RETAIL HEALTH AND SAFETY AUDIT

LOCATION: #REF!
D= Documentation (written policies, procedures, training programs/records,
STORE NUMBER: maintenance records, logs, instructions )
STORE MANAGER: S= Signage (warnings, operating instructions, posters)
INSPECTION DATE: MARCH 31, 2010 O= Observation(testing, observing work, looking at physical space)
AUDITOR: I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation

DELI/SALAD #REF! #REF! #REF! #REF! ### #REF!

1.1 #REF! #REF! ###
1.2 #REF! #REF! ###
1.3 #REF! #REF! ###

1.4 #REF! #REF! ###

1.5 #REF! #REF! ###
1.6 #REF! #REF! ###
2.1 #REF! OI ###
2.2 #REF! O ###
2.3 #REF! O ###

2.5 #REF! O ###

2.5 #REF! S ###
2.6 #REF! O ###

2.9 #REF! O ###

2.11 Guard on slicer installed and functioning OI ###
2.19 Gas cylinders (fountain pop) secured/chained to wall O ###
3.0 #REF! O ###
3.1 #REF! S ###
3.1 #REF! O ###
3.1 #REF! DO ###
3.2 Emergency Fire Plan Posted DI ###
3.2 #REF! S ###
3.3 #REF! OS ###
3.3 #REF! DO ###
3.3 #REF! DO ###
3.4 #REF! S ###

3.5 #REF! OI ###

3.6 #REF! OI ###
3.7 #REF! OI ###
3.8 #REF! O ###
3.9 #REF! S ###
3.10 PPE's being used & in good repair - oven mitts OID ###
3.10 PPE's being used & in good repair - 'cut resistant' gloves OID ###
3.10 PPE's being used & in good repair- goggle/gloves/apron OID ###
Region Specific Issues
###
###
Interview - use guide in descriptions

4.6 #REF! #REF! ###

4.7 #REF! #REF! ###
Lock/tag-out procedures implemented and training completed (should
4.11 include deli slicer). DI ###
Total Possible 36
TOTAL# COMPLIANT 0
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your
action plan as a priority.
Other (successes/concerns not addressed above)

Department Manager Name:

RETAIL HEALTH AND SAFETY AUDIT
LOCATION: #REF!
D= Documentation (written policies, procedures, training programs/records,
STORE NUMBER: maintenance records, logs, instructions )
STORE MANAGER: S= Signage (warnings, operating instructions, posters)
INSPECTION DATE: MARCH 31, 2010 O= Observation(testing, observing work, looking at physical space)
AUDITOR: I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation

