SAMPLE COR REQUEST COVER LETTER - AMTA · • Questions can only be marked as “not applicable” (n/a) if the guidelines allow it, and Assessor notes must fully justify why thequestion

Sample Cover Letter

ABC Trucking Ltd.

Box 1000 Anytown, Alberta T2H 1L1

Tel: (780) 555-000 Fax: (780) 555-1000 (Date) Alberta Motor Transport Association 285005 Wrangler Way Rocky View, AB T1X 0K3 Attn: COR Administrator, Injury Reduction & Training RE: Certificate of Recognition Program Dear COR Administrator: I would like to apply for the Small Employer Certificate of Recognition and have included all documentation required for the first year Self-Audit. Please find enclosed our completed audit document, National Safety Code Quiz, and all required supporting documentation. At the front of the Audit Binder is the Small Employer Information Sheet. Thank you in advance for reviewing this material. If you have any questions, please feel free to contact me at (XXX) XXX-XXXX or on my cell at: (XXX) YYY-YYYY. Regards, (signature) Joe Smith President/CEO ABC Trucking Ltd.

SAMPLE COR REQUEST COVER LETTER

Small Employer Certificate of Recognition

(SECOR) Audit Instrument Guidelines

Using Range-of-Points Scoring

Approved January 23, 2013

- 2 - Approved January 23, 2013 Section A

SMALL EMPLOYER CERTIFICATE OF RECOGNITION

(SECOR) PROGRAM Overview The SECOR Program provides an opportunity for small employers to measure their health and safety management system against a provincial standard, and if successful, achieve a Certificate of Recognition (COR). The program is specifically designed to meet the application and training needs of small employers, while considering their resource limitations. Employers that want to participate in the SECOR Program must evaluate whether or not their business will continue to fit the definition of a Small Employer over the course of the next 3 years. Once an employer's staffing numbers exceed 10, their COR audit process must move to the next program level for their industry. What is a Small Employer Certificate of Recognition? A Small Employer COR (SECOR) is issued to an employer that has a health and safety management system that meets or exceeds the standards of the Partnerships SECOR Program, as evidenced through a successful assessment/audit. Audit success is measured by achieving a minimum audit score of 80% overall, and at least 50% on each individual element. The SECOR is typically issued for three years, as long as the employer continues to meet the definition of a small employer, has met training and refresher requirements, and completes the annual maintenance assessments/audits, according to Partnerships’ standards and requirements. Employers who achieve a SECOR are eligible to receive a 5% to 20% WCB premium rebate.

Am I a “Small Employer?” A “Small Employer” is defined as an employer that has no more than 10 employees at any given time. The owner(s) and any person covered by the employer’s WCB account must be included in this number. Material suppliers, inspectors, equipment rental deliverers, etc. who supply a service to the small employer are not included in the definition of a Small Employer, though employers may find they are responsible for orienting these individuals to some of their basic workplace health and safety rules, such as personal protective equipment requirements (see the Occupational Health and Safety Act, Regulation and Code for specific obligations of the employer). The definition of a Small Employer will be applied to the employer’s whole operation when issuing a SECOR. Therefore, as a general rule, an employer cannot be issued multiple SECORs on the same account and still be categorized as a small employer unless the total number of employees for the whole operation does not exceed 10 employees.


The Basic Steps for Achieving a Small Employer Certificate of Recognition

1. Contact a Certifying Partner.

2. Take the training necessary to develop a health and safety management system.

3. Develop and implement a health and safety management system.

4. Complete the SECOR assessment and submit it to your Certifying Partner for review and scoring, or conduct an external audit.

For more information on the SECOR Program and certification requirements, contact your Certifying Partner.


Partnerships Small Employer Audit Instrument

This audit instrument is designed to measure whether or not the small employer has implemented the basics of a health and safety management system. The instrument can be used, by a certified external auditor, to conduct an external audit, or by the owner, a key employee or a trained consultant to submit a SECOR Assessment for review by the Certifying Partner. SECOR Assessments require submission of notes and adequate documentation to allow the CP to verify the status of the small employer’s health and safety system and score the questions in the audit instrument. A minimum overall score of 80% is required to pass the audit, and each individual element must score at least 50%.

Anyone conducting a SECOR Assessment must have completed the Certifying Partner’s Health and Safety Program Building Training prior to completing the assessment. Please contact your Certifying Partner for further information on SECOR training requirements.

Instructions for completing a SECOR Assessment

1. Read each question and the guidelines, and respond to the question in the Notes fields provided. 2. Questions marked with “(D)” indicate that documentation/records must be attached. Where attached

documents/record samples are required by the guidelines, attach copies of the requested documentation. Records submitted must be sufficient to verify health and safety activities over the previous 12-month period. DO NOT ATTACH ORIGINAL DOCUMENTATION, as submissions will not be returned to the employer.

3. Ensure that documentation is submitted in a logical and orderly manner, and avoid submitting more documentation than required by the question guidelines. The CP may reject submissions that are difficult to assess.

4. Questions marked with an “(I)” or an “(O)” indicate that the assessor must explain a process or describe an observation in the “Notes” section. Some questions will require both a written explanation and attached documentation (D).

5. While completing the audit document, you will likely identify deficiencies in your health and safety system. For each deficiency identified, consider what steps you could take to improve this area of your system, and enter an appropriate action item in the attached Action Plan.

Tips for completing the SECOR Assessment. • Questions can only be marked as “not applicable” (n/a) if the guidelines allow it, and Assessor notes

must fully justify why the question should be “n/a.”

• Assessors will not assess a score for each question, or fill out the Summary Score Sheet at the end of the audit. Scoring will be determined by the CP reviewer.

• Ensure the SECOR Summary Sheet is completed filled out, and signed off as required. Fields highlighted in grey will be filled out by the Certifying Partner reviewer.

• SECOR Assessors internal to the operation are not required to conduct worker interviews, but must fill out the Employee Breakdown and Sampling Details table, except for the sections highlighted in grey.

• Instructions for external auditors are included inside question guidelines. SECOR Assessors should ignore these instructions, as they will not be assigning question scores or conducting interviews.


• Unless this is your first SECOR Assessment, a completed action plan based on the results of your previous year’s audit must be included in the SECOR submission.

Tips for certified auditors completing an external SECOR Audit • When this audit is completed by a certified auditor external to the operation, questions marked with a

“(D)” indicate that review of relevant documentation is required to assess a score for the question. External auditors are not required to attach sample documentation/records to their audit submission, unless asked to do so by the Certifying Partner.

• Questions marked with an “(I)” indicate that interviews are required. Interview sampling for small employer audits should meet the same criteria as interview sampling for a regular audit. Use the attached sampling tables (including the fields highlighted in grey) to communicate your sampling methodology to the CP reviewer.

• Questions marked with an “(O)” indicate that observations are required to score the question.

• Notes for all questions must fully explain the auditor’s findings and justify the points awarded.

• External auditors should assess a numeric score for each question. All questions are scored based on the range-of-points noted in the scoring column. No half-marks are allowed. The Audit Summary Score Sheet must be completed to reflect the scores awarded inside the audit document.

• The question guidelines are designed for the use of SECOR Assessors, but external auditors should use them to identify the documentation they need to review when scoring the audit questions. Special scoring instructions for external auditors are also included in the guidelines where required, and must be followed.

• SECOR audit reports conducted by a certified external audit are subject to the same quality assurance requirements as a regular audit report.


AMTA SECOR SUMMARY SHEET

Employer Legal Name (as registered with WCB):

Employer Trade Name (if applicable):

Address:

WCB Account(s) in scope: Industry Code(s) in scope:

Facilities/Work Sites in scope: Contact Person: Phone Number:

Fax Number: Email:

Contact person’s original SECOR Training date:

Contact person’s last refresher date:

Course taken as refresher session:

Assessor Name: Assessor most recent training /refresher date:

Code of Ethics signed?

Assessor Phone Number: Assessor Email:

Audit/Assessment Start Date: Audit/Assessment End Date:

Audit Purpose (certification or maintenance): Number of employees covered by WCB account:

Name of the OHS Consultant used to help build the OHS management system (if applicable):

Consultant Training Date:

Auditor Name (if applicable: Auditor Certification # (if applicable):

Code of Ethics signed?

Employer Sign off:

Assessor/Auditor Sign off:

Fields in grey are applicable only to external auditors.

Fields asking for information about the “Assessor” are not applicable when the audit is conducted by a certified external auditor.


Employee Breakdown and Sampling Details

Levels Total Number

Number Interviewed

Departments/Shifts List departments, and (if applicable) shifts

below

Employee/Dept. Totals

Total Employees # Interviewed

Full-Time

Part-Time

Casual

Full-Time

Part-Time

Casual

Managers

Supervisors

Workers

Total Employees

Contractors

Visitors

Fields in grey are for use only by external auditors.


Document List

The list below contains examples of documentation that can be attached to the SECOR submission to verify the questions listed. External consultants should use the list as a guideline to dictate what should be reviewed to score the listed questions.

QUESTIONS DOCUMENTATION

1.1 Health and Safety Policy

1.3 Written statement of responsibilities, job descriptions, employee contracts, and program manuals

2.1 Inventory of job positions, and job/task inventories

2.2, 2.5 Completed formal hazard assessment forms, job safety analysis

2.3 Procedure for rating hazards, hazard rating forms

2.4 Documents outlining process/procedural changes and updated hazard assessment forms, memos directing a hazard control be implemented

2.5 Completed field-level hazard assessment forms, policy, procedures

3.1 Completed hazard assessment and control forms

3.3 Preventative maintenance records for equipment, tools, and PPE. Work order records, maintenance logs, defective equipment tags, written procedures/policy regarding the removal of defective equipment

3.4 Discipline policy, supervisor training records, supervisor and worker responsibilities

3.5 PPE policy and training records

3.6 Copy of the work site health and safety plan developed in consultation with your contracting organization

4.1, 4.4 Inspection policy and process, inspection records, inspection schedule, sample inspection reports

4.2, 4.4 Sample inspection forms, checklists

4.3 Sample inspections checklist(s)

4.5 Hazard reporting policy, sample hazard report forms, blank hazard report forms

5.1, 5.2 Orientation policy /process, sample completed orientation checklists, orientation records

5.3, 5.4, 5.5 Training policy/process, sample training records, sample training certificates

6.1 Emergency response plan, evacuation procedures, emergency numbers, radio codes, emergency communication procedures, list of emergency response personnel/fire wardens.


