1. Inspections in Healthcare Facilities by the Ministry of Labour
Presented to the WSIB Safety Group Sponsored by the Ontario Safety Association for Community and Healthcare (OSACH)
February 28, 2008
Leonard Kuehner, M.Sc.
Provincial Specialist

2. Disclaimer
The material in this presentation is being provided as information only. Reference should always be made to the Occupational Health and Safety Act and the regulations to ascertain one's rights and duties under the law. It is the responsibility of all workplace parties to ensure compliance with the OHSA and the regulations and to seek independent legal advice where questions remain.

3. Outline Elements of an Inspection in a Healthcare facility
Administrative Review
A sample of the elements reviewed:
Infection Prevention and Control
Pandemic Influenza Planning
Workplace Violence Prevention
Ergonomic Issues
Needle Safety
Physical Inspection
Enforcement
After the Inspection

4. The Ministry of Labour’s Role in Occupational Health and Safety
Set, communicate and enforce the Occupational Health and Safety Act (the “Act”) and associated regulations.
4 Programs:
- Industrial - 28 sectors (Healthcare)
- Construction
- Diving
- Mining

5. Role of the MOL Inspector
Enforcement of the Act and related regulations
Conduct:
Proactive inspections
Reactive investigations
Sanctions and Recommendation of prosecutions under the Act for contraventions

6. Process for Inspections
Unannounced/unscheduled
Components:
Administrative review
Consultation with workplace parties, worker health and safety representative, Joint Health and Safety Committee
Physical inspection of the workplace
Preparation and delivery of inspection findings in field visit report(s)
Sections:
Orders where there is a contravention with the legislation (Notice of Compliance Form issued)
Narrative (commentary)

7. Administrative Review
Internal Responsibility System – members, minutes, issues, monthly inspections
Copy of the Act and current Policy posted
Effective Programs and training, maintenance
MSDS and WHMIS training
Infection Prevention and Control Programs
Pandemic Planning and Response
Safety Engineered Medical Devices (SEMDs)
Workplace Violence Prevention Programs and Training
Musculoskeletal Disorders (MSDs)/Ergonomic Injuries - review of From 7s, recurring injuries, issues, actions to address issues

8. Infection Prevention and Control:
Written measures and procedures, developed in consultation with JHSC
Annually reviewed (or when new information available, for example MOHLTC Important Health Notices (IHNs))
Risk assessment to identify risk of exposure to blood, body fluids, infectious diseases or sharps injury

9. Infection Prevention and Control:
Implement control measures to reduce risk
Training and education of staff
Use of personal protective equipment
Reporting of occupational illnesses under s.52(2) of the Occupational Health and Safety Act

10. Pandemic Influenza Planning:
Regulation for Healthcare and Residential Facilities requires employers to have written measures and procedures for the control of infections
Written procedures dealing with Health and Safety of workers in the event of pandemic influenza
Consultation with the Joint Health and Safety Committee required
Worker training
Personal protective equipment
Training, proper use and maintenance, proper fit

11. Workplace Violence Prevention
Under the Occupational Health and Safety Act, all employers must take every precaution reasonable in the circumstances to protect the health and safety of their workers in the workplace. This includes protecting them against the risk of workplace violence.

12. Workplace Violence Prevention
Greater potential of risk of workplace violence in healthcare settings
Issue order for risk assessment where appropriate
Where risk assessment reveals a hazard, the employer is to establish and implement written measures and procedures for a violence prevention program, developed in consultation with JHSC
Annually reviewed (or when new information available)
Worker training

13. Ergonomic Injuries/MSD Initiative
Half of all work days lost are due to ergonomics-related injuries
Inspectors focus on workplace MSD at high-risk workplaces
Where appropriate, require employers to conduct risk assessments and implement programs where MSDs are prevalent.