RECEIVING/ BACK
ROOM/ GROCERY #REF! #REF! #REF! #REF! ### #REF!
1.1 Emergency lighting working (test if not hard wired) O/D ###
1.2 Cooler & freezer handles functioning O ###
1.3 Fans and lights in coolers/freezers guarded. All lights working. O ###
Department floor free of slip/trip hazards (work area, sales floor,
1.4 freezers/coolers) O ###
1.5 Emergency exits clear and security bar unlocked, exit signs installed SO ###
1.6 Electrical panels accessible, unobstructed and properly labeled O ###
Pallets properly stored (i.e. not leaning, securely stacked) both inside
1.7 and outside of store. O ###
Cardboard bales stored on sturdy wooden pallets and are not stacked
(Note: in workplaces with very limited storage space, bales may be
1.8 stacked two high) OS ###
Trash compactor is tidy, has proper signage, and functions properly
(including inter-lock and emergency stop button). Employees trained in
1.9 safe use. DSOI ###
Cardboard baler is tidy, has proper signage, and functions properly
(including inter-lock and emergency stop button). Employees trained in
1.10 safe use. DSOI ###
Power operated mobile equipment in safe operating condition, and
1.11 signed (only trained personnel permitted to use) OSI ###
2.1 Only grade 1 or 2, CSA approved, ladders/step ladders used. OI ###
2.6 Proper electrical cords being used (power bar for temporary use) O ###
2.7 Top of coolers/freezers free of product, fenced off, and signed SO ###
2.9 Only case cutters that limit blade extensions used to open boxes/strapping. OI ###
Racking (back room and sales floor) in good repair, secure, and,
2.14 shelving is secure OI ###
Propane tanks not stored inside store (propane may be used by BBQ/forklift/
2.15 floor cleaner) OI ###
2.16 Receiving - wheel chocks being used at all times OIS ###
2.16 - truck engines shut off while at receiving dock OIS ###
2.17 Loading dock free of debris O ###
2.18 Receiving door and ramp in good condition OI ###
2.19 Gas cylinders in compressor room secured/chained to wall O ###
2.23 Product in back room stored properly/safely OI ###
Electrical room - free of clutter, not used for storage, door locked, and
2.26 has Danger High Voltage sign affixed to door. SO ###
Compressor room - free of clutter, not used for storage, door locked,
2.27 and has Danger High Noise Level sign affixed to door. SO ###
2.28 Displays/product on sales floor, at least 36" high (to prevent trip hazard) OI ###
2.30 Mop and cleaning area well maintained O ###
2.34 Carts/u-boats in good repair - check wheels, handles, beds O ###
2.35 Doors working properly O ###
3.0 At least 18" clearance for all sprinkler heads O ###
3.1 Fire extinguisher marked (sticker/sign highlighting its location) S ###
3.1 - accessible (not blocked) O ###
3.1 - charged and checked monthly (check tag for verification) DO ###
3.2 Emergency plan available - "Sobeys Emergency Response Plan" DI ###
3.2 - Store schematic current/posted, showing emergency items/exits S ###
3.3 First aid kit - free of medications/unauthorized items OS ###
3.3 - inspected monthly using checklist DO ###
3.3 - first aid log being used and located in kit DO ###
3.4 Names of employees trained in first aid posted S ###
Chemical bottles/containers properly labeled (with Supplier or Workplace
3.5 labels) OI ###
3.6 Only authorized cleaning products being used OI ###
3.7 MSDS sheets posted/accessible and current OI ###
3.9 Emergency phone numbers posted S ###
3.11 15 minute eye wash flush O ###
3.12 Steel toe safety shoes worn by store's Receiver O/I ###
Power mobile equipment lift capacity tested annually - verify
3.13 documentation D ###
Region Specific Issues
###
###
Interview - use guide in descriptions

4.1 #REF! #REF! ###

4.2 #REF! #REF! ###

4.5 #REF! #REF! ###

4.6 #REF! #REF! ###

4.7 #REF! #REF! ###
4.8 Checklist completed daily- high lift DI ###
4.8 Checklist completed daily- power jack DI ###
4.9 Ladders inspection completed weekly D ###
4.10 Lift/power mobile equipment operators trained DO ###
4.11 Lock/tag-out procedures implemented and training completed. DI ###
Total Possible 56 ###
TOTAL# COMPLIANT 0
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your
action plan as a priority.
Other (successes/concerns not addressed above)

Department Manager Name:

RETAIL HEALTH AND SAFETY AUDIT
LOCATION: #REF!
D= Documentation (written policies, procedures, training programs/records,
STORE NUMBER: maintenance records, logs, instructions )
STORE MANAGER: S= Signage (warnings, operating instructions, posters)
INSPECTION DATE: MARCH 31, 2010 O= Observation(testing, observing work, looking at physical space)
AUDITOR: I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation

MEAT #REF! #REF! #REF! #REF! ### #REF!

1.1 Emergency lighting working (test if not hard wired) O/D ###
1.2 Cooler & freezer handles functioning O ###
1.3 Fans and lights in coolers/freezers guarded. All lights working. O ###
1.4 Department floor free of slip/trip hazards (work area, sales floor, freezers/coolers) O ###
1.5 Emergency exits clear and security bar unlocked, exit signs installed SO ###
1.6 Electrical panels accessible, unobstructed and properly labeled O ###
2.1 Only grade 1 or 2, CSA approved, ladders/step ladders used. OI ###
2.2 Knives stored properly & in good condition O ###
2.3 Teflon pad on wrapping machine in good repair O ###
Machines/equipment in good repair and guarded to prevent access to
2.5 moving parts O ###
2.5 - Equipment/machinery has legible "safe use instructions" signage S ###
2.6 Proper electrical cords being used (power bar for temporary use) O ###
2.9 Only case cutters that limit blade extensions used to open boxes/strapping. O ###
2.11 Guard on slicer installed and functioning OI ###
2.12 Guide on meat saw being used and functioning OI ###
2.13 Guard/inter-lock on grinder installed/functioning OI ###
3.0 At least 18" clearance for all sprinkler heads O ###
3.1 Fire extinguisher marked (sticker/sign highlighting its location) S ###
3.1 - accessible (not blocked) O ###
3.1 - charged and checked monthly (check tag for verification) DO ###
3.2 Emergency plan available - "Lococos Emergency Response Plan" DI ###
3.2 - Store schematic current/posted, showing emergency items/exits S ###
3.3 First aid kit - free of medications/unauthorized items OS ###
3.3 - inspected monthly using checklist DO ###
3.3 - first aid log being used and located in kit DO ###
3.4 Names of employees trained in first aid posted S ###