QUESTIONS DOCUMENTATION

6.2 Emergency response training records

6.3, 6.4 Records of Emergency Response drills, minutes of h&s meetings, records of emergency response table-top review exercises

7.1 Incident reporting procedure

7.2 Training records

7.3, 7.4, 7.5, 7.6

Investigation procedure, report forms, investigation forms, sample investigation records

8.1 Sample newsletters, sample safety meeting minutes, sample toolbox meeting minutes

8.2 Sample documents showing statistics are reviewed and trends identified

8.4 Action plan reflecting deficiencies identified from this year’s audit process

8.5 Completed action plan from previous audit


Interview Questions For use by external consultant auditors

Question

No. Question Response

+ - 1.2 (All) Does your organization have a Health and Safety Policy? What

does it say?

1.4 (All) Do you have any specific health and safety responsibilities? Could you describe them? (Examples: arranging health and safety meetings, reviewing incident reports, inspections, etc.) What responsibilities do you have under the Occupational Health and Safety Act and Regulation?

1.5 (Managers/Owner) What OHS legislation is applicable to your work site? How do you make it available to workers?

2.5 (All) When are field-level hazard assessments conducted? How often are they completed?

3.4 (All) How is the use of hazard controls enforced? (PPE use? Use of engineering and administrative controls?)

3.6 (Managers/Owner) How is the your safety and the safety of your workers ensured when working on a contracted work site?

3.7 (All) How are you made aware of safety hazards at a contracted work sites? How are you made aware of the rules at a contracted work site?


Question No. Question

Response + -

4.3 (All) Are formal inspections carried out on a regular basis? Do you have any involvement with the inspection process? What is your role?

4.4 (All) What process is in place to help ensure deficiencies identified during inspections are dealt with in a timely manner?

4.5 (All) Is there a system in place that allows employees to report unsafe conditions? What is it?

5.3 (All) What job specific training is given to workers?

6.3 (All) Are emergency drills conducted? When was the last one?

7.2 (All) What happens when a work-related incident or illness occurs? (I.e. What is the process? How are incidents or illnesses reported?)

8.1a (All) How are you made aware of health and safety issues?

8.1b (All) Do you have the opportunity to provide feedback on health and safety issues?

8.1c (All) How are the identified issues dealt with?

AMTA IMPLEMENTATION: JANUARY 2016

Small Employer Certificate of Recognition (SECOR) Audit Instrument Using Range-of-Points Scoring

AMTA IMPLEMENTATION: JANUARY 2016 2

AMTA Employer & Audit Information Summary

Employer Legal Name (as registered with WCB): Employer Trade Name (if applicable): Address (include town/city and postal code): WCB Account(s) in Scope:

Industry Code(s) in Scope:

Length of Time Health & Safety Management System/Program in Place:

SECOR Number:

Contact Person:

Phone Number:

Fax:

Email:

Audit/Assessment Start Date:

Audit Assessment End Date:

Audit Purpose (certification/maintenance/renewal): Choose One

Number of Employees (including owners) during the 12 month audit period:


AMTA Self- Assessor/Self Evaluator/External Auditor/Consultant Information Self-Assessor/Self Evaluator SECOR Training Date:

Self Assessor/Self Evaluator Code of Ethics signed?

Assessor/Evaluator Name:

NSC (National Safety Code) Score (if applicable):

Assessor/Evaluator Phone Number:

Assessor/Evaluator Email:

Self Assessor/Self Evaluator Sign off:

Consultant Information (if applicable)

Name of the OHS Consultant/Company used to help build the OHS management system (if applicable):

External Auditor Information (if applicable): External Auditor Name: External Auditor Certification #:

HSPB Trained Employee (must be company employee ):

HSPB Training Date:


AMTA Employer Information

COMPANY PROFILE/BIOGRAPHY


Employee Breakdown and Sampling Details

Levels Total Number Number Interviewed

Departments/Shifts List departments, and (if applicable) shifts below

Employee/Dept. Totals

Total Employees # Interviewed

Full-Time

Part-Time Casual Full-

Time Part-Time Casual

Managers

Supervisors

Workers

Total Employees

Contractors

Visitors


Fields in grey (Interviewed) are for use only by external auditors.

1. Management Leadership And Organizational Commitment

Questions Guidelines Auditor/CP

Assessed Score

1.1 Is there a written Health and Safety Policy for the organization, signed and dated by the owner? (D)

Document attached

Attach the policy document. The policy must include: - statement of management commitment to health and safety - overall goals and objectives - general responsibilities of managers, supervisors, workers and

contractors regarding health and safety - requirement to comply with relevant government regulations - requirement to comply with organization’s own health and safety

standards 0/0-2

Notes:

1.2 Are employees aware of the policy’s content? (I)

Document attached

Explain how employees are made aware of the policy’s content. This question is not applicable (n/a) if the operation does not have any employees. Auditor: score question based on percentage positive responses in interviews.

N/A

/0-3




Assessed Score

Notes:

1.3 Have specific health and safety responsibilities been written for: (D) a. Managers? b. Supervisors?* c. Workers?*

Document attached

Attach documentation, other than the policy (e.g. contracts, job descriptions, and program manuals) that states employee responsibilities at each level. Depending on size or nature of the organization, one or more of these categories may not be applicable (n/a). Where the operation has no workers, the owner will be considered the Manager.

/0-2

N/A

/0-2

N/A

/0-2

Notes:

1.4 Are the employees aware of their specific health and safety responsibilities under legislation and employer policy: (I) a. Managers?

Explain how employees are made aware of their health and safety responsibilities. Depending on the size and nature of organization, one or more of these employee types may not be applicable (n/a). Where the operation has no

/0-2

N/A

/0-2




Assessed Score

b. Supervisors?* c. Workers?*

workers, the owner will be considered the Manager. Auditor: Scores are based on the percentage positive responses in interviews.

N/A

/0-2

Notes:

1.5 Is the most current health and safety legislation related to your operation available at the work site? (I, O)

List the specific legislation (federal, provincial and municipal) applicable to your operation, and explain how it is made available to workers.

Auditors: This question should be scored based on results of management /owner interviews and work site observations that verify availability of the relevant legislation. /0-2

Notes:

TOTAL POINTS POSSIBLE:

/19

/N/A


2. Hazard Identification and Assessment


Assessed Score

2.1 Does the employer have a list of all jobs and tasks carried out at the work site? (D)

Document attached

Attach a list of all employee jobs, and the tasks within those jobs. Both the jobs and the tasks must be clearly identified.

Auditors: Points are awarded based on the percentage completion of the job and task inventories.

/0-6

Notes:

2.2 Are health and safety hazards identified for the tasks in the inventory? (D)

Document attached

Attach documentation that identifies the hazards related to the employer’s list of tasks (from question 2.1). Both health and safety hazards should be identified to ensure that ergonomic risks, exposure to chemicals, noise, heat stress, road safety, etc. are addressed. Auditors: The maximum score allowed for this question cannot exceed the total points awarded in question 2.1. /0-6

Notes:




Assessed Score

2.3 Have the health and safety hazards been evaluated according to risk, and have the risks been prioritized? (D)

Document attached

Hazard assessments should show that the employer used a system to assess hazards for: - Severity (how serious an outcome could there be if the hazard resulted in

incident) - Probability (how likely is it that an incident could happen) - Frequency (how often workers are exposed to the hazard) The assessment must result in prioritization of work site hazards. Auditors: Score is based on the percentage of identified hazards that have been assessed and prioritized. /0-3

Notes:

2.4 Are the formal health and safety hazard assessments reviewed: (D)

a. when changes are made to the operation?

b. in response to inspection and investigation results?

Document attached

Attach documentation that supports ongoing review of formal hazard assessments. This may include meeting minutes, supervisor log books, assessment documents, etc. Describe how and when these reviews occur. /0-1

/0-1

Notes:




Assessed Score

2.5 Is a field-level hazard assessment process in use at field sites? (D, I)

Document attached

Describe when and how this process is used. Attach a copy of the field-level hazard assessment policy/process document, and samples of field-level hazard assessment forms completed over the past 12 months. This question is not applicable (n/a) if the operation does not work at field sites.

Auditors: Award points based on review of documentation. Use interview responses to verify worker knowledge of this process. If interview responses do not support what is found in the documentation review, points can not be awarded.

N/A /0-4

Notes:

TOTAL POINTS POSSIBLE

/21


3. Hazard Control


Assessed Score

3.1 Have hazard controls been identified? (D)

a. Engineering? b. Administrative? c. Personal Protective Equipment (PPE)?

Document attached

Attach hazard assessment documents that show what hazard control methods have been recommended to control the hazards identified. Auditors: Documentation must show a connection between the hazards assessed in question 2.3, and the controls identified in order to award points for this question.

/0-2

/0-2

/0-1

Notes:

3.2 Have identified hazard controls been implemented? (O)

a. Engineering? b. Administrative? c. Personal Protective Equipment (PPE)?

Document attached

For each type of control (engineering, administrative, PPE), give examples of controls that are being used at the work site(s).

Auditors: For each type of control identified in question 3.1, award points based on the percentage of these controls implemented by the employer.

/0-3

/0-3

/0-2

Notes:


3. Hazard Control


Assessed Score

3.3 Is there a preventative maintenance program for equipment, vehicles and machinery? (D)

Document attached

Describe the process used for maintaining equipment and preventing the use of defective/broken equipment. Attach sample maintenance records (maintenance logs, work orders, etc.) from the last 12 months. Note that documentation must show a schedule of preventative maintenance.

/0-2

Notes:

3.4 Does the owner ensure health and safety policies are followed and hazard control methods are used? (D, I)

Document attached

Describe how this is done, and attach applicable documentation/records.

Auditors: Interview responses must confirm results of documentation review in order for points to be awarded.

/0-3

Notes:


3. Hazard Control


Assessed Score

3.5 Where Personal Protective Equipment (PPE) is used as a method of control, are employees trained in the use, care, and maintenance of the protective equipment? (D)

Document attached

Attach the PPE policy. It should include PPE training requirements. Attach training records to verify training was completed. Where the operation has no workers, describe how the owner is trained.

