Board of Canadian Registered Safety Professionals
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191
CONFIDENTIAL
APPLICATION FOR CANADIAN REGISTERED SAFETY PROFESSIONAL (CRSP)®
PROFESSIONAL PRACTICE EXPERIENCE FORM
You must complete a Professional Practice Experience Form for each position for which you are seeking
professional practice experience credit. Positions must meet all five (5) criteria listed in the CRSP
Application (see below) to receive credit. Use a separate form for each position or time period, including
different positions for the same employer.
All professional experience must meet all of the five following criteria to be acceptable to BCRSP:
1. The position must be full time and OHS must be the primary function of the position
2. The professional OHS function must be greater than 50% of the listed position’s duties (i.e. – a
minimum of 900 hours per year)
3. The position’s responsibility must be the prevention of harm to people, property, and the
environment, rather than the responsibility for responding to harmful events. Duties could include
systems analysis, preventive methods, risk management, and audit functions. Collateral duties in
OHS are not considered the primary function.
4. The position must be at a professional level. This is determined by evaluating the responsibilities,
activities, and reliance by peers, employers, or clients on the applicant’s ability to defend
analytical approaches used in professional practice and the recommendations made for
controlling hazards through engineering and/or administrative approaches.
5. The position must have a broad scope of duties. This is determined by evaluating the variety of
hazards about which a candidate must advise and the range of skills involved in recognizing,
evaluating, and controlling hazards. Examples of skills are analysis, synthesis, design,
investigation, planning, administration, and communication.
Beginning with your current position, complete a separate Professional Practice Experience Form for
each position for which you are seeking credit. If you held more than one position with an employer, you
must complete a separate Professional Practice Experience Form for each position.
All sections must be completed. In the SUMMARY OF ACTIVITIES section write in each space the
percent of time that you devoted to each of domain areas listed. All functions must total 100%.
Evaluators can only consider the information provided. If information does not clearly define job functions
in detail, or give specific examples of work activity, evaluators cannot award credit for the work
experience.
BCRSP may request additional information to decide on credit for a position, and such requests may
delay the evaluation process.
Board of Canadian Registered Safety Professionals
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191
CONFIDENTIAL
APPLICATION FOR CANADIAN REGISTERED SAFETY PROFESSIONAL (CRSP)®
PROFESSIONAL PRACTICE EXPERIENCE FORM
Applicant Information:
Last Name
First Name
Position Information:
Dates Employed in Position
(MM/YY)
From
To
Position Title
Total Months In Position
Was the Primary Function of this position OHS Practice (protecting people, property, and the environment from harm)?
Yes
No
Was this Position?
Full-Time
Part-Time
Number of Hours per Week
on Average
hrs/wk
Portion of Job Duties Which
Were OHS-Related
%
Did OHS-Related Duties
Comprise at Least 900 hrs/yr
(75 hrs/mo or 18 hrs/wk)?
Yes
No
Employer Information:
Employer and Address
Employer’s Major Product or Service
Name of Supervisor
Employer/ S u p e r v i s o r Phone Number
Employer/Supervisor Email Address
TABLE A. Professional Safety Experience In This Position - Summary Of Activities
Indicate the percentage of your time in this position devoted to each area listed below. If the OHS
position job duties do not equal 100%, non-OHS percent should be listed in letter J.
%
A
Applied Safety Fundamentals (e.g. inspections, investigations, hazard analysis, etc.)
%
B
Environmental Practice
%
C
Ergonomics
%
D
Fire Prevention and Protection
%
E
HSE Auditing
%
F
Health and Wellness
%
G
Occupational Hygiene
%
H
Risk Management
%
I
OHS Management (communication, supervision, training, leadership, policy & procedure
development, etc)
%
Functions that are not OHS-related
%
J
Total (The total for A - J must equal 100%)
100%
Board of Canadian Registered Safety Professionals
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191
CONFIDENTIAL
APPLICATION FOR CANADIAN REGISTERED SAFETY PROFESSIONAL (CRSP)®
PROFESSIONAL PRACTICE EXPERIENCE FORM
Last Name
First Name
Professional Safety Experience in This Position (Continued) - Details For Top Three Job Activities
Referring to the Summary of Activities (Table A), describe the three job activities in which you spend
the most time. Do not provide a description for Area J (Functions that are NOT OHS-related).
#1 activity with
greatest time ( f r o m
table A)
Description of Activity
Example(s) of Work Activity or Work Product
(Letter)
(% of time)
#2 activity with
greatest time ( f r o m
table A)
Description of Activity
Example(s) of Work Activity or Work Product
(Letter)
(% of time)
#3 activity with
greatest time ( f r o m
table A)
Description of Activity
Example(s) of Work Activity or Work Product
(Letter)
(% of time)
BCRSP Assessment Notes ONLY