14. Needle Safety Regulation (O. Reg. 474/07)
Comes into effect September 1, 2008
Applies to acute care facilities in Ontario.
It will mandate the use of safety-engineered hollow-bore needles and needle-less devices in hospitals.
Proposed amendment in the future that extends the requirements to other health care workplaces such as long term care homes
Currently, where a safety-engineered needle would be a reasonable precaution to protect a worker, an employer is required to provide for its use

15. Physical Inspection A walk through random areas of the facility
Physical hazards, such as slips/trips/falls, machine guarding, lock-out, storage of materials, lift devices
Personal Protective Equipment - eye, foot, skin, respirator, etc
WHMIS (Workplace Hazardous Material Information System) – labels, Material Safety Data Sheets (MSDSs) and worker education
Designated Substances

16. Enforcement Tools for Contraventions
Progressive Enforcement
Orders
Part I Offence Notice and Summons
Part III Summons

17. Enforcement Tools: Orders
Time-based (deadline)
Requirement (deadline)
Forthwith (complied with at the time of the field visit)
Compliance plan (deadline)
Stop work (effective immediately, no deadline)

18. Enforcement Tools - no prison time
Part I Offence Notice – schedule of offences
Part I Summons – court appearance with maximum fine of $500
- no prison time
Part III Summons
Individual
- court appearance with maximum fine of $25,000 per count and/or up to twelve months imprisonment
Corporation
- court appearance with maximum fine of $500,000 per count

19. After the Inspection
When the Inspector conducts the inspection and delivers the field visit report of the findings, ask questions.
If uncertain about how to comply with an Inspector’s order, the employer may wish to contact a Health and Safety Association for assistance or contact the MOL Inspector for further explanation.

20. After the Inspection
If a delay is anticipated in complying with an Inspector’s order - inform the MOL Inspector immediately.
If there is disagreement with an Inspector’s order, there is a 30-day time period (from the date the order was issued) during which to file an appeal of the order with the Ontario Labour Relations Board (OLRB).
For information about their firm’s Illness and Injury rates, a business should contact their WSIB Client Service Representative.

21. Questions?

22. Explanation of Orders:
The employer shall take every precaution reasonable in the circumstances for the protection of a worker.
An employer shall ensure that the equipment, materials and protective devices provided by the employer are maintained in good condition.
OHSA s.25(2)(h)
OHSA s.25(1)(b)

23. Explanation of Orders:
O.Reg. 67/93 s.9(1)
The employer shall reduce the measures and procedures for the health and safety
of workers established under section 8 to writing and such measures and procedures
may deal with, but are not limited to, the following:
1. Safe work practices.
2. Safe working conditions.
3. Proper hygiene practices and the use of hygiene facilities.
4. The control of infections.
5. Immunization and inoculation against infectious diseases.
6. The use of appropriate antiseptics, disinfectants and decontaminants.
7. The hazards of biological, chemical and physical agents present in the
workplace, including the hazards of dispensing or administering such agents.
8. Measures to protect workers from exposure to a biological, chemical or
physical agent that is or may be a hazard to the reproductive capacity of a
worker, the pregnancy of a worker or the nursing of a child of a worker.
9. The proper use, maintenance and operation of equipment.
10. The reporting of unsafe or defective devices, equipment or work surfaces.
11. The purchasing of equipment that is properly designed and constructed.
12. The use, wearing and care of personal protective equipment and its
limitations.
13. The handling, cleaning and disposal of soiled linen, sharp objects and waste.

24. Explanation of Orders:
O.Reg. 67/93 s.70(1)
O.Reg. 67/93 s.9(4)
O.Reg. 860/90 s.17(3)
When used outdoors or in wet locations, portable electrical tools shall be protected by a ground fault circuit interrupter installed at the receptacle or on the circuit at the electrical panel.
The employer, in consultation with and in consideration of the recommendation of the joint health and safety committee or health and safety representative, if any, shall develop, establish and provide training and educational programs in health and safety measures and procedures for workers that are relevant to the workers' work.
When a supplier material safety data sheet is 3 years old, the employer shall, if possible, obtain from the supplier an unexpired supplier material safety data sheet if any of the controlled product remains in the workplace.

25. Explanation of Orders:
OHSA s.25(2)(a)
OHSA s.25(2)(j)
O.Reg. 67/93 s.9(2)
OHSA s.57(4)
Without limiting the strict duty imposed by subsection (1), an employer shall provide information, instruction and supervision to a worker to protect the health or safety of the worker.
The employer shall prepare and review at least annually a written occupational health and safety policy and develop and maintain a program to implement that policy.
At least once a year the measures and procedures for the health and safety of workers shall be reviewed and revised in the light of current knowledge and practice.
An order made under subsection (1) may require a constructor, a licensee or an employer to submit to the Ministry a compliance plan prepared in the manner and including such items as required by the order.

26. Additional sources of material