1. HEALTH & SAFETY FORMS, FORMS, FORMS!!! REPORT, REPORT, REPORT!!!
New Teacher WORKSHOP

2. Health and Safety Forms - Notification of Risk of Injury (Form A)
Used for students with an IEP and Safety Plan
A detailed Review of the Safety Plan is still required by all staff who work with the student
Confidential Record to be Kept by Principal

3. Health and Safety Forms - Notification of Risk of Injury (Form A)

4. Health and Safety Forms - Notification of Risk of Injury (Form A)
Personal information is collected under the authority of the Occupational Health and Safety Act, as amended for the purpose of outlining the precautionary measures staff should follow to protect themselves in the workplace and to alert staff of the “risk of injury” from a student with a known history of violence

5. Health and Safety Forms - Notification of Risk of Injury (Form A)
Staff signature indicates that the staff member has been informed of:
The risk of injury with respect to the above student;
The nature of the behaviour that may present a risk of injury;
Prevention strategies that are in place to prevent injury (Safety Plan);
Expected employee response using interventions if this behaviour occurs (Safety Plan);
and Incident-reporting procedures.

6. Health and Safety Forms - Notification of Risk of Injury (Form B)
Used for Students and Adults with NO Identification and NO Safety Plan
CONFIDENTIAL RECORD TO BE KEPT BY PRINCIPAL

7. Health and Safety Forms - Notification of Risk of Injury (Form B)
For an employee with direct contact (supervision and instruction) with a student who does not have an IEP/Safety Plan but may pose a risk to self or others and for all other employees or persons who MAY come in contact with the student
For an employee or third party who is at risk of workplace violence from another adult:

8. Health and Safety Forms - Notification of Risk of Injury (Form B)
Personal information is collected under the authority of the Occupational Health and Safety Act, as amended for the purpose of outlining the precautionary measures staff should follow to protect themselves in the workplace and to alert staff of the “risk of injury” from another employee,parent/guardian, visitor, contractor or other third party with a known history of violence.

9. Health and Safety Forms -
Notification of Risk of Injury (Form B)

10. Employee Accident/Incident Reporting

11. Employee Accident/Incident Reporting
All employee accidents or incidents/near misses (including those defined as actual, attempted or threatened physical force against an employee that caused or could have caused physical injury) must be reported using this form, including those situations involving students regardless of age or mitigating circumstances
Employee Accident/Incident
Reporting

12. Employee Accident/Incident Reporting

13. Employee Accident/Incident Reporting
- This report is in addition to the Safe Schools Incident Reporting forms (see Policy and Procedure 668.0, Caring and Safe Schools). In some instances, both forms may have to be completed.
Employee Accident/Incident
Reporting
-Accidents that result in medical attention and/or lost time must be reported to WSIB by the Board.

14. Safe Schools Reporting Form - Part 1

15. Safe Schools Reporting Form - Part 2

16. WSIB Worker’s Exposure Incident Form
The Worker's Exposure Incident Form (form 3958A) is intended for voluntary use when an unplanned workplace incident exposure has resulted from a leak, spill, explosion, release, or an unexpected contact with a chemical or other substance. The event may have exposed workers to an infectious, chemical or other substance. The purpose of this form is to obtain information about the exposure incident experienced by the worker should an illness or disease occur in the future.
WSIB Worker’s Exposure Incident Form

17. WSIB Worker’s Exposure Incident Form
The Worker's Exposure Incident Form should be completed if you have experienced an unplanned workplace exposure where there has been:
no lost time
no ongoing illness
If you are experiencing any illness needing medical treatment, (such as diagnostic tests, prescribed medication or ongoing treatment), please complete a Worker's Report of Injury/Disease (Form 6).
WSIB Worker’s Exposure Incident Form