Health and Safety Policy

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Approved by: Health and Safety Policy President and Chief Executive Officer Corporate Policy & Procedures Manual Number: II-130 Date Approved November 4, 2016 December 9, 2016 Next Review December

1 Approved by: Health and Safety Policy President and Chief Executive Officer Corporate Policy & Procedures Manual Number: II-130 Date Approved November 4, 2016 December 9, 2016 Next Review December 2019 Purpose The Covenant Health Occupational Health and Safety Policy will provide the framework for the development of a culture that promotes and encourages occupational health and safety, aims to mitigate and eliminate workplace hazards and risks, and has ZERO harm as its goal. In combination with the Covenant Health Occupational Health and Safety Program, this policy will provide guidance on developing strategies to meet requirements of the Alberta Occupational Health and Safety Act, Regulation and Code. Policy Statement Covenant Health is committed to providing a safe place to work for our employees, physicians, volunteers, students and contractors; and a safe environment for visitors and patients/residents. We will provide appropriate health and safety education, training and guidelines in support of continuous improvement. To this end, we expect our employees, physicians, volunteers, students and contractors to perform according to their responsibilities and legislative requirements in support of the overall goal of an uncompromising safe workplace. Behavior that may jeopardize personal safety or the reputation of the organization is subject to discipline. Applicability This policy and procedure applies to all Covenant Health facilities, employees, physicians, volunteers, students, contractors and any other persons acting on behalf of Covenant Health. Principles Covenant Health shall enable a safe and healthy work environment by providing a range of occupational health, safety and wellness programs and services that includes, but is not limited to, the following elements: 1. Management, Leadership and Commitment 2. Hazard Management 3. Workplace Inspections 4. Qualifications, Orientation and Training 5. Emergency Disaster Management Response 6. Incident Management 7. Program Evaluation Responsibility Covenant Health s administrative and medical leaders will demonstrate commitment to meeting the requirements of the Alberta Occupational Health and Safety Act, Regulation and Code and other initiatives which support the elements of an uncompromising safe workplace.

2 II-130 Page 2 of 6 Covenant Health employees, physicians, volunteers, students, contractors, or other persons acting on behalf of Covenant Health will demonstrate commitment to making their workplace safe for themselves, their co-workers, and the public by adhering to the requirements of this policy. 1. Delegation by the Covenant Health Board and Senior Executive Team Covenant Health Senior Leadership Team Provides leadership and direction in Occupational Health and Safety for Covenant Health. Approves the Covenant Health Occupational Health and Safety (OHS) Plan, including the Policies and Procedures. Ensures that the Covenant Health OHS Plan is consistent with Covenant Health s mission, vision, values, and strategic directions and is compliant with provincial and federal legislation. Monitors the effectiveness of the Covenant Health OHS program. Monitors occupational health and safety performance measures. Covenant Health Senior Operating Officers / Executive Directors / Site Administrators Each site is responsible for providing healthy and safe workplaces and for ensuring the health and safety of its employees, physicians, volunteers, students, contractors and other people at those workplaces. This means that site representatives must implement and maintain the Covenant Health OHS Program in their programs, departments, units and workplaces. Senior Operating Officers, Executive Directors, and Site Administrators ultimately have the following responsibilities: Allocate funds, time and human resources to implement and maintain the operation of the Covenant Health OHS Program within the site. Direct the implementation and operation of the Covenant Health OHS Program within the site. Champion and demonstrate the site s commitment to health and safety through: o Approval and communication of any site-specific occupational health and safety procedures and practices. o Communication and recognition of site results and employee accomplishments for health and safety performance.

3 II-130 Page 3 of 6 2. Corporate Human Resources/Occupational Health and Safety Develops, recommends and maintains all elements of the Covenant Health OHS Program in collaboration with all sites and health and safety committees. Director, Covenant Health OHS Chairs the Corporate Health Safety Committee. Consults with sites on all aspects of occupational health and safety, including implementation of the Covenant Health OHS Program, legislative requirements, workplace best practices and other resources for the identification, evaluation and control of health and safety hazards at workplaces. Identifies occupational health and safety training needs, approves training content and leads the development and delivery of common training courses for Covenant Health employees. Tracks and coordinates with sites the administration of regulated health monitoring programs for exposed employees. In collaboration with sites, monitors, evaluates and reports on the effectiveness of the Covenant Health OHS Program in meeting established indicators of occupational health and safety. Enter and maintain incident information as reported by supervisors and managers. Provide reports that support the operation and evaluation of the Covenant Health OHS Program. Administer Short-term, Long-term and Worker s Compensation claims through the Covenant Health OHS Ability Management Team. Coordinate return to work and the gathering of restrictions and limitations for duty to accommodate claims. Consult with site management and Health and Safety Committees on all aspects of occupational health and safety, including the following: o implementation and compliance with the Covenant Health OHS Program, standard requirements and standard processes o health and safety best practices o legislation for the identification, evaluation and control of health and safety hazards at workplaces. Provide direction on the development of occupational health and safety policies, procedures and practices in accordance with guidelines provided within the Covenant Health OHS Program. With site management identify, develop and arrange for the delivery of specialized operational training needs for site employees. Coordinate within departments the administration of regulated healthmonitoring programs for exposed workers in accordance with legislated standards and Covenant Health OHS Program standards. Coordinate the Covenant Health OHS Immunization Program. Lead or assist in investigations of serious incidents upon request by site managers. Consult with management and chairpersons on the organization and operation of the Health and Safety Committees. Coordinate or conduct evaluations (audits) of, and report results on, the effectiveness of the Covenant Health OHS Program within the site.

