Fillable HR 16 100 Orientation Checklist For UPSP New (Waterloo Region District School Board)

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HR 16 100 Orientation Checklist For UPSP New (Waterloo Region District School Board)

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SAFETY ORIENTATION CHECKLIST FOR
UNPAID POST-SECONDARY PLACEMENTS
HR
-
16
-
10
0
A safety orientation must be completed with all unpaid post-secondary placement students prior to the student
performing any work at a Waterloo Region District School Board (WRDSB) site. Use this checklist to document and
For more information and resources visit:
www.wrdsb.ca/unpaid-post-secondary-placements
SECTION A
:
General Information
(
completed by placement student)
A
1.
Student Information
Full Name:
Student ID:
Institution/
Training Agency
:
A
2.
WRDSB
Supervisor Information
Full Name:
School/Building(s):
SECTION B:
Training and Records Check
(
completed
by placement student
prior to start date)
B
1. Online Training
(
v
erify completion with
p
lacement
s
tudent)
Worker Health and Safety Awareness
Covid-19 (2020 Pandemic) Modules
Human Rights 101
WHMIS
Kevin Mitnick Security Awareness
Anaphylaxis
Concussion Management
Violence and Harassment in the Workplace
B
2
.
Original
Police
Vulnerable Sector Check
(dated within the past 6 months
, maintain a copy for
record
purposes
)
SECTION C:
O
nsite O
rientation Checklist
(
completed
with placement student
prior to
performing work
)
C1
.
Site Specific Policies and Procedures
Emergency
Contacts
Provide the name and contact of immediate supervisor
,
a list of names and phone numbers of the
person(s) who must be contacted in case of
an
emergency.
Emergency
Procedures
Show and explain how to use emergency eyewashes and showers,
other
emergency
equipment
,
and
call buttons
(
as applicable
)
;
identify
location
s
of
first aid kits
, AED
s
and fire alarm pull stations
.
Review the “Tornado Procedures” and “In Case of Emergency” posters.
Explain
all emergency
procedures (e.g.,
shelter in place
,
hold
and
secure
,
lockdown procedures
etc.
)
.
Review the site’s Emergency Evacuation Plan and explain
the evacuation signals and procedures,
point out proper exit routes and the designated assembly area for your site.
Develop an Individual Emergency Response Plan or Safety Plan if required.
NA
Workplace Health
and Safety
Bulletin Board
Identify the location of the
workplace H
ealth and
Safety B
ulletin
B
oard. Explain how the employee
can participate in the health and safety process (e.g., reporting hazards
, raising safety concerns
).
Identify the name and location of their
Joint Health and Safety Committee (JHSC) Representative.
Review the
WRDSB
Occupational Health and Safety P
olicy (Board Policy 1002), Violence in the
Workplace Policy (Board Policy 1009), and the Harassment Policy (Board Policy 1004).
Explain the
worker’s
rights and workplace parties’ responsibilities under the
Occupational Health
and Safety
Act (MOL Prevention Starts Here poster).
Review the WSIB “1234” Injury reporting poster
and Employment Standards Act (ESA) poster
.
Notice of Collection: Personal information contained on this form is collected under the authority of the current Education Act of the Province of Ontario, and in accordance with the Municipal
Freedom of Information and Protection of Privacy Act. It will be securely stored in your employee file and used for administrative purposes. Questions about your employee file should be directed
to the Human Resource Services Department. Questions about this notice of collection should be directed to the Freedom of Information, Privacy and Records Information Management Officer,
Waterloo Region District School Board, Education Centre, 51 Ardelt Avenue, Kitchener, ON N2C 2R5 or privacy@wrdsb.ca
October 2020 | 1
Waterloo Region District School Board
HR-16-100 Safety Orientation Checklist for Unpaid Post-Secondary Placements
Waterloo Region District School Board
October 2020 | 2
Raising Safety
Concerns
Explain the process for raising a
general safety concern and how to report it to their supervisor
(AP3140, HR
-
05
-
770 Form).
First Aid
-
In Case
of Injury or Illness
Review the location of first aid supplies, equipment and facilities. Identify the designated staff
responsible for first aid.
Review the reporting procedures in the event of an injury and/or accident (AP3140, HR
-
05
-
770
Form).
Workplace
Hazardous
Materials
Information
System (WHMIS)
Identify workspaces where hazardous materials are used, stored or disposed. Provide
additional
training
and instructi
on
as necessary.
Identify the location of the Material
/
Safety Data Sheets (MSDS/S
DS). Review the MSDS/SDS for all
hazardous materials to be used by the employee. Explain hazardous material labelling
requirements. Conduct
job
-
specific training
on any procedures requiring controlled products
.
Review chemical spill response procedures (Spill Response Poster)
(if applicable)
.
Personal
Protective
Equipment (PPE)
I
f the individual will be required to wear protective equipment
r
eview the P
ersonal
P
rotective
E
quipment
(PPE)
program.
Assign
equipment
and provide instruction on the safe us
e
, maintenance
or disposal of
appropriate PPE required
for
the work being performed.
C2
. Other Work Specific Safety Information
(attach additional pages
as needed)
NA
Potential hazards
Tour the work areas and facility and discuss associated work area hazards and safe work practices.
Document the identified hazards
and Safe Work Practices
below
.
SECTION
D
:
Signature
s
By signing below I
acknowledge
that I have
completed all required online training,
provided a valid
Police
Vulnerable Sector
Check, and
reviewed
and understood
all of
the above
policies, procedures and safe work practices as explained to me
during
my orientation
.
Student Signature:
Date:
By signing below I
acknowledge
that I have
verified that the placement student has
completed all required online training,
provided a valid
Police
Vulnerable Sector Check, and
reviewed and understood all of the above policies, procedures and safe
work practices as explained
during the safety
orient
ation
.
Supervisor
/Administrator
Signature:
Date:
PLEASE ENSURE THAT THE ORIGINAL COMPLETED FORM IS RETAINED ON SITE BY THE ADMINISTRATOR/
SUPERVISOR
OR OFFICE OF THE WRDSB SUPERVISING THE PLACEMENT, FOR A MINIMUM OF THE DURATION OF
THE PLACEMENT PLUS SIX YEARS.
A copy may be provided to the student, institution or training agency upon request.
A completed copy of this form, along with any supporting documentation, may be
requested by the Waterloo Region District School Board for audit purposes.
Notice of Collection: Personal information contained on this form is collected under the authority of the current Education Act of the Province of Ontario, and in accordance with the Municipal
Freedom of Information and Protection of Privacy Act. It will be securely stored in your employee file and used for administrative purposes. Questions about your employee file should be directed
to the Human Resource Services Department. Questions about this notice of collection should be directed to the Freedom of Information, Privacy and Records Information Management Officer,
Waterloo Region District School Board, Education Centre, 51 Ardelt Avenue, Kitchener, ON N2C 2R5 or privacy@wrdsb.ca
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HR 16 100 Orientation Checklist For UPSP New (Waterloo Region District School Board)

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Completed 21 February 2021

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