3.5 Chemical bottles/containers properly labeled (with Supplier or Workplace labels) OI ###
3.6 Only authorized cleaning products being used OI ###
3.7 MSDS sheets posted/accessible and current OI ###
3.8 Eye wash bottle accessible/current O ###
3.9 Emergency phone numbers posted S ###
3.10 PPE's being used & in good repair- goggles at knife sharpener OID ###
3.10 PPE's being used & in good repair- metal mesh glove OID ###
3.10 PPE's being used & in good repair - goggles/gloves/apron OID ###
Region Specific Issues
###
###
Interview - use guide in descriptions

#REF! ###

#REF! ###
4.5 #REF! #REF! ###

4.6 #REF! #REF! ###

4.7 #REF! #REF! ###
Lock/tag-out procedures implemented and training completed (should
4.11 include saw/slicer/grinder). DI ###
Total Possible 38 ###
TOTAL# COMPLIANT 0
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your
action plan as a priority.
Other (successes/concerns not addressed above)

Department Manager Name:

RETAIL HEALTH AND SAFETY AUDIT
LOCATION: #REF!
D= Documentation (written policies, procedures, training programs/records,
STORE NUMBER: maintenance records, logs, instructions )
STORE MANAGER: S= Signage (warnings, operating instructions, posters)
INSPECTION DATE: MARCH 31, 2010 O= Observation(testing, observing work, looking at physical space)
AUDITOR: I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation

PRODUCE #REF! #REF! #REF! #REF! ###

1.1 Emergency lighting working (test if not hard wired) O/D
1.2 Cooler & freezer handles functioning O
1.3 Fans and lights in coolers/freezers guarded. All lights working. O

1.4 Department floor free of slip/trip hazards (work area, sales floor, freezers/coolers) O
1.5 Emergency exits clear and security bar unlocked, exit signs installed SO
1.6 Electrical panels accessible, unobstructed and properly labeled O
2.1 Only grade 1 or 2, CSA approved, ladders/step ladders used. OI
2.2 Knives stored properly & in good condition O
2.3 Teflon pad on wrapping machine in good repair O
2.6 Proper electrical cords being used (power bar for temporary use) O
2.9 Only case cutters that limit blade extensions used to open boxes/strapping. O
2.28 Displays/product on sales floor, at least 36" high (to prevent trip hazard) OI
2.24 Approved knives being used in the Produce department OID
2.25 Anti-slip mats at Produce counters visible and being used. O
3.0 At least 18" clearance for all sprinkler heads O
3.1 Fire extinguisher marked (sticker/sign highlighting its location) S
3.1 - accessible (not blocked) O
3.1 - charged and checked monthly (check tag for verification) DO
3.2 Emergency plan available - "Lococos Emergency Response Plan" DI
3.2 - Store schematic current/posted, showing emergency items/exits S
3.3 First aid kit - free of medications/unauthorized items OS
3.3 - inspected monthly using checklist DO
3.3 - first aid log being used and located in kit DO
3.4 Names of employees trained in first aid posted S
Chemical bottles/containers properly labeled (with Supplier or Workplace
3.5 labels) OI
3.6 Only authorized cleaning products being used OI
3.7 MSDS sheets posted/accessible and current OI
3.8 Eye wash bottle accessible/current O
3.9 Emergency phone numbers posted S
3.10 PPE's being used & in good repair- 'cut resistant' gloves (trimming) OID

Interview - use guide in descriptions

4.5 #REF! #REF!