/0-2

Notes:

3.6 Has a plan been developed in discussions with your contracting organization to ensure the safety of you and your workers? The plan should include: (D or I)

a. Identification of site-specific hazards and controls

b. Ongoing site specific hazard assessment c. Reporting of changes to work site

conditions d. Review of emergency response plans e. Process for dealing with worker

noncompliance f. On-site supervision of contract workers

Document attached

Attach a copy of the plan. Ideally it should be signed by your primary contracting organization. OR Explain how this is done. Notes must address each sub-point specifically. This question is not applicable (n/a) if the operation does not work as a contractor or a sub-contractor. Auditors: Scoring is based on whether or not the plan addresses the sub-points noted in the question (one point for each sub-point). If there is no evidence of a plan, no points can be awarded for this question.

N/A

/0-1

N/A

/0-1

N/A

/0-1

N/A

/0-1

N/A

/0-1


3. Hazard Control


Assessed Score

N/A

/0-1

Q 3.6 Notes:

3.7 Is the plan communicated to all employees? (I) Explain how the plan is communicated to your employees. This question is not applicable (n/a) if the operation does not have any employees. This question is not applicable (n/a) if the operation does not work as a contractor or sub-contractor. This question is not applicable (n/a) if no points were awarded for question 3.6. Auditors: Documentation must show communication of all required parts of the plan to employees, or interviewees must confirm communication of the plan.

N/A 0-4

Notes:


3. Hazard Control


Assessed Score


/30 /N/A


4. Ongoing Inspections


Assessed Score

4.1 Is there a formal written policy that includes how often formal inspections should be conducted by: (D) a. Managers? b. Supervisors?* c. Workers?*

Document attached

Attach a copy of the policy. The employer should consider the risk level of the workplace when determining the frequency of inspections.

Depending on the size or nature of the organization, one or more of these employee levels may not be applicable (n/a). If the operation has no employees, the owner will be scored as a Manager.

/1

N/A

/1

N/A

/1

Notes:

4.2 Is a site- specific checklist used for inspections? (D)

Document attached

Attach a copy of checklist(s) in use.

/1

Notes:




Assessed Score

4.3 Are formal, written health and safety inspections carried out as required by the employer’s inspection policy by: (D, I) a. Managers? b. Supervisors?* c. Workers?*

Document attached

Attach sample inspection records from the past 12 months. These will be used to confirm if the inspection policy/process is being followed. Depending on the size and nature of the organization, one or more of these employee levels may not be applicable (n/a). If the operation has no workers, the owner will be considered the Manager. Auditors: In order to award full points, formal documentation must exist, and interviewees for each level must verify that inspections are conducted as required.

/0-2

N/A

/0-2

N/A

/0-2

Notes:

4.4 Are deficiencies identified in inspections corrected quickly? (D, I)

Document attached

Explain how identified issues are addressed. Attach samples of completed inspection reports from the past 12 months. Include sample records to confirm that required corrections have been completed (e.g. work orders, purchase orders, memos, etc.). Auditors: Documentation should reflect a reasonable timeframe for correction (as soon as practical), and who is responsible. If interview responses do not support what is found in the documentation review, full points cannot be awarded. /0-3

Notes:




Assessed Score

4.5 Is there a system in place that employees can use to report unsafe or unhealthy conditions and actions? (D, I)

Document attached

Explain/describe how this is done. If a formal process exists, attach it for review by the AMTA.

This question is not applicable (n/a) if the operation does not have any employees.

N/A

/0-2

Notes:


/15

/N/A


5. Qualifications, Orientations and Training


Assessed Score

5.1 Does the orientation: (D)

a. Address critical health and safety issues?

b. Cover employer health and safety policies, procedures, and responsibilities?

Document attached

Describe what is covered in the orientation. Explain how the orientation is delivered, and attach documents that outline the orientation process. Critical issues include the following:

• organization rules/enforcement • right to refuse unsafe work • emergency response • incident notification • critical hazards • hazard reporting

Attach documentation (orientation records, orientation checklists) to show that orientations cover h&s policies/procedures. If the operation does not have any employees, this question is not applicable (n/a).

N/A

/0-3

N/A

/0-3

Notes:

5.2 Is the new employee orientation completed on or before the first day of work? (D)

Document attached

Describe how/when this is done. Attach orientations from the past 12 months. Orientations must be dated and signed off. This question is not applicable (n/a) if the operation does not have any employees, or if no new employees have been hired in the past 12 months.

N/A

/0-2

Notes:


5. Qualifications, Orientations and Training


Assessed Score

5.3 Do employees receive the job-specific training required to perform their jobs/assignments in a healthy and safe manner? (D, I)

Document attached

Attach training records, and describe how job-specific training is conducted. Examples of job specific training include training of safe work procedures, PPE, ergonomics, use of equipment, WHMIS, first aid, defensive driving, TDG, etc.

If the operation does not have any workers, consider the owner’s own job-specific training in scoring this question. Auditors: Job-specific training conducted must be relevant to the scope of the operation. If interview responses do not support what is found in the documentation review, full points cannot be awarded. /0-3

Notes:

5.4 Are on-going training/refresher sessions provided as required? (D)

Document attached

Explain how this is done. Attach documentation that shows on-going training, refreshers, and recertification for job-specific training (e.g. skills upgrading, WHMIS, First Aid, Defensive Driving, TDG, maintenance procedures, respiratory protection, etc.). /0-3

Notes:

TOTAL POINTS POSSIBLE: /14

/N/A


6. Emergency Response


Assessed Score

6.1 a. Is there a written emergency response plan that addresses all possible emergencies, and reflects the hazards at the work site(s)? (D)

b. Does the plan include: (D) - Communication procedures? - Emergency phone numbers? - List of responsible emergency response personnel? - Evacuation procedures?

Document attached

Attach the emergency response plan.

Note that it is acceptable for a small employer to work under the ERP of the contracting organization, as long as they can show that this plan is communicated to the small employer and their workers.

/0-2

/0-2

Notes:

6.2 Are employees given emergency response training appropriate to their individual responsibility? (D)

Document attached

Attach emergency response-related training records from last 12 months. If the operation does not have any workers, the owner’s Emergency Response training will be considered to score the question.

/0-2

Notes:




Assessed Score

6.3 Are planned emergency response drills conducted annually or more often, as required? (D, I)

Document attached

Give a description and date of the last drill. Explain how often drills are scheduled and the types of drills held. Participation in drills held by the contracting organization may be appropriate to the needs of the small employer.

Auditors: If interviews do not confirm that a drill was held in the last year, full points cannot be awarded. /0-2

Notes:

6.4 Are emergency response records kept? (D)

Document attached

Attach policy. Describe what records are kept, and (if available) attach sample records from the past 12 months. Employee names must be removed from sample first aid/medical aid records.

This question cannot be marked as "n/a." In the absence of an actual emergency, attach records of participation in drill(s), and a policy requiring ER records to be kept. /0-2

Notes:




Assessed Score


/10 /N/A

7. Incident Investigation


Assessed Score

7.1 Is there a written procedure that requires the reporting of workplace incidents, illness and near misses? (D)

Document attached

Attach reporting procedure. It should include legal requirements for incident reporting. Documentation must also require internal reporting of incident, injuries, illness and near misses.

/0-3

Notes:

7.2 Are employees aware of their responsibilities to report work-related incidents, illness and near-misses? (D, I)

Document attached

Attach relevant training documents, and explain how employees are made aware of their responsibility to report incidents/illnesses. This question is not applicable (n/a) if the operation does not have any employees. Auditors: If interview responses do not confirm awareness of reporting responsibilities, full points cannot be awarded.

N/A

/0-2




Assessed Score

Notes:

7.3 a. Is there a written procedure for investigating workplace incidents, illness and near misses? (D)

b. Does the procedure include a requirement to correct deficiencies identified in investigations? (D)

Attach the investigation procedure. /0-2

/1

Q. 7.3 Notes:

7.4 Is there an investigation form? (D)

Document attached

Attach a copy of the investigation form. If the employer’s contracting organization requires the use of their form, employers may use this instead of developing their own. Auditors: The form must include fields for a description of the circumstances, identified causes (direct, indirect and root), corrective actions, and follow-up. /1

Notes:




Assessed Score

7.5 Do investigation reports identify root causes and corrective action? (D)

Document attached

Attach copies of completed investigation report forms from the past 12 months. If no incidents or near misses have occurred, this question is not applicable (n/a). Auditors: if root causes are not correctly identified and proposed action is not likely to be effective, no points can be awarded for this question.

N/A

/0-2

Notes:

7.6 Are corrective actions taken to prevent incidents from happening again? (D, O)

Document attached

Describe how action is taken as a result of incident investigations, and give examples where possible. Attach documentation that verifies corrective action taken. Auditors: Documentation must show that corrective action was taken in an effort to prevent a recurrence. If no incidents have occurred in the past 12 months, this question may be scored based on written requirements to take corrective action (in employer policy). /0-2

Notes:




Assessed Score


/13 /N/A


8. Program Administration


Assessed Score

8.1 Is there a system to ensure: (D, I)

a. Health and safety issues are communicated to employees?

b. Feedback on health and safety issues from employees?

c. Follow-up on health and safety issues?

Document attached

a. Describe how employees are advised of health and safety issues. Attach sample documentation (e.g. records of safety meetings/toolbox meetings, bulletins, etc.).

b. Describe the system used for employees to offer feedback on health and safety issues, and how employees are made aware of the system.

c. Describe how follow-up is done, and explain how employees are made aware of any follow-up completed.

This question is not applicable (n/a) if the operation does not have any employees. Auditors: Verify that the required communication systems exist. If interview responses do not support what is found in the documentation review, full points cannot be awarded.

N/A

/0-2

N/A

/0-2

N/A

/0-2

Notes:

8.2 Does the employer review their health and safety performance using statistics? (D)

Document attached

Attach samples of the statistics maintained by the employer (e.g. first aids, medical aids, claims rates, # of inspections, # of orientations, # of safety meetings, etc., etc.). Describe any trends that were identified.

/0-2

Notes:




Assessed Score

8.3 Is the health and safety system evaluated at least annually through the use of an audit process? (D)

Document attached

Give the date of the last audit.

If this is the employer's first health and safety audit, this question is not applicable (n/a).

