241-5 CWEX Employer Health and Safety Checklist

Form 241-5
Career Work Exploration
Employer Health and Safety Orientation Checklist
Insert School Name,
Address, Town, Sask., Postal Code
Phone: (Number) Fax: (Number)
email address if applicable
AP 241 Career Work Exploration
July 9, 2013
Submit to
CWEX Teacher
First Days of Placement
Name of Student
Name of School
Name of Course
Name of Business
This checklist will provide you with a guideline of some Occupational Health and Safety Issues which
must be reviewed with your work-placement student. The objective is to make students aware of any
potential hazards or occupational health and safety issues.
Are these topics covered in the student’s orientation?
Name of immediate supervisor and Occupational Health Committee member
(or health and safety representative)
Worker/Supervisor rights and responsibilities
Safe work procedures and operation of equipment
Use of Personal Protective Equipment (PPE)
Identification of restricted or prohibited areas, tools, equipment, and
Identification of hazards in the workplace that may affect the student.
Discussion on how hazards are controlled
What to do and who to see if the student has a safety concern.
What to do when there is a fire or other emergency (ex. Evacuation
Location of fire exits and fire extinguishers
Location of the first aid supplies, equipment, facilities, etc.
Names of staff responsible for first aid
How to record first aid treatment
Procedures for reporting accidents and injuries
Workplace Hazardous Materials Information System (WHMIS)
Workplace policies and procedures on:
Violence Prevention
Working in Isolation
Location of other important information:
Materials Safety Data Sheet (MSDS)
Occupational Health Committee Minutes
Instructions for safe operation of each piece of equipment
Important telephone numbers
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OTHER (Unique to employer setting)
In completing the Health and Safety Orientation with students, please consider the following questions
and determine how the student is protected. Be sure all safety concerns and potential hazards are
addressed with the student at the beginning of the work placement and that the safety messages are
reinforced throughout the placement. This will help provide for a safe placement experience as well as
expose students to issues they may encounter in the “real world”. Thank you!
Will the student be working with hand tools, power tools, equipment, etc?
Will the student be exposed to any electrical hazards?
Will the student be working with anything under compression?
Will the student be working close to pressure pipes or steam boilers?
Human Element
Does your company have a harassment policy?
Are there any situations where student could be exposed to violence?
Is there a policy on smoking?
Will the student be working alone? Does this pose any safety concerns?
Will the student be working shifts?
Will the student be exposed to high levels of stress?
Work Environment
Will the student be subject to heavy lifting?
Will the student have to work in a cluttered workspace?
Will the student work at elevation? Is there fall protection in place?
Will the student be exposed to flammable, corrosive, toxic, or reactive chemicals?
Is there any special safety gear the student must wear?
Will the student be in proximity to trenches or confined spaces?
Will the student have contact with hot materials or surfaces?
Will student spend periods of time exposed to the sun?
Will the student work in extreme temperature-related conditions?
Will the work environment be noisy? Any needed safety equipment?
Will the student be exposed to excessive dust, fumes, or gases?
Please discuss any potential hazards or occupational health and safety issues with the student that are
unique to your organization and indicate on the checklist.
Employer’s Signature
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