4.6 #REF! #REF!

Total Possible 32
TOTAL# COMPLIANT 0
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your action
plan as a priority.
Other (successes/concerns not addressed above)

Department Manager Name: JEREMY PERRIN

 #REF!
es, procedures, training programs/records,
ctions )
instructions, posters)
g work, looking at physical space)
ask questions, demonstrate)
ant/N/A column for tabulation

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highlighted items MUST be reflected in your action

RETAIL HEALTH AND SAFETY AUDIT
LOCATION: #REF!
D= Documentation (written policies, procedures, training programs/records,
STORE NUMBER: maintenance records, logs, instructions )
STORE MANAGER: S= Signage (warnings, operating instructions, posters)
INSPECTION DATE: MARCH 31, 2010 O= Observation(testing, observing work, looking at physical space)
AUDITOR: I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation
Front
End/Offices/
Lunchroom #REF! #REF! #REF! #REF! ### #REF!
1.1 Emergency lighting working (test if not hard wired) O/D ###
1.4 Department floor free of slip/trip hazards O ###
1.5 Emergency exits clear and security bar unlocked, exit signs installed SO ###
2.1 Only grade 1 or 2, CSA approved, ladders/step ladders used. OI ###
2.6 Proper electrical cords being used (power bar for temporary use) O ###
2.19 Gas cylinders secured/chained to the wall O ###
2.20 Cashiers ensure bleach bottle caps secure - ask cashier if needed O/I ###
2.21 Buggies/shopping carts in good working order O ###
2.22 Sidewalks/parking lot/cart corral in good repair - check for trip hazards O ###
2.25 Anti-slip mats at entrances visible and being used. O ###
2.32 Stairways clear, handrails secure, and stair treads in good condition OS ###
2.33 Anti-fatigue mats present and in good condition at each check-out. O ###
2.35 Doors operating properly O ###
3.0 At least 18" clearance for all sprinkler heads O ###
3.1 Fire extinguisher marked (sticker/sign highlighting its location) S ###
3.1 - accessible (not blocked) O ###
3.1 - charged and checked monthly (check tag for verification) DO ###
3.1 O ###
3.2 Emergency plan available - "Lococos Emergency Response Plan" DI ###
3.2 - Store schematic current/posted, showing emergency items/exits S ###
3.3 First aid kit - free of medications/unauthorized items OS ###
3.3 - inspected monthly using checklist DO ###
3.3 - first aid log being used and located in kit DO ###
3.4 Names of employees trained in first aid posted S ###
Chemical bottles/containers properly labeled (with Supplier or Workplace
3.5 labels) OI ###
3.6 Only authorized cleaning products being used OI ###
3.7 MSDS sheets posted/accessible and current OI ###
3.9 Emergency phone numbers posted S ###
PPE's being used & in good repair (i.e. reflective vest being worn when
3.10 working outside the building) OID ###
Interview - use guide in descriptions

4.6 #REF! #REF! ###

Robbery Prevention/Response Training completed. Employees
4.12 (including cash office staff) able to explain associated procedures. DI ###
Region Specific Issues
###
###
Total Possible 31 ###
TOTAL# COMPLIANT 0
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your
action plan as a priority.
Other (successes/concerns not referenced above)

Department Manager Name:

Provide information/feedback on cashier work station:

RETAIL HEALTH AND SAFETY AUDIT

#REF! #REF!
D= Documentation (written policies, procedures, training programs/records,
#REF! maintenance records, logs, instructions )
#REF! S= Signage (warnings, operating instructions, posters)
#REF! O= Observation(testing, observing work, looking at physical space)
#REF! I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation
Front-end/
JH&SC/ H&S
Station #REF! #REF! #REF! #REF! ### #REF!
H&S Board
5.1 Government inspections posted O X ###
5.2 Most current month's JH&SC Meeting Minutes posted O X ###
5.3 Most current month's JH&SC Workplace Inspections posted O X ###
5.4 Health & Safety Act posted O x ###
5.5 Lococos H&S Policy posted S X ###
5.6 Names of employees trained in first aid posted S X ###
5.7 Emergency plan available - "Lococos Emergency Response Plan" D X ###
5.7 - Store schematic current/posted, showing emergency items/exits S X ###
5.8 WHMIS information (i.e. symbol poster) posted on/near Board S X ###
5.9 MSDS sheets posted/accessible and current O X ###
5.10 Safety Committee Member names posted S X ###
5.11 Emergency phone numbers posted S X ###
Region Specific Issues