N/A

/1

Notes:

8.4 Was an action plan developed to address the deficiencies identified in the previous audit? (D)

Document attached

Attach the action plan from the previous year. For each item on the action plan, the person responsible should be identified. Target completion dates and (if applicable) actual completion dates should also be noted for each action item. If this is the employer's first health and safety audit, this question is not applicable (n/a). Auditor: The action plan must include items addressing all of the deficiencies identified in the previous year’s audit, and must contain the required components noted above. The items do not have to be completed to achieve the point for this question.

N/A

/ 1

Notes:




Assessed Score

8.5 Were the action items from last year’s action plan completed? (D)

Document attached

Attach the completed action plan from the previous year’s audit.

If this is the employer's first health and safety audit, this question is not applicable (n/a).

Auditors: Score is awarded based on percentage completion of the action items from the previous year’s audit results.

N/A

/ 0-2

Notes:


/12 /N/A


Partnerships Small Employer Action Plan Audit Date: ___________

IDENTIFIED DEFICIENCY ACTION PROPOSED PERSON (S)

RESPONSIBLE TARGET

DATE ACTION TAKEN DATE COMPLETED

Use the above template to develop an action plan from the audit results. Deficiencies identified by the assessor, external auditor

and/or the Certifying Partner reviewer should be itemized in this plan, and completed before your next audit.


Self Assessor/Self Evaluator Code of Ethics Agreement

As a Self Assessor/Self Evaluator trained by Alberta Motor Transport Association I agree to the following: Audits will be conducted with the utmost integrity, confidentiality and with no conflict of interest. As a Self assessor/Self evaluator I have

read and agree to follow the Code of ethics policy of the Alberta Motor Transport Association.

I agree and understand the Alberta Motor Transport Association has the right and responsibility to take disciplinary action if I do not abide

by the Code of Ethics as outlined in the policy.

I agree to complete the audit information gathering within the 45 day time frame and to submit completed audits within 45 days from last

day of on site activities.

I also agree to correct any deficiencies noted in the reviews within 30 days of notice.

I also agree to complete my Self assessor/ Self evaluator refresher training every three years as required by AMTA and Partnerships

Standard.

If at any time I am found to be in breech of this agreement or the Code of Ethics, I understand the Alberta Motor Transport Association has the right and responsibility to cancel my Self assessor/Self evaluator certification.

______________________________________________ Date: _____________________ Certified Self assessor/Self evaluator


SUMMARY SCORE SHEET

*For use only by external auditors or CP reviewers *

Employer Name:_________________________________________________________ Audit Dates:_____________________ Auditor Name: __________________________________________________________

Element Number Total

Points Possible

Points N/A

Total Points

Total Points Scored Percentage

1. Management Leadership and Organizational Commitment 19

2. Hazard Identification and Assessment 21

3. Hazard Control 30

4. Ongoing Inspections 15

5. Qualifications, Orientation and Training 14

6. Emergency Response 10

7. Incident Investigation 13

8. Program Administration 12

Total Audit Points 134

APPENDIX A

Updated January 31, 2017 1

CONTRACTING ORGANIZATION HEALTH AND SAFETY QUESTIONNAIRE

This questionnaire will determine how you fit into your principal contracting organization’s health and safety management system. Meet with your contracting organization’s contact and determine the answers to the questions. If they answer “no” to any of the questions, you will have to implement systems to deal with the item. While completing this form, take notes, ask for copies, ask for examples, ask how often, etc. These questions will allow you to be prepared when health and safety issues arise.

Small Employer Name :

Representative :

Telephone Number : Fax Number :

QUESTIONS TO ASK THE CONTRACTING ORGANIZATION YES NO

1. Do I/we have a contact person for health and safety issues? (Name: )

If “No” or for any variances, please explain.

2. Will you be conducting safety inspections on the work that I do?

2.1 Are there specific procedures for reporting hazards to you?

2.2 Will I/we be notified when the hazards have been corrected?

2.3 Are there specific health or safety hazards we should be aware of on your site?



3. Are there specific job procedures that we are required to follow?



4. Are there site specific safety rules to follow?

4.1 Is there specific PPE required on this site?

4.2 Do you provide any PPE?


5. Are there specific emergency response procedures we need to follow for:

5.1 Site evacuation (responsibilities, signals, communications)?

5.2 Medical emergency evacuations?

5.3 First aid for serious injuries?


6. Do you require site health and safety orientation?


7. Do I/we require specific health and safety training for work performed on your site (H2S, WHMIS, confined space, etc.)?




8. Are we required to attend your safety meetings?


9. Are there specific procedures we must follow for accident/incident reporting?


10. Are there specific procedures we must follow for accident/incident investigations?


Contracting Organization Name:

Representative:

Telephone Number: Fax Number:

Signature: _____________________________________________________ Date: _________________________

Revised 4/5/2017 4:23 PM 1

National Safety Code/Transportation Compliance Questionnaire Instructions to Carrier:

• This worksheet must be completed in order to verify your compliance to transportation legislation. There are several sections to this worksheet. In some cases not all sections will apply. 50% positive score required in each section and 80% positive overall score required.

• External auditors must validate their answers by ensuring the documentation exists. • Internal auditors – please answer to the best of your ability. Retain a copy of this questionnaire. • Blue text is help text. Red text identifies important information relating to the question.

Section 1: Carrier Written Safety Program – must be completed by all trucking and bus companies Section 2: General Carrier Safety Policies and Procedures – must be completed by all trucking and bus companies Section 3: Driver File and Certification – must be completed by all trucking and bus companies Section 4: Longer Combination Vehicle (LCV) Driver Certification – to be completed only by carriers with a permit that allows drivers to operate longer

combination vehicles (if not applicable answer all questions N/A) Section 5: Financial Responsibility and Insurance – must be completed by all trucking and bus companies Section 6: Dangerous Goods – to be completed only by carriers who transport dangerous goods (if not applicable answer all questions N/A) Section 7: Collisions – must be completed by all trucking and bus companies Section 8: Hours of Service – must be completed by all trucking and bus companies Section 9: Vehicle Files and Information – must be completed by all trucking and bus companies Section 10: Preventative Maintenance and Inspection Program– to be completed by all trucking and bus companies To calculate your score in each section, subtract the number of N.A. responses from the total points possible and then divide the number of Yes points scored by the number of total points possible. For example, in Section One if you are an owner operator and have never had any employees, there are 6 questions that are not applicable. 14 minus 6 equals 8, which is your adjusted applicable total points possible. If you had 7 “yes” answers, you would divide 7 by 8, giving you an overall score of 87.5% or 88%. Please remember to transfer your percentage score to the final scoring page at the end of the questionnaire.

Revised 4/5/2017 4:23 PM 2

National Safety Code/Transportation

Compliance Questionnaire Carrier Name: _______________________________ (As registered with Workers Compensation Board)

Date Completed: ______________

Auditor Name: _________________________

Auditor Signature: ______________________

* “Written” means a program documented on paper or in electronic form that can be printed. A chalkboard or equivalent is not acceptable. 3

SECTION 1 – CARRIER WRITTEN SAFETY PROGRAM (All truck and bus carriers must complete this section)

Response Yes No N.A.

1. Does the safety program include a statement that it applies to all staff authorized to operate the carrier’s commercial vehicles? The Safety Program must clearly state that it applies to all staff authorized to operate the company’s commercial vehicles (including maintenance staff, lease operators, swampers, administration staff, management, etc.). Regulation: AR314/2002 Section 40(3) Note: Enter N/A if carrier is an Owner/Operator and has never had any full-time or part-time drivers.

2. Is safe use and operation of commercial vehicles including; speed limits, seat belt use, drug and alcohol use, defensive driving, load security and fuelling written into the Safety Program? Carrier must have written policies and instructions relating to the operation of the vehicle. These must include at least such subjects as speed limits, seat belt use, drug and alcohol use, defensive driving, load security, fuelling. The actual policies documented should be relative to the size and type of operation of the carrier. Regulation: AR314/2002 Section 40(1)(a)

3. Is proper records and recording of information including, as required; bills of lading, manifests, dangerous goods documents, time records, drivers’ daily logs, and weigh slips written into the Safety Program? Carrier must have written instructions on how to properly complete records and record information relevant to their operation including, as required: bills of lading, manifests, dangerous goods documents, time records, drivers’ daily logs and weigh slips. These instructions may only reference sections of regulations that address completion of relevant documents (e.g. Drivers’ Hours of Service Regulation AR317/2002 Section 9). However, if only regulatory references are made, then the carrier must be able to produce the relevant legislation and staff must have access to it. Regulation: AR314/2002 Section 40(1)(b) Note: Enter N/A if carrier is an Owner/Operator and has no documented on-road violations related to record completion.

4. Is compliance with the law written into the Safety Program? The carrier must have a written policy that drivers are to comply with the law. The carrier does not have to list specific acts or regulations. Regulation: AR314/2002 Section 40(1)(c) Note: Enter N/A if carrier is an Owner/Operator and has never had any full-time or part-time drivers.

5. Are instructions for the use of safety equipment including, as required: the use of advanced warning triangles, fire extinguishers and personal protective equipment written into the Safety Program? Carrier must have written instructions for the use of safety equipment that pertains to the operation of their vehicles. Minimum requirement would be the use of approved advanced warning triangles. If the carrier uses fire extinguishers, goggles and hard hats and if any other safety equipment is used or required by the carrier, then there should be instructions on how and when to use each. The carrier’s instructions may state “in accordance with a specific regulation” if the regulation can be produced and staff must have access to it. Regulation: AR314/2002 Section 40(1)(d)

6. Are policies and procedures relating to drivers’ responsibilities, conduct and discipline written into the Safety Program? The carrier must have a written policy that addresses driver conduct and a written disciplinary policy for failure to comply (e.g. conducting the safe operation of vehicle by driving defensively and obeying the posted speed limits). The disciplinary procedures should be progressive and outline options, such as, written warnings, training and suspensions and termination. Regulation: AR314/2002 Section 40(1)(c) Note: Enter N/A if carrier is an Owner/Operator and has never had any full-time or part-time drivers.

7. Is providing training to employees about safety laws and their application and an on-going program of evaluating their driving skills written into the Safety Program? Carrier must have a written policy which addresses employee training about safety laws and their application (e.g. orientation, logbooks, load securement, weights & dimensions, etc.) and includes a written performance evaluation for driving skills that is on-going (e.g. annual employee reviews through road tests, and/or periodic knowledge testing). Regulation: AR314/2002 Section 40(1)(e) Note: Enter N/A if carrier is an Owner/Operator and has never had any full-time or part-time drivers.


