is available and used by workers to protect their eyes from potentially infectious droplets. HAND SANITIZERS During the inspection it was learned that olcohol-boseo hand rub (ABHR) is provided on vehicles in small personal size containers. These are also available for carrying by the workers on their belts/clothing. The ABHR is not accessible to a worker who is wearing a gown or suit when it is carried on their person. On board the ambulance it was observed that the ABHR for workers was inside a bin, that was wrapped in plastic, and on a shelf behind a sliding door. It was not readily accessible to workers that may need it, requiring workers with contaminated hands to go through many steps to get to it. It is a reasonable precaution for the employer to ensure that ABHR is readily available to workers that may need it to disinfect hands. CLEANING/ENVIRONMENTAL ETC. Cleaning ambulances was discussed. It was learned that currently the primary disinfectant used is an accelerated hydrogen peroxide product. It is a hospital grade disinfectant. Worker Representative REBECCA MCCREITH Leslie Street. Unit 102 Newmarket. 'iax: r ;? '\' ~,\ (y '(. ~- Signatur I»: You ore required under the Act to post a copy this report in a conspicuous place at the workplace and provide a copy to the health and safety representative or the joint health and safety committee if any. Failure to comply with on order, decision or requirement an inspector is an fence under Section 66 the Health ond Safety Act. You hove the right to appeal any order or decision within 30 days the date the order issued and to request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Relations Board. 505 University Ave.. 2nd Floor, Toronto, Ontario M5G 2Pl. You may also contact the Board by phone at &7500 or Itoll free). mail or by website at htip:// for more information.

4 . ano Page 4 7 Workplace Identification: PEEL REGIONAL PARAMEDIC SERVICES Notice ID: 6825 TOMKEN ROAD, MISSISSAUGA, ON, CANADA LST 1N4 Standard operating procedures related to waste disposable following a patient with (or suspected with) EVD has not been developed and should be part the standard operating procedures mentioned earlier. INFORMATION AND INSTRUCTIONTO WORKERSABOUT HAZARDS At the time this visit it was learned that workers have not been acquainted by the employer with the hazard related to EVD. Further, the workers have not been provided training and instruction related to the use care and limitations, including how to don and safely remove (df) PPEthat must be used during an interaction with a patient with confirmed or suspected EVD. An order has been issued for the employer to acquaint workers with the hazards ebola virus and measures required for worker safety. A further order is being issued for the employer to ensure that workers are instructed and trained in the proper use, including dfing, PPErequired for a patient with (or suspected with) EVD. Training must be provided to all workers that may be required to respond to a call where EVD is known or suspected. Tille REBECCA MCCREITH Newmarket, ~ax: 905-! I r\' ", r Signatur~, ' y,l;: Tille Worker Representative You are required under the Health and Sety Act to post a copy this report in a conspicuous place at the workplace and provide a copy to the health and safety representative or the joint health ond sety committee if any. Failure to comply with an order, decision or requirement an inspector isan fence under Section 66 the Act. You have the right to appeal any order or decision within 30 days the date the order issued and to request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Relations Board 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2Pl. You may also contact the Board by phone 01 [416) CXJOf [loll free). mail or by website at for more information.

5 Safe At Wo k. Field Visit no: 03916HSKK039 Visit Date: CT-14 Field Visit Type: INITIAL arlo 6825 TOMKEN ROAD, MISSISSAUGA, ON, CANADA L5T1N4 Order(s) /Requirement(s) Issued To: To: REGIONAL MUNICIPALITY OF PEEL Mailing Address: 5299 MAINGATE DR, MISSISSAUGA, ON, CA L4W 1G6 Org/lnd Role Primary Employer Order(s) /Requirement(s) Description: You are required to comply with the order(s) /requirement(s) by the dates listed below. Page 5 7 No Type ActReg Year Sec. Sub Clause Text Order/Requirement Comply by Date Code Sec. TIme OHSA h The employer shall take every precaution CT HSKS040 reasonable in the circumstances for the protection a worker from the hazard contact with patients with suspected or confirmed Ebola Virus Disease. At the time this inspection infection prevention and control procedures had not been developed specific to Ebola Virus disease 2 Time OHSA h The employer shall take every precaution CT HSKS041 reasonable in the circumstances for the protection a worker from the hazard contact patients with suspected or confirmed Ebola Virus Disease by ensuring that personal protective equipment available is a proper fit. At the time this inspection the protective full body suits provided by the employer had not been fitted to ensure proper sizing 3 Time OHSA h The employer shall take every precaution CT HSKS042 reasonable in the circumstances for the protection a worker from the hazard exposure to Ebola Virus Disease by ensuring that the personal protective equipment that is provided by the employer are fluid resistant/impervious as REBECCA MCCREITH Newmarket, Tel: ,4: / "', ~ i,-, ~ Worker! ( - i Representative You are required under the Act to post a cop isrepa in a spicuous place at the workplace and provide a copy to the health and safety representative or the joint health and safety committee if any. Failure to comply with an order, decision or requirement on inspector isan fence under Section 66 the Act. You have the right to appeal any order or decision within 30 days the date the order issued and to request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Relations Board, 505 University Ave.. 2nd Floor, Toronto. Ontario M5G 2Pl You may also contact the Board by phone at (416) 32& 7500 Of (toll free). moil or by website at for more information.