###
JH&SC DESCRIPTION
6.1 Representation is in compliance with legislation D/I X ###
6.2 Certification/training in compliance with Provincial Regulations D X ###
6.3 Meetings held monthly D X in need of first meeting
Store safety inspection conducted monthly. Inspection involves a
6.4 JH&SC worker member D/I X first inspection
Review all "old/outstanding business" at each meeting, identify
6.5 outstanding issues D X x ###
6.6 Review government inspector visit reports/orders D x ###
Review accident investigations & recommend ways to prevent
6.7 recurrence. D X ###
6.8 Prepare recommendations to improve workplace safety D X ###
Interview JH&SC member(s) re: how Committee promotes safety at the
6.9 store. OI X ###
Total Possible 18 ###
TOTAL# COMPLIANT 13
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your
action plan as a priority.
Other (successes/concerns not addressed above)

Department Manager Name:

RETAIL HEALTH AND SAFETY AUDIT
LOCATION: #REF!
D= Documentation (written policies, procedures, training programs/records,
STORE NUMBER: maintenance records, logs, instructions )
STORE MANAGER: S= Signage (warnings, operating instructions, posters)
INSPECTION DATE: MARCH 31, 2010 O= Observation(testing, observing work, looking at physical space)
AUDITOR: I = Interview/speak to employee (ask questions, demonstrate)
DEPARTMENT Place an "X" under the Compliant/Non-compliant/N/A column for tabulation

Administration/
Management #REF! #REF! #REF! #REF! ### #REF!
Store Mgr. ensures department safety inspection conducted weekly
7.1 and issues requiring attention are addressed D ###
7.2 WHMIS - all employees trained annually D ###
7.3 Management replies to all JH&SC recommendations within 21 days D ###
7.4 Annual fire drill conducted D ###
7.5 Approved Fire Plan available, implemented and training completed. D ###
Emergency plan and associated training completed. Training & plan
7.6 documentation available DI ###
Employees trained in first aid, training is current, and sufficient number
7.8 of persons trained D ###
Issues raised at JH&SC meetings reviewed and, as appropriate, acted
7.9 on. DI ###
Management offers modified work to injured employees. Available
modified duties suitable to accommodate reasonably expected physical
7.10 restrictions. DI ###
7.11 Copies of JH&SC Minutes/Inspections on file for 2 years D ###
7.12 Workplace injuries/illnesses reported immediately (no late fees) D ###
7.13 Employees disciplined for unsafe work practices D ###
Outside contractors/subcontractors have Workers' Compensation
7.14 coverage ID ###
7.15 Safety issues reviewed during dept. meetings D ###
Management investigates workplace accidents resulting in
injury/illness. Accident investigation findings used to implement
7.16 preventative measures. Records maintained for 2 years. DI ###
Employees receive safe materials handling procedures training. New
employees provided training before beginning work. Training records
7.17 available. DI ###
Equipment/machinery/building maintenance and repair records
7.18 available for review. Records maintained 2 years D ###
Interview Store Manager, asking the following questions. Appropriate answers noted in "bold" in Descriptions Section.
9.1 How are employees informed of workplace hazards? ID ###
9.2 How do you ensure employees are trained in safe work practices? ID ###
9.3 How do you respond to a serious injury? I ###
How are accidents investigated and what actions are taken once
9.4 investigation completed? ID ###
9.5 How do you promote workplace safety? I/D ###
How do you ensure employees are trained prior to being assigned a
9.6 new task? I ###
What do you do when new equipment/machinery is installed/delivered
9.7 to the store? I ###
9.8 How do you ensure equipment/machinery is in proper working order? I/D ###
9.9 How are Safety Alerts communicated/acted on? I/D ###
What are contractor/subcontractor responsibilities?.... What do you do
9.10 if they perform work unsafely? I ###
9.11 How do you support work of JH&SC? I/D ###
Do employees/contractors work above 3 meters (10 feet)? If "yes",
9.12 what fall protection equipment and training is provided/required? I/D ###
9.13 Who is on modified work and what are their modified duties? I/D ###
9.14 Who is on a Workers' Compensation claim? I/D ###
What are the financial costs of Workers' Compensation claims and late
9.15 accident reporting? …. What impact have they had on your store? I ###
Region Specific Issues ###
###
###
Total Possible 32 ###
TOTAL# COMPLIANT 0
*Any shaded non-compliant item has been identified as a high priority item and requires immediate attention. Each of these highlighted items MUST be reflected in your
action plan as a priority.
Other (successes/concerns not addressed above)
 RETAIL HEALTH AND SAFETY AUDIT SUMMARY