SECTION 1 – CARRIER WRITTEN SAFETY PROGRAM (All truck and bus carriers must complete this section)


8. Is retention of complete records for drivers written into the Safety Program? Carrier must have a written policy indicating the specific drivers’ records which will be maintained and for how long; or a statement that drivers’ records will be maintained in accordance with the regulation. If the carrier states that records will be maintained in accordance with a regulation, then they must be able to produce the Regulation. Regulation: AR314/2002 Section 41(a-j) and 43(1)(a-b) Note: An Owner/Operator is not required to retain an application form or a 3-year employment history for him/herself, but is required to maintain all other drivers’ records listed in AR314/2002 Section 41(1).

9. Is ensuring all drivers are properly qualified for the type of vehicle they operate written into the safety program? Carrier has a written policy clearly specifying what the carrier considers to be a “qualified driver” for the type of vehicles they operate. This may be as simple as stating a class of license that meets the minimum regulatory requirements). Regulation: AR314/2002 41(1)(g) Note: Enter N/A if carrier is an Owner/Operator and has never had any full-time or part-time drivers.

10. Has the carrier substantially complied with their written safety program? Answer “yes” if there is evidence on file that there is a substantial level of implementation of the policies in the carrier’s current written Safety Program. Note: Carrier does not have to have all required policies in place. If the carrier produces a written Safety Program, they must substantially comply with those policies that are currently in their written Safety Program. Regulation: AR314/2002 Section 40(3)

11. Is a copy of the Safety Program retained at the carrier’s principal place of business? Answer “no” if the carrier is unable to produce a copy of the written Safety Program. Regulation: AR314/2002 Section 43(1)(a) and (c) 12. Are copies of all the carrier’s records located at the principal place of business or comply with a valid Divided Record Authority Permit? Answer “yes” if carrier can produce all of the records required to be maintained at the principal place of business or holds a valid divided record authority permit indicating where those records are kept. Must produce the permit for those records not produced. Regulation: AR314/2002 Section 43(1)(a)(b) and (c)

13. Does the carrier have a designated person (Safety Officer) to maintain and implement the safety program and ensure compliance with safety laws? Answer “yes” if carrier has a written policy or statement in place stating they have a person designated to maintain and implement the safety program and ensure compliance with safety laws. Regulation: AR314/2002 Section 40(2)(a) and (b)

14. Does the carrier have a process to ensure a copy of their Safety Fitness Certificate is carried in the cab of each vehicle? Answer “no” if there is a violation on the profile, confirmation from an employee or an inspection confirms not all vehicles contain a copy of the Safety Fitness Certificate. Regulation: AR314/2002 Section 42(1)

Score in Each Category Total Number of Questions 14 Subtract Number of Questions N/A Equals Total Applicable Questions (A)

Number of Questions Answered Yes (B) B divided by An equals your score in Section One. %


SECTION 2 – GENERAL CARRIER SAFETY POLICIES AND PROCEDURES (All truck and bus carriers must complete this section)

Response Yes No N/A

1. Does the carrier have a recall system to ensure driver’s licenses remain current? Answer “no” if the carrier cannot produce documentation indicating when driver’s licenses expire, or does not have a system to ensure that the licenses remain current. 2. Are copies of current relevant transportation legislation located at the principal place of business? Answer “no” if carrier does not have hard or electronic copies of relevant legislation and does not have internet access at the principal place of business. Answer “no” if not all relevant legislation is available.

3. Has the carrier obtained their Carrier Profile with the past year? Answer “no” if carrier cannot produce a copy of their Profile or the Profile is over a year old. 4. Does the carrier have a written policy regarding passengers? Answer “yes” if the carrier has a written policy that addresses drivers carrying passengers.

5. Are the drivers trained in first aid or other emergency response procedures? Answer “yes” if there is documented evidence that the carrier has provided drivers with training in first aid or other training that deals with emergency response.

6. Has the carrier provided training to drivers and freight loaders in weight and dimension laws? Answer “yes” if there is documented evidence that the carrier has given training to drivers and freight loaders/handlers in the laws governing weights and dimensions.

7. Has the carrier provided training to drivers in the cargo securement laws that came into effect in 2005? Answer “yes” if there is documented evidence that drivers have been training in the new cargo securement standards.

8. Does the carrier ensure each commercial vehicle operated has a valid CVIP Inspection? Answer “no” if there is evidence on the carrier profile that a vehicle was operated without a valid CVIP inspection. Regulation: AR211/06 Section 19(1)(a) and (d) or AR211/06 Section 20 (1)(a) and (d)

9. Does the carrier ensure each commercial vehicle is operated with a valid CVIP Inspection certificate and decal located within/on each commercial vehicle? Certificate Regulation: AR211/06 Section 19(1)(b) and 19(2) or AR211/06 Section 20 (1)(b) ; Decal Regulation: AR211/06 Section 19(1)(c) or AR211/06 Section 20(1)(c)

10. Do drivers only operate the carrier’s vehicles applicable to their license, class, conditions and endorsements? Answer “no” if there are violations on the profile or other evidence that indicates drivers drove when not qualified.

11. Do drivers hold a valid operators license while driving the carrier’s vehicles? Answer “no” if there are violations on the profile or other evidence that indicates drivers drove without a valid operator’s license.

12. Is there a written policy that requires drivers to report all driving violations? Answer “yes” if there is a written policy requiring all driving violations to be reported including those committed in private vehicles. Note: Enter N/A if carrier is an Owner/Operator and has never had any full or part time drivers.

13. Do drivers report all violations to the carrier as required by the written policy? Answer “no” if the carrier cannot produce all the violations on the profile and abstracts

14. Is there a written policy that management will periodically review driver violations? Answer “yes” if there is a written policy indicating management is to periodically review each driver’s violations, which should include obtaining a copy of the carrier profile and driver abstracts. Note: Enter N/A if carrier is an Owner/Operator and has never had any full or part time drivers.

15. Does the designated person (Safety Officer) have the authority to hire and terminate drivers? Note: Enter N/A if carrier is an Owner/Operator and has never had any full or part time drivers. 16. Are all employees required to attend regular safety meetings? Answer “no” if there is no written policy regarding regular safety meetings or indication of who must attend or if the carrier cannot produce minutes, list of attendees. Carrier must be able to produce documentation confirming dates and list of attendees in order to answer “yes”. Note: Enter N/A if carrier is an Owner/Operator and has never had any full or part time drivers.


SECTION 2 – GENERAL CARRIER SAFETY POLICIES AND PROCEDURES

(All truck and bus carriers must complete this section) Response

Yes No N/A 17. Is there documented evidence on file that proves the carrier complies with their own disciplinary policies and procedures? Answer “yes” if there is documented proof that the carrier enforces their own disciplinary policy. Answer “no” if violations are found whereby employees should have been disciplined and there is no evidence of disciplinary action being taken. Answer N/A if there is no evidence of employee committing an act which required disciplinary action. Regulation: AR314/02 Section 40(3)

Score in Each Category Total Number of Questions 17 Subtract Number of Questions N/A Equals Total Applicable Questions (A)

Number of Questions Answered Yes (B) B divided by A equals your score in Section Two. %

7

SECTION 3 – DRIVER FILE AND CERTIFICATION (All truck and bus carriers must complete this section)


1. Does the carrier have a driver file for each driver in their employ? Answer “yes” if drivers employed (full time, part time, casual) has their own individual driver file. Regulation: AR314/2002 Section 41(1) 2. Does each driver file contain a completed application form if hired after April 1, 1998? Answer “yes” if there is a completed application or resume on file in every file reviewed. Regulation: AR314/2002 Section 41(1)(a) Note: Enter N/A if driver is hired prior to April 1, 1998 or is an Owner/Operator and does not employ ANY drivers

3. Does each driver file contain a copy of the driver’s employment history for at least 3 years prior to working for the carrier if hired after April 1, 1998? Answer “no” if less than three years work history is on file or if work history is incomplete or if not every file contains the required history. Regulation: AR314/2002 Section 41(1)(d)

4. Does each driver file contain a copy of the drivers abstract dated within 30 days of the date of employment or hire if hired since May 20, 2003? Answer “no” if every file does not contain an abstract dated within 30 days prior to hiring, re-hiring or employing the driver. Regulation: AR 314/2002 Section 41(1)(b)

5. Does each driver file contain an annually updated driver’s abstract? Answer “yes” if every file contains driver’s abstracts, obtained at intervals no greater than 12 months, for the previous 5 years or since the driver was hired. All abstracts must be on file. Regulation: AR 314/2002 Section 41(1)(c)

6. Does each driver file contain a record of convictions of safety laws in the current year and each of the preceding 4 years? Answer “yes” if every file contains a record of all their personal and commercial vehicle violations for the past 5 years. Regulation: AR314/2002 Section 41(1)(e) 7. Does each driver file contain a record of all administrative penalties imposed on the driver under safety laws? Answer “no” if the Carrier Profile indicates an administrative penalty was imposed on the driver and there is no record in the driver file. Regulation: AR 314/2002 Section 41(1)(f)

8. Does the driver file contain a record of all collisions reportable to a Peace Officer, in any jurisdiction, involving a motor vehicle Answer “yes” if All motor vehicle collision information is in the driver’s file or the driver’s file contains a reference to a separate collision file. Regulation: AR314/2002 Section 41(1)(g) Note: Answer N/A if driver not involved in any reportable collisions known to the auditor.

9. Does each driver file contain a record of all training completed with respect to the operation of a commercial vehicle and compliance with safety laws? Answer “yes” if every file contains a record of all related training. It is acceptable if this information is contained in a separate training file or in a computer system viewable by the auditor. Regulation: AR314/2002 Section 41(1)(h) Note: Answer N/A if no training has been given.

10. Does each driver file contain a copy of a valid training certificate issued under the Transport Dangerous Goods Control Regulations? Answer “yes” if every file for drivers required to be trained contains a copy of the certificate and the certificate indicated the subjects trained in and the date of the training. Regulation: AR314/2002 Section 41(1)(i)Note: Answer N/A if the driver does not transport dangerous goods and does not require training.