4 II-130 Page 4 of 6 Champion the integration of the Covenant Health OHS Program within the site. 3. Delegated Responsibilities of Covenant Health Managers Program/Department Managers Manage funds, time and human resources to implement, maintain and evaluate the operation of the Covenant Health OHS Program programs/departments. Implement and maintain the Covenant Health OHS Program within their programs/departments by: o developing occupational health and safety procedures and practices to meet operational requirements within their programs/departments; and o assigning health and safety responsibilities to supervisors and employees. Demonstrate the program/department commitment to health and safety by: o providing leadership and direction to staff in the achievement of Occupational Health and Safety Plans in their department/program, o conducting workplace inspections to encourage health and safety practices, and o stopping work that is an imminent danger or immediately dangerous to life or health. Write and maintain hazard assessments on employee activities and ensure hazard and control measures are communicated to employees within the program/department. Determine and implement hazard controls based on risk analysis for hazards of activities at workplaces. Determine the types of potential emergencies at their workplaces through Hazard Assessment, Elimination and Control (eg. workplace violence, patient/resident handling, manual material handling, chemical spill, etc.) Ensure that employees are familiar with the sites emergency response procedures and the respective codes. Implement the Standard Process for Incident Management as defined in Element 6 Incident Management of the OHS Program. o Review incident investigations conducted by investigators (supervisors/designates). o Establish teams and participate in or oversee Incident Investigations for serious incidents. o Oversee the communication of serious incident investigation results.. Manage employee competency and achievement of their health and safety performance plans. Supervisors In some cases, supervisors may be the designated representative for their site/program/department, in which case they will have the responsibilities and accountabilities described for managers. Managers may also assign responsibilities to supervisors in addition to those outlined here.

5 II-130 Page 5 of 6 Recommend maintenance requirements and maintain facilities, vehicles, furniture and equipment in safe operating condition for employee use. Identify and communicate to employees the hazards of their work and the use of required controls to perform the work safely. Participate in the hazard assessment process, including the identification of hazards and controls. Instruct employees in the safe work procedures and practices. Supervise, monitor and initiate enforcement measures related to the safe use of the appropriate equipment and safe work procedures and practices. Stop work where there is an immediate life threatening hazard to workers. Conduct assigned workplace inspections to identify hazards; recommend and implement approved corrective actions. Recommend employee training needs to the manager and schedule employees to attend approved training courses. Provide new employees, visitors and contractors to the workplace with health and safety orientation or instruction. Investigate incidents to identify causes (underlying, immediate, and root); recommend and implement corrective actions. Report to their manager on health and safety responsibilities and performance by employees in relation to the performance review cycle. Participate on workplace emergency response teams or operate regular practices and drills. 4. Personal Responsibility Employees, physicians, volunteers, students and contractors must take reasonable care to protect their own and other s health and safety at the workplace. Cooperate with their supervisors and managers and actively participate in the Covenant Health OHS Program. Participate in and perform responsibilities as assigned to: o Health and Safety Committees o Hazard Assessment teams o Workplace Inspection teams o Incident Investigation teams o Emergency Response teams Perform work safely using the appropriate equipment. Follow safe work procedures and practices. Responsible to take all training required by the employer for their position as identified in hazard assessments, job descriptions and/or other documents that outline the employer s expectations. Inform co-workers of and report to their supervisor on new hazards that occur during the performance of their work. Report to their supervisor on equipment that is not working safely; use the appropriate safe work practice to prevent other employees from using it.

6 II-130 Page 6 of 6 Inform their supervisor and do not perform activities if imminent danger exists or is created through the performance of an activity. Report all incidents, including near misses, to their manager/supervisor and call the Workplace Incident/Injury Reporting Line to notify OHS of the incident/injury. Participate with their manager/supervisor in performance plans and identify training opportunities and instructions required for performance improvement. Be familiar with and follow written workplace emergency procedures during emergencies. Related Documents Covenant Health Occupational Health and Safety Program Covenant Health Policy #II-135, Reporting of Work-Related Incidents, Injury, Illness References Alberta Occupational Health and Safety Act, Regulation and Code Revisions September 16, 2013 May 25, 2011

OH&S Policy Aims. Scope and Application. Definitions

OH&S Policy Aims. Scope and Application. Definitions OH&S Policy 2016 Aims To provide a school environment that is safe and healthy, where hazards are minimised and controlled. Scope and Application The School must notify Dept Education Services of any critical