LOCATION:
STORE NUMBER:
STORE MANAGER:
INSPECTION DATE: MARCH 31, 2010
AUDITOR:

Number of Items
Department Compliant
DELI 0
GROCERY + 0
MEAT 0
PRODUCE 0
FRONT END, JH&SC, BOARD 13
ADMINISTRATION 0
TOTAL # COMPLIANT 13

POSSIBLE TOTAL (subtract NA's) 243

PERCENTAGE COMPLIANT 5.35%

AUDIT HIGHLIGHTS (completed by
auditor)
The following summary highlights particularly
noteworthy positive or negative audit findings.

Note:
You are required to review this
audit with the JH&SC and
Department Managers and to
keep a record (i.e. minutes of
meetings, signatures on store
copy of audit) confirming that
they have reviewed the audit.
 RETAIL HEALTH AND SAFETY AUDIT
Method of Auditing each item:
D= Documentation (written policies, procedures, training programs/records, maintenance records, logs, instructions )
S= Signage (warnings, operating instructions, posters)
O= Observation(testing, observing work, looking at physical space)
I = Interview/speak to employee (ask questions, demonstrate)

Item # CRITERIA for EVALUATING COMPLIANCE

Section 1
1.1 Emergency lighting - can be tested if not hard wired. If hard wired, determine date of last system test.
1.2 Handles on coolers/freezers should be operational on both sides. Check to ensure not damaged
1.3 All fans and lights in coolers/freezers have a guard/cover. Check to ensure all lights working.
1.4 Back room, cooler/freezer, sales floor free of slip/trip/fall hazards (i.e. garbage, debris, boxes, broken/cracked flooring, water/ice, grease)
Emergency exits have: functioning, illuminated signs; clear/easy access; and, unlocked security bars. Nothing blocking/stored in front of, or
1.5 behind, exit doors.
1.6 Electrical panels closed, accessible, unobstructed, and correctly/legibly labeled.
1.7 Pallets are properly stored (i.e. not leaning, not too high). Check inside and outside of the store.
Cardboard bales are: placed on sturdy wooden pallets that are in good repair; properly balanced on the pallet; are not stacked (note: stores with
very limited storage space may stack bales to a maximum of two high); and, are not stored near a heat source. A sign is posted in an appropriate
1.8 area of the backroom reminding employees of these requirements.
Trash compactor: is tidy; has "Do not operate unless trained" and "safe operating instructions" signs affixed; and, functions properly (including its
interlock device and emergency stop button). Test machine to confirm it is functioning properly. Review training records. Employees should be
1.9 able to describe safe compactor operating procedures.
Cardboard baler: is tidy: has "Do not operate unless trained" and "safe operating instructions" signs affixed; and, functions properly (including its
interlock device and emergency stop button). Test machine to confirm it is functioning properly. Review training records. Employees should be
1.10 able to describe safe cardboard baler operating procedures.
Confirm power operated mobile equipment is in safe operating condition. And has sign affixed stating that "Only trained and authorized
1.11 personnel permitted to use it". Ask operator for feedback re: operational soundness of this equipment.
Section 2
Only grade 1 or 2, CSA approved, ladders/step ladders used (no plastic step stools or milk cartons). Employees should confirm only approved
2.1 ladders/step ladders used.
2.2 Knives stored in holders when not in use (not left on counters). Knives in good condition, sharp, and appropriate for intended use.
2.3 Burn hazard - Teflon pad should be free of rips/tears. There should not be any exposed metal.
Mixer is equipped with a properly functioning, inter-locked guard. Employees should be able to explain (or demonstrate) safe mixer operating
2.4 procedures.
Equipment/machinery is in good repair, guarded to prevent access to moving parts and, has legible "safe use instructions" signage affixed/posted.
2.5
2.6 Proper electrical cords being used (power bar for temporary use). Check to confirm cords are in good repair.
Tops of coolers/freezers: not used for storage(unless there is documentation to confirm that a particular unit was specifically designed and
2.7 constructed for product storage purposes); are fenced off; and, have "No Storage/Access" sign affixed.
Only case cutters that limit blade extensions are used to cut boxes, strapping or shrink wrap. Knives and other cutting tools that do not permit the
2.9 user to limit the amount of blade exposed are not used for cutting boxes, strapping, shrink wrap.
2.11 Guard on slicer installed and functioning properly. Employees should be able to explain (or demonstrate) safe slicer operating procedures.
Guide on meat saw being used and saw functioning properly. Employees should be able to explain (or demonstrate) safe saw operating
2.12 procedures.
Guard/inter-lock on grinder installed and functioning properly. Employees should be able to explain (or demonstrate) safe grinder operating
2.13 procedures.
Back room and sales floor racking in good repair - safety pins in place and/or beams bolted, all parts in good condition, beam brackets are
properly engaged, posts in good condition (no corrosion/dents), unit is secure. Employees should be asked if there are any known issues of
2.14 concern regarding the stores' racking.
Propane tanks are not permitted to be stored inside the building (propane may be used for BBQ's, floor cleaners, forklift). Employees should be
2.15 asked to confirm propane not stored inside of the store and, where applicable, appropriate storage facilities exist outside of the building.
Receiving Area - wheel chocks are available. Store Receiver confirms chocks being used and trucks' engines turned off while parked at dock.