11. Does the driver file contain a copy of a current medical certificate required for a driver’s license? Answer “yes” if every file for drivers who hold a Class 1, 2, or 4 license has either a valid medical, current license or an abstract dated within the past 12 months on file. Regulation: AR314/2002 Section 41(1)(j)

Total in Each Category Total Number of Questions 11 Subtract Number of Questions N/A Equals Total Applicable Questions (A)

Number of Questions Answered Yes (B) B divided by A equals your score in Section Three. %

8

SECTION 4 – LONGER COMBINATION VEHICLE (LCV) DRIVER CERTIFICATION (To be completed only by those carriers who hold a LCV Permit)


1. Does each LCV driver file contain documented proof that the driver is a holder of a valid Class one driver’s license? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 2. Does each LCV driver file contain documented proof that the driver has passed a recognized air brake course? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 3. Does each LCV driver file contain documented proof that the driver has 24 months or 150,000 km of driving experience with articulated vehicles? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii)

4. Does each LCV driver file contain documented proof of the driver passing a PDIC within the past 48 months? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 5. Does each LCV driver file contain documented proof of the driver passing the Canadian Trucking Alliance’s “Longer Combination Vehicles Driver Training Course”, or equivalent? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 6. Does each LCV driver file contain a driver’s abstract obtained within one month prior to the issue date of the Drivers LCV Certificate? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 7. Does each LCV driver file contain documented proof that the driver has no driving-related criminal code convictions in the past 36 months? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 8. Does each LCV driver file contain documented proof that the driver no more than 2 moving violations in the prior 12 months? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 9. Does each LCV driver file contain documented proof that the driver has no more that 3 moving violations in the prior 36 months? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 10. Does the LCV driver file contain documented proof that the driver has been instructed on all current regulations, permit conditions and issues covering the operation of LCV’s? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 11. Does the carrier ensure that each LCV vehicle carries a copy of the appropriate permit? Answer “no” if there is evidence on the carrier profile that a driver failed to produce the required permit copy. Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 12. Does the carrier ensure that they submit a record of all reportable LCV collisions to the Transport Engineering Branch within one week of the date of occurrence? Answer “no” if there is evidence that a LCV collision occurred more than one week ago and a record has not been submitted as required. Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii)

13. Does the carrier ensure they issue an annual LCV certificate every 12 months to qualified drivers? Answer “yes” if ALL LCV driver files contain a carrier issued certificate dated within the past 12 months. Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 14. Does the carrier ensure that their LCV Driver Instruction maintains the requirements set out in the LCV Instructors Manual? Regulation: Traffic Safety Act Section 62 (2) and Section 131 (1)(c)(i)(ii) 15. Is the Carrier Profile clear of any evidence to indicate the carrier has not complied with any of the above?


Number of Questions Answered Yes (B) B divided by A equals your score in Section Four. %

9

SECTION 5 – FINANCIAL RESPONSIBILITY AND INSURANCE (All truck and bus carriers must complete this section)


1. Does the carrier have the minimum level of Public Liability and Property Damage insurance? Answer “yes” if the carrier can produce an insurance policy or certificate of insurance with the following information: policy number, insurance type, insurance company name, insurance broker (agent) name, effective date, expiry date and coverage limit. Regulation: AR 314/2002 Section 25(b) Note: Cannot be answered N.A.

2. Does the carrier have the minimum level of Public Liability and Property Damage Insurance for Dangerous Goods that require an Emergency Response Assistance Plan? Regulation: AR 314/2002 Section 25(a), Referencing SOR 2001-286 Part 7 and Schedule 1, Column 7 Note: Can be answered N.A. if the carrier does not transport these goods.

3. Does the carrier have the minimum level of Inland (Cargo) Transportation Insurance? Regulation: AR 314/2002 Section 24 Note: Can be answered N.A. if the carrier hauls their own goods and/or those goods are exempt from Cargo Insurance requirements.

4. Does the carrier have the minimum level of Passenger Hazard Insurance (Bus only)? Regulation: AR 314/2002 Section 26(1) Note: Can be answered N.A. if the carrier does not operate any buses. 5. Does the carrier ensure each vehicle registered in their name carries a proof of valid insurance (pink card)? Regulation: TSA Section 167 (1)(c) Answer “no” if there are violations on the Carrier Profile for failing to produce valid insurance.


Number of Questions Answered Yes (B) B divided by A equals your score in Section Five. %

10

SECTION 6 – DANGEROUS GOODS

(To be completed by all carriers who transport Dangerous Goods) Response

Yes No N.A. 1. Does the carrier ensure Dangerous Goods certificates are provided to the applicable drivers? Answer “no” if there is evidence on the carrier profile that drivers have operated vehicles without a valid TDG Certificate. Regulation: SOR 2001/286 Part 6, Section 6.6,

2. Does the carrier retain or arrange for copies of Dangerous Goods shipping documents to be kept for at least the two previous years? Answer “no” if the carrier cannot produce Dangerous Goods shipping documents for at least two years, or if the carrier can produce them for the length of time they have been transporting them if that period is less than two years. Regulation: Provincial – AR157/97 Section 2.1, Federal SOR2001-286 Part 3, Section 3.11(2)

3. Is the carrier filing 30 – Day incident reports with Transport Canada when required? Answer “no” if a reportable Dangerous Goods occurrence has occurred more than 30 days ago and the 30 day follow-up report has not been filed with the Director General. Regulation: Provincial – AR157/97 Section 2.1, Federal SOR2001-186 Part 8, Section 803(2)

4. Is the carrier aware of the consignor’s Emergency Response Plan filed with Transport Canada and know how to implement it? Answer “no” if the carrier hauls Dangerous Goods that require an Emergency Response Plan and they are not aware of the consignor’s Emergency Response Plan or how to implement it. Regulation: Provincial – AR157/97 Section 2.1, Federal SOR2001-286 Part 3.6(1) referencing Part 7 and Schedule 1 Column 7 Note: Answer N.A. if the carrier does not transport Dangerous Goods that require an Emergency Response Plan.

5. Does the carrier ensure Dangerous Goods training is provided to the applicable drivers? Answer “yes” if the carrier has a system and training materials to train drivers who will transport Dangerous Goods. Regulation: Federal SOR2001/286 Part 6.1 (2) (a)

6. Does the carrier have a system to ensure shipping documents accompanying Dangerous Goods loads are prepared properly? Answer “yes” if there is evidence that there is a system in place to ensure DG documentation is correctly completed. Regulation: SOR 2001/286 Part 3 (3.4 - 3.6)

7. Can the carrier explain the accessibility requirements for Dangerous Goods documentation? Answer “yes” if employees can clearly explain where shipping documentation should be placed in the vehicle while in transit. Regulation: SOR 2001/286 Part 3 (3.7)

8. Can the carrier explain the safety mark requirements (placards and labels)? Total in Each Category

Total Number of Questions 8 Subtract Number of Questions N/A Equals Total Applicable Questions (A)

Number of Questions Answered Yes (B) B divided by A equals your score in Section Six. %

11

SECTION 7 – COLLISIONS (All truck and bus carriers must complete this section)


1. Can the carrier explain what a reportable collision is? Answer “yes” if the carrier can explain the criteria that determines whether a collision is reportable to the police.

2. Has the carrier reported or caused to be reported all collisions as required? Answer “no” if there is evidence that a collision, involving death, injury or damage greater than $1000 was not reported. Regulation AR320/2002 Section 147, Traffic Safety Act Section 69(4) and 71(1)

3. Does the carrier have a written policy that requires the reporting of all collisions in company vehicles? Answer “no” if the carrier does not have a written policy that requires the reporting of all company vehicle collisions.

4. Do drivers report all collisions to the carrier as required by the written policy? Answer “no” if there is evidence that drivers failed to report collisions as required.

5. Does the carrier have a written policy that requires management to review all collisions in company vehicles? Answer “no” if the carrier does not have a written policy or there is evidence that indicates no internal review of collisions has taken place in accordance with the policy.

6. Does the carrier review all “reportable collisions”? Answer “yes” if a review of all collision files contains documented evidence that 100% have been reviewed. Note: Answer N.A. if the carrier has not had any reportable collisions.

7. Does the carrier determine whether they where preventable or non preventable? Answer “yes” if 100% of the files contain documented evidence that indicates they have been reviewed and preventability has been determined. Note: Answer N.A. if the carrier has not had any reportable collisions.

8. Does the carrier determine what the root cause of the collision was? Answer “no” if any files reviewed do not contain information regarding what the root cause of the collision was. Note: Answer N.A. if the carrier has not had any reportable collisions.

9. Does the carrier take any action with drivers involved in preventable collisions? Answer “yes” if preventable collision files contain comments regarding the action taken with the driver. Note: Answer N/A if the carrier has not had any preventable or reportable collisions.


Number of Questions Answered Yes (B) B divided by A equals your score in Section Seven. %

12

SECTION 8 – HOURS OF SERVICE (All truck and bus carriers must complete this section)


1. Does the carrier file hours of service records in a neat and orderly manner and are they readily available? Answer “yes” if records are sorted by driver and are in chronological order. Regulation: AR317/2002 Section 16(2)(a) SOR 313/2005 Section 85(3)(b) 2. Can the carrier produce the prior 6 months of hours of service records for all drivers selected at random? Answer “yes” if all the records for each driver selected can be produced. Regulation: AR317/2002 Sections 16(1) and 16(2) SOR 313/2005 Section 85(3)(b) 3. Does the carrier accurately record shift start and shift end times on PROVINCIALLY LEGISLATED drivers who operate within the 160 km radius? Does the carrier accurately record off duty, driving and on duty time for FEDERALLY LEGISLATED drivers who operate within the 160 km radius? Answer “yes” if all the records for each driver selected has met the applicable federal or provincial legislation. Regulation: Provincial AR317/2002 Section 12(1), Federal SOR 313/2005 Section 81 (2)(a-d) Note: Answer N.A. if there are no drivers who operate within the 160 km radius

4. Does the carrier have a system to monitor drivers hours of service and ensure they have adequate hours available prior to and during trips? Answer “yes” if there is a system in place that ensures drivers are legal on shift and cumulative cycles prior to and during trips. Note: Answer N.A. if carrier is an Owner/Operator and has no full time or part time employees that are dispatched.