6 Safe At Wo k f'~ t ::> t»: On aria Page 6 7 Field Visit no: 03916HSKK039 Visit Date: CT-14 Field Visit Type: INITIAL 6825 TOMKEN ROAD, MISSISSAUGA, ON, CANADA L5T 1N4 Order(s) /Requirement(s) To: Issued To: REGIONAL MUNICIPALITY OF PEEL Mailing Address: 5299 MAINGATE DR, MISSISSAUGA, ON, CA L4W 1G6 Org/lnd Role Primary Employer Order(s) /Requirement(s) Description: You are required to comply with the order(s) /requirement(s) by the dates listed below. No Type ActReg Year Sec. Sub Clause Text Order/Requirement Comply by Date Code Sec. indicated as required by current guidance on Ebola Virus Disease. At the time this inspection it was unknown if the gowns and full body protective suits were resistant and/or impervious to fluids. 4 Time OHSA h The employer shall take every precaution CT HSKT044 reasonable in the circumstances for the protection a worker from the hazard exposure to Ebola Virus Disease by ensuring that the personal protective equipment that is required by current guidance on Ebola Virus Disease is available for workers. At the time this inspection workers who may be dispatched to a patient with suspected or confirmed Ebola Virus Disease did not have access to shoe covers as indicated within the current guidance documents 5 Time OHSA h The employer shall take every precaution CT HSKT045 reasonable in the circumstances for the protection a worker from the potential exposue to infectious agents transmitted on workers hands. At the time this inspection alcohol based hand sanitizer was not readily accessible in the back the ambulance where patient care occurs Worker Representative "-'_. REBECCA MCCREITH Newmarket. Fax: /_'~' =: //"/,ii y.;1..:/ - «: You are required under the Act to post a copy this report in a conspicuous place at the workplace and provide a copy to the health ond safety representative or the joint health and safety committee if any. Failure to comply with an order. decision or requirement an inspector isan fence under Section 66 the Act. You have the right to appeal any order or decision within 30 days the date the order issued and to request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Relations Board. 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2Pl. You may also contact the Board by phone at 1416)32& 7500 Of 1-ll77~ Itoll free) _mail or by website at far more intorrnotioo.

7 Safe At Wo k ano o Page 7 7 Field Visit no: 03916HSKK039 Visit Date: CT-14 Field Visit Type: INITIAL 6825 TOM KEN ROAD, MISSISSAUGA, ON, CANADA L5T1N4 Order(s) /Requirement(s) Issued To: To: REGIONAL MUNICIPALITY OF PEEL Mailing Address: 5299 MAINGATE DR, MISSISSAUGA, ON, CA L4W 1G6 Org/lnd Role Primary Employer Order(s) /Requirement(s) Description: You are required to comply with the order(sj Irequirement(sj by the dates listed below. No Type Act Reg Year Sec. Sub Clause C~e S~. Text Order/Requirement Comply by Date 6 Time OHSA HSKT046 7 Time OHSA HSKT d The employer shall acquaint a worker or a person CT-21 in authority over a worker with the information on the hazard exposures from patients with suspected or confirmed Ebola Virus Disease. At the time this inspection workers had not been provided with this information a The employer shall provide information, instruction CT-21 and supervision to a worker to protect the health or safety the worker on the use, care and limitations personal protective equipment (including the donning and dfing) when exposed to a patient with suspected or confirmed Ebola Virus Disease. At the time this inspection workers who may be dispatched to patients with suspected or confirmed Ebola Virus Disease had not been provided with information and instruction related to the care, use, and limitations the personal protective equipment that is indicated to be worn. h Worker Representative REBECCA MCCREITH Newmarket, ~: \7-,( (.: \ (,C ',' ;~ I cl / You are required under the Occupationol Act to post a copy this report in () conspicuous place at the workplace and provide a c~y to the health and safety representative or the joint health and safety committee if any. Failure to comply with an order, decision or requirement an inspector isan ottenceurioer Section 66 the Act. You have the right to appeal any order or decision within 30 days the date the order issued oridlo request suspension the order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Relations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may also contact the Board by phone at (416) 32&7500 Of (toll free). moil or by website at for more information.