Signs posted inside and outside the receiving dock area noting requirements to use chock wheels and turn off engine. Receiver should be able to
2.16 explain procedures followed if driver fails to use chocks or turn off engine.
2.17 Loading dock free of debris, no damaged equipment.
Receiving door and ramp in safe operating condition. Inspect ramp for obvious signs of damage. Arrange to have the door opened and closed to
2.18 confirm it is operating properly.
2.19 Gas cylinders (i.e. fountain pop machine, helium, etc ) are secured to prevent from being knocked/tipped over.
2.20 Cashiers handle bleach bottles correctly (i.e. they secure bottle cap). If possible, observe this practice.
Buggies/shopping carts in good working order. Randomly check carts for damage that may injure employee/customer (i.e. review condition of
2.21 wheels, look for any broken/protruding objects, confirm "seat belts" are properly installed (not tied on)).
2.22 Sidewalk/parking lot/cart corral free of slip/trip hazards (i.e. uneven, broken, or cracked pavement/concrete).
Product stored in a safe manner - loads are stacked at a height and in a manner that permits safe handling/product retrieval. Pallets on top rack
levels have loose items secured by shrink wrap or strapping to prevent product from falling. No double stacking of loaded pallets on top level
2.23 racking. Employees should be able to explain proper product stacking/storage/handling procedures.
Approved knives available and used in Produce Department. Employees use proper knife for the job. Documentation is available confirming
2.24 employees instructed on this issue. Employees should be able to explain which knives they use, for what purpose, and safe use procedures.
2.25 Anti-slip mats are located at each entrance and in the Produce and Seafood Departments.
2.26 Electrical room: not used as storage area; floor free of debris; has "Danger High Voltage" sign on door; and, door is locked.
2.27 Compressor room: not used as storage area; floor free of debris; has "Danger High Noise Level" sign on door; and, door is locked.
2.28 Displays at least 36" in height to prevent creating trip hazard. Employees should be able to confirm their awareness of this requirement.
2.30 Mop/cleaning area well maintained - MSDS's available, chemicals labeled, buckets emptied
2.32 Stairways clear, handrails secure, and stair treads in good condition. Stairway hazard sign posted.
2.33 Anti-fatigue mats present and in good condition at each check-out.
2.34 Carts/u-boats in good repair. Check wheels, handles, and beds.
2.35 Doors operating properly
Section 3
3.0 Products not be stored closed than 18" from sprinkler heads.
Ensure fire extinguisher is: charged (arrow in green area); tagged; pin in place; checked monthly; is accessible (not blocked); and, has sticker/sign
3.1 to highlight/identify its location.
Current "Sobeys Emergency Response Plan" and store schematic exist and are posted in each department. Employees should be able to explain
3.2 emergency response procedures and actions to be taken in different types of emergency situations (i.e. medical, fire, bomb threat).
JH&SC: checks first aid kits monthly& initial inspection card; ensure first aid logs are being completed; ensure kits free of pills/medications and
3.3 contain a sign stating "No pills/medication permitted in First Aid Kit".
Names of first aid trained employees posted in each department. The First Aiders' list is current (i.e. training still valid, first aiders listed still work
3.4 at the store).
All chemical containers are labeled with a Supplier or Workplace label and employees able to explain chemical container labeling requirements.2
3.5 Safely discard unlabeled chemical containers/bottles.
Only authorized cleaning products being used (no "off the shelf" products). MSDS's for each of the products are easily accessible. Employees
3.6 should be able to explain the purpose of MSDS's and where the MSDS's for cleaning products used are located.
3.7 MSDS's are: current (prepared less than 3 years ago); and, easily accessible (employees should be able to locate MSDS's).
3.8 Eye wash bottle accessible (not blocked/covered with product). There is a clear path to bottle. The date on bottle is current and the bottle is full.
3.9 Emergency #'s are posted, legible & current in each department. Should be posted near the department phone.
Confirm PPE in dept. is: appropriate for the type of work performed; available; used; and, in good repair. Employees should be able to explain
what PPE is used in the dept., for what tasks, and how it is used. Documentation (department and/or WHMIS training records) should exist that
3.10 notes requirement to use PPE when performing specific tasks.
15 minute eye wash flush located in appropriate location (based on location of potential chemical hazards). The unit is accessible and full. Test to
3.11 ensure it is functioning properly.
3.12 Steel toe safety shoes worn by store's Receiver. Confirm this with Receiver if unable to confirm visually.
Power mobile equipment lift capacity tested annually. Documentation (i.e. maintenance records, sticker/signature on equipment) confirming
3.13 testing date available for review.
Sharps container handled/stored/disposed properly. Pharmacy staff should be able to explain proper procedures for handling/storage/disposal of
3.15 "sharps containers".
"Universal Precautions" are followed by Pharmacy staff (including: infection control/sanitation procedures; use of PPE's; proper hand washing
techniques). Pharmacy staff should be able to explain how they apply "Universal Precautions" in their work setting. Documentation should be
3.16 available confirming employees have received "Universal Precautions" instructions.
Section 4