5. In cases where drivers are employed by more than one carrier, are drivers submitting daily logs to each motor carrier with whom they are employed or otherwise engaged? Answer “no” if there is evidence that drivers work for more than one carrier and you cannot find time records from the other employer. Regulation: AR317/2002 Section 15(1) SOR 313/2005 Section 85(2) Note: Answer N.A. if there are no drivers who operate for more than one carrier. If federally regulated all compensated work for a non-motor carrier must be reported.

6. Do drivers complete daily records and/or logs as required? Regulation: AR317/2002 Section 9 (1) SOR 313/2005 Section 81(1) Answer “yes” if drivers complete either log sheets or a record of work times in accordance with the requirements. 7. Do drivers submit daily logs and supporting documentation within 20 days of the day of completion? Regulation: AR 317/2002 15(2) SOR 313/2005 Section 85 (1) Answer “yes” if there is a written policy that requires drivers to turn in logs or daily time sheets within 20 days of the day of completion.

8. Does the carrier conduct internal audits (or use an outside provider) to verify the completeness of the FEDERAL daily records and ensure that driving and on duty limits are not exceeded? Regulation: SOR313/2005 Section 87 (1) Answer “yes” if there is documented evidence (reports, summaries) that show the carrier reviews logs and time records. Answer “no” if there is no documented evidence.

9. Does the carrier use independent records such as fuel or toll receipts to verify the accuracy of the FEDERAL daily records? Answer “yes” if you can verify that logs or time records are checked against a time marker such as fuel receipts, toll receipts, enforcement forms or other document that confirms the drivers location at a given time. Regulation: SOR313/2005 Section 86 (2)

10. Are the logs clear of any driving, on duty or cumulative cycle violations? Regulation: AR 317/2002 Section 6(1)(a)(b), SOR 313/2005 Section 13 (1)(2)(3), Section 24. Answer “yes” if the auditor reviewed the appropriate sampling size and found ZERO evidence of driving, on duty or cumulative cycle violations.

11. Does the carrier understand the hours of service regulations and how they apply to their operation? Answer “yes” if the carrier can answer correctly questions regarding hours of service requirements and regulations.


Number of Questions Answered Yes (B) B divided by A equals your score in Section Eight. %

13

SECTION 9 – VEHICLE FILES AND INFORMATION (All truck and bus carriers must complete this section)


1. Does each individual file for the randomly selected vehicles contain all the following information? Unit/plate or VIN number, make and year? Answer “yes” if all required information is on file. Can be electronic database, copy of registration, label on file, etc. Regulation: AR 121/2009 Section (2) (a) Note: Cannot be answered N.A.

2. Does each vehicle file for the randomly selected vehicles contain all inspection, repair, lubrication and maintenance records for the previous 5 years or since put into service if less than 5 years? AR121/2009 Section 38(1)(a)

3. Can the carrier produce trip inspections each recorded with the date and time, vehicle identification, odometer/hubometer reading, carrier name, location of inspection, a statement of defects found or a statement no defects were found, name and signature of the person conducting the inspection and a statement that the vehicle was inspected in accordance with the applicable schedule? Answer “yes” if a substantial number of trip inspections and/or defect notices for at least the past 6 months are recorded with all the required. These inspections are to include; pre/post trip inspections conducted in any jurisdiction. Note: All documented "trip inspections and defect notices" are considered to be "inspections" under the regulations and these documents must be retained. Regulation: AR121/2009 Section 37(2)(b) Note: Answer “N.A. if newly purchased vehicle that hasn’t yet had any trip inspections

4. Can the carrier produce repair records each recorded with the date, vehicle identification, odometer/hub or hour meter reading and a description of any work performed? Answer “yes” if a substantial number of repairs for at least the past year are recorded with all the required information (i.e. date; vehicle identification; nature of work performed; and, if equipped, one of the following; odometer reading, or hour meter reading, or hubometer reading). These repairs are to include; in-house or outside facilities in any jurisdiction. The repair bills must be in the vehicle file or a reference indicating the provider and the invoice or work order number. Regulation: AR121/2009 Section 37(2)(b) Note: Answer “N.A. if newly purchased vehicle that hasn’t yet had any repairs

5. Can the carrier produce lubrication records each recorded with the date, vehicle identification, odometer/hub or hour meter reading and a description of any work performed? Answer “yes” if a substantial number of lubrications for at least the past year are recorded with all the required information (i.e. date; vehicle identification; nature of work performed; and, if equipped, one of the following; odometer reading, or hour meter reading, or hubometer reading). These repairs are to include; in-house or outside facilities in any jurisdiction. Regulation: AR121/2009 Section 37(2)(b) Note: Answer “N.A. if newly purchased vehicle that hasn’t yet had any lubrication

6. Can the carrier produce scheduled maintenance records each recorded with the date, vehicle identification, odometer/hub or hour meter reading and a description of any work performed? Answer “yes” if a substantial number of scheduled maintenance records for at least the past year are recorded with all the required information (i.e. date; vehicle identification; nature of work performed; and, if equipped, one of the following; odometer reading, or hour meter reading, or hubometer reading). The scheduled maintenance is to include; all scheduled maintenance that the carrier has outlined in their maintenance program. The scheduled maintenance is to include work done; in-house or outside facilities in any jurisdiction. Regulation: AR121/2009 Section 37(2)(b) Note: Answer “N.A. if newly purchased vehicle that hasn’t yet had any scheduled maintenance

7. Have all modifications to the vehicle that affect its weight capacity been recorded? Answer “yes” if all written documentation indicating alterations to components, which affect weight capacity is on file. Note: Answer “N.A. if the vehicles have not been modified.

8. Have all manufacturer recalls been recorded? Answer “yes” if there is evidence on file that all recalls received by the carrier have had the work completed. Regulation: AR121/2009 Section 37(2)(c) Note: Answer “N.A. if the vehicle has not had any recalls from the manufacturer.

9. Does the vehicle file contain records of all CVIP inspections for the past 5 years? Answer “yes” if there are records on file of all CVIP Inspections for the current calendar year plus previous 4 calendar years or for as long as the vehicle has being in service with the carrier. Regulation: AR121/2009 Section 37(2)(b)

14

SECTION 9 – VEHICLE FILES AND INFORMATION (All truck and bus carriers must complete this section)


10. Does the vehicle file contain records of all on the road CVSA Commercial Vehicle Inspection Reports? Answer “yes” if a substantial number of CVSA Commercial Vehicle Inspection reports for at least the past year are on file. Regulation: AR121/2009 Section 37(2)(b) Verify to carrier profile.

11. Are notices of defects being recorded when a defect is identified during the driver pre or post trip inspection? Answer “yes” if there is written document indicating vehicle defect is on file (“cry sheet”, pre-trip and post-trip inspections, etc.). Notices written only on whiteboard or equivalent are not acceptable. Regulation: AR121/2009 Section 14 Note: Answer “N.A. if newly purchased vehicle that hasn’t yet had any defects


Number of Questions Answered Yes (B) B divided by A equals your score in Section Nine. %

* “Written” means a program documented on paper or in electronic form that can be printed. A chalkboard or equivalent is not acceptable.

15

SECTION 10 – PREVENTATIVE MAINTENANCE AND INSPECTION PROGRAM

(To be completed by ALL carriers operating commercial vehicles) Response

Yes No N.A. 1. Does the carrier’s written Maintenance and Inspection Program pertain to all regulated vehicles? All carriers that operate under the authority of an Alberta Safety Fitness Certificate (SFC) must implement a written Maintenance and Inspection Program. Chalkboard or equivalent not acceptable. Regulation: AR121/2009 Section 6(1)

2. Does the carrier’s written Maintenance and Inspection Program cover the requirement to conduct Commercial Vehicle Inspection Program (CVIP) inspections? Answer “yes” if the carriers written program address mandatory annual CVIP inspections be conducted and that the inspections are completed on time and that there is a process to ensure a copy of a valid inspection is carried in each vehicle. Regulation: AR121/2009 Section 6(3)

3. Do employees have access to the carrier’s written Maintenance and Inspection Program? Answer “yes” if there is a copy of the written program at their principal place of business and in every location where maintenance and inspections are carried out under the carrier’s program. All employees required to comply with the program must have access to the written program. Regulation: AR121/2009 Section 6(4) and (5)

4. Does the carrier’s written Maintenance and Inspection Program require drivers to conduct trip inspections? Answer “yes” if the program requires drivers or another person designated by the carrier to complete a trip inspection of vehicles registered for greater than 4,500 kgs. The person completing the inspection must inspect the operating condition of the vehicle using Schedule 1, of Part 2 of the National Safety Code (NSC) Standard 13. Regulation: AR121/2009 Section 10(2) and (4)

5. Does the carrier’s written Maintenance and Inspection Program require that Schedule 1 or 2 or 3 as applicable, and as may be modified by the regulation, is retained in all vehicles? Answer “yes” if the written program requires a copy of the Schedule to be carried in the vehicle. Regulation: AR121/2009 Section 10(9)

6. Does the carrier’s written Maintenance and Inspection Program require written Trip Inspection Reports? Answer “yes” if the written program requires a driver or other authorized person to complete written vehicle trip inspection reports that meet the requirements outlined in AR121/2009 Section 12. Regulation: AR121/2009 Section 12(2) (3) (4)

7. Does the carrier’s written Maintenance and Inspection Program address distribution and retention of Trip Inspection Reports? Answer “yes” if the written program requires the original Trip Inspection Report to be submitted within 20 days of completion AND if a review of the documentation confirms the Trip Inspection Reports are filed for each vehicle in chronological order and retained for at least 6 months since the carrier received them. Regulation: AR121/2009 Section 13

8. Does the carrier’s written Maintenance and Inspection Program require a person completing the trip inspection to report defects and take appropriate action? Answer “yes” if the written program instructs a driver or other authorized person to document any defects found during their vehicle inspection on the Trip Inspection Report or other document and to report the identified defect to the carrier right away if it is a major defect, and no later than the next required trip inspection if it is a minor defect. Regulation: AR121/2009 Section 14

9. Does the carrier’s written Maintenance and Inspection Program require a driver to report defects identified during their work shift? Answer “yes” if the written program instructs a driver to document any defects found during their work shift on the Trip Inspection Report or other document and to report the identified defect to the carrier right away if it is a major defect, and no later than the next required trip inspection if it is a minor defect. Regulation: AR121/2009 Section 15

10. Does the carrier’s written Maintenance and Inspection Program cover the requirements to repair or correct defects? Answer “yes” if the written program states that when a “major” defect is repaired, the Trip Inspection Report or other document used to report the defect shall be amended to certify that the defect has been repaired or corrected, or that no repair was necessary. Regulation: AR121/2009 Section 16


16

SECTION 10 – PREVENTATIVE MAINTENANCE AND INSPECTION PROGRAM (To be completed by ALL carriers operating commercial vehicles )


11. Does the carrier’s written Maintenance and Inspection Program provide directions on retaining vehicle inspection, maintenance, and repair records? Answer “yes” if the carrier maintains a vehicle file for each vehicle regulated. The vehicle file must contain at least an identification of the vehicle as per Section 37 (2) (a), a record of all CVIP inspections, repairs, lubrication and maintenance, notices of defects from the manufacturer and trip inspection reports. Records must be located at the principal place of business unless otherwise provided by the Registrar. Trip Inspections must be maintained for the current month and previous 6 months, all other records must be retained for at least the current calendar year and the 4 preceding years. Regulation: AR121/2009 Section 37 and 38

12. Does the carrier’s written Maintenance and Inspection Program address inspection/repair of items in Schedule 2 of the regulation? Answer “yes” if the written program includes reference to ALL items below, including providing for a continuous and regulation program for the inspection, maintenance and repair of the carrier’s commercial vehicles. Regulation: AR121/2009 Section 16(a) and (b) and Schedule 2.

Comments: Body and Seats (S.1) Chassis Frame (S. 2) Body Frame (S. 3) Sliding Subframe (S. 4) Underbody (S. 5) Drive Shaft (S. 6) Window and Mirrors (S. 7) Fuel (S. 8) Exhaust (S. 9) Friction Components (S. 10) Hydraulic and Vacuum-assist Brake Components (S.

11) Mechanical Components (S. 12) Brake Pedal (S. 13) Air Brake System (S. 14) Park Brake (S. 15) Brake System (S. 16)

Engine Controls (S. 17) Steering Column and Box (S. 18) Wheel Alignment (S. 19) C-Dolly Steering (S. 20) Steering Linkage (S. 21) Suspension (S. 22) General Requirements (S. 23) Windshield Wipers and Washers (S. 24) Heating and Defrosting System (S. 25) Starting Switch (S. 26) Lamps and Reflectors (S. 27) Tires (S. 28) Wheels (S. 29) Lubrication (S. 30) Fifth Wheel Coupling Device (S. 31) Trailer Hitch, Trailer Mount & Connecting Devices (S.

32) Rear Impact Guards (S. 33)

13. If the vehicle is equipped with a ramp or lift for the purpose of transporting persons with physical disabilities, the vehicle must meet the following requirement as outlined in Schedule 3 of the Regulations. Answer “yes” if the written program includes reference to ALL items below, including providing for a continuous and regulation program for the inspection, maintenance and repair of the carrier’s commercial vehicles. Regulation: AR121/2009 Schedule 2.

Mobility Aid Securement Devices (S. 1) Ramps and Lifts General Requirements (S. 2) Ramp and Lift Controls (S. 3) Lift Capacity (S. 4) Lift Platform Requirements (S. 5)

Warning Notice (S. 6) Ramp requirements (S.7) Storage of ramp in passenger compartment (S. 8) Symbol (S.9)


17



14. FOR HANDI-BUS VEHICLES ONLY. Does the vehicle/program meet requirements outlined in Schedule 4 (Maintenance Standards for Handi-Buses) Answer “yes” if the written program includes reference to ALL items below, including providing for a continuous and regulation program for the inspection, maintenance and repair of the carrier’s commercial vehicles. Regulation: AR121/2009 Schedule 4.

Masor System Required (S. 2) Masor System Requirements (S. 3) Mobility Aid and Occupant Restraint Requirements (S. 4) Protection Materials (S. 5) Exhaust System (S. 6) Rear Bumpers(S. 7) Doors (S.8) Steps (S.9) Additional Lighting (S.10) Floor Covering (S.11) Seats (S.12) Emergency Equipment (S.13) Signs (S.14)

15. FOR SCHOOL BUSES ONLY. The vehicle must comply with Schedule 5 (School Bus Maintenance Standards) of the regulation as noted below. AR121/2009 Schedule 5

Colour (S. 2) Exhaust (S. 3) Instruct and Instrument Panel (S. 4) Steering Gear and Linkage (S. 5) Tires (S. 6) Rear Bumper (S. 7) Colour (S.8) Service Door (S.9) Emergency Exit – General Requirements (S.10) Emergency Doors (S.11) Safety Equipment (S.12) Floor Coverings (S.13) Heater (S.14) Signage (S.15) Inside Height (S.16)

Alternating flashing warning lamps (S.17) Floor level side marker lamps (S.18) Interior lamps (S.19) Exterior lamps (S.20) Mirrors (S.21) Body mounting (S.22) Noise suppression (S.23) Rub rails (S.24) Steps (S.25) Stirrup steps (S.26) Stop arm (S.27) Crossing arm (S.28) Sun visor (S.29) Undercoating (S.30) Ventilation (S.31)


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16. Does the carrier’s written Maintenance and Inspection Program cover lubrication? Answer “yes” if the written program includes the lubrication of vehicle components on a regularly scheduled basis and ensures active oil or grease leaks are corrected. Is there a schedule? Is it being followed? Regulation: AR121/2009 Section 6(3)(a)


Number of Questions Answered Yes (B) B divided by A equals your score in Section Ten. %

19

FINAL SCORING SHEET Response Total Yes No N.A. %

Section 1 – Carrier Written Safety Program 14 Section 2 – General Carrier Safety Policies And Procedures 17 Section 3 – Driver File And Certification 11 Section 4 – Longer Combination Vehicle (LCV) Driver Certification 15 Section 5 – Financial Responsibility And Insurance 5 Section 6 – Dangerous Goods 8 Section 7 – Collisions 9 Section 8 – Hours Of Service 11 Section 9 – Vehicle Files And Information 11 Section 10 – Preventative Maintenance and Inspection Program 16

Total Responses In Each Section 117

Total Number Of Questions In The Quiz 117

Subtract The Number Of N.A. Responses

Total Applicable Number Of Questions (A)

Total Number Of Yes Answers (B)

Divide The Yes (B) Answers By The Total Applicable Number (A) To Find Your Overall Percentage %

CARRIER NAME (as registered with W.C.B.): ___________________________________________________________________

Each Section requires a score of at least 50%. Minimum overall 80% score required.

20

Hours of Service File Sample Size Guide

Range of Number of Drivers

Hours of Service File Sample Size

1 1 2 2 3 3 4 4 5 5

6 – 9 6 10 – 12 8 13 – 15 9 16 – 18 10 19 – 22 11 23 – 26 12 27 – 32 13 33 – 40 14 41 – 50 15 51 – 64 16 65 – 85 17 86 – 121 18 122 – 192 19 193 – 413 20 414 – 500 21

501 – 10000 25

Vehicle File Sample Size Guide

Range of Number of Vehicles

Vehicle File Sample Size

1 1 2 2 3 3 4 4 5 5

6 – 9 6 10 – 12 8 13 – 15 9 16 – 18 10 19 – 22 11 23 – 26 12 27 – 32 13 33 – 40 14 41 – 50 15 51 – 64 16 65 – 85 17 86 – 121 18 122 – 192 19 193 – 413 20 414 – 500 21

501 – 10000 25

Updated January 31, 2017

SMALL EMPLOYER CERTIFICATE OF RECOGNITION (COR) AUDIT CHECKLIST

In order for AMTA to proceed with the review process, please submit the following:

SECOR request cover letter Small Employer Audit Information Sheet Title page Company Biography Completed Audit tool including action plan

o Audit must be dated and signed by the auditor, along with your WCB account number and WCB industry code(s) listed.

o Did you use a Safety Consultant for assistance with the audit process? If yes, this must be acknowledged in the audit.

o all Yes/No boxes and the Notes Column are required to be filled out in full Contracting Organization Questionnaire or equivalent (for Element 3 Question

3.6 of the audit tool) National Safety Code (NSC) Worksheet Last year’s action plan (this is n/a if this is your first audit) All supporting documentation required to support your answers. Sign Code Of Ethics and Discipline Policy.

Critical Timelines to Remember: The auditor has 45 calendar days to start and complete the audit

AMTA Calgary office must receive the audit within 45 calendar days from the completion date - Please note there are no exceptions

Amendment to COR!

If you have ANY changes to your company, such as ownership; WCB account changes (such as account number/industry codes); a name change – Please contact the COR Department for

direction, before you proceed with your audit.

Is Your Company Still a Small Employer? When the number of employees (including owners) goes beyond ten at any point in a given

year, Partnerships Standards consider the company to be a Large Employer. Please contact the COR Department for direction before you proceed with your audit.

Filling Out Your Audit – No Pencil Allowed!

Please ensure to complete the audit in pen or on the computer (the audit tool and the information cover page), as we do not accept audits in pencil.

If you have any questions, please call the COR Department at 1-800-267-1003 or 403-243-4161.

COMPANY BIOGRAPHY This document gives us a good backgrounder on who you are and what you do. See this as a good item to advertise your company (i.e., positive aspects; good for putting in with your bid for contracts). Following is an example

AABBCC TTRRUUCCKKIINNGG LLTTDD..

ABC Trucking Ltd. was founded in the fall of 1979 and incorporated on May 7, 1990. ABC Trucking is based out of Calgary and is managed by the company’s current President/CEO Joe Smith. The company has been contracted out mainly to the City of Calgary and its various departments that involve hauling sand, gravel, asphalt, mud, loam and various commodities as required. It has maintained continuous seniority status with the City of Calgary since its inception. We operate 2 tractors, 3 end dump trailers and 3 pup trailers. Our office is located at 123 Any Street where we have a small maintenance shop and office. We operate solely as a Small Employer with five full-time employees and two part-time employees.

Please make sure that your Company Biography contains the following information:

• Name of company • Date of inception/incorporation • Name of the owner(s)/president/CEO • Type of work the company is involved in • Type of equipment that your company uses • A description of your office location • The number of people employed • Any other information that you think would be helpful

COMPANY BIOGRAPHY