Interview employees using open-ended questions to establish level of knowledge on the following issues. Employees should be able to: a)
describe hazards that exist in department and how they protect themselves against the hazard(s); b) explain procedures to follow if they observe a
hazardous situation; c) describe proper materials handling procedures for tasks associated with their responsibilities; d) describe what to do if
4.1 injured at work; e) explain what to do in an emergency; and, where applicable, f) proper knife handling procedures.
Interview Department Managers using open-ended questions to establish competencies in the following areas: Dept. Managers should be able
to: a) describe the hazards that exist in their department; b) explain how employees are informed of the hazards; c) describe how they control
hazards; d) explain what to do in case of emergency; e) describe how their employees are trained in emergency response, accident reporting,
hazard reporting, and safe materials handling procedures; f) describe actions taken when new equipment/machinery brought into department; g)
provide overview of their health & safety and accident reporting responsibilities; and, h) describe measures he/she takes to maintain a safe
4.2 workplace.
4.5 Sweep log - confirm completed daily. Need to have copies going back 2 years.
4.6 Documented safety inspection of department (including equipment/machinery) completed weekly and kept on file for 2 years. .
Department training booklet is available and complete in each department. All new employees have been trained and signed the training record.
4.7 Employees should be able to describe the training provided and how they use the training when performing their duties.
Documented safety inspection of stacker/power jack completed daily. Power Equipment Operators should be able to describe inspection
procedures followed and steps taken when a hazard/defect is identified. Work orders confirming deficiencies identified through inspections have
4.8 been completed should be available for review. Inspections records are maintained for 2 years.
4.9 Ladder condition inspected weekly and documented. Documentation should be available confirming deficiencies identified are corrected.
All lift/power equipment operators trained. Training conducted by competent instructor and included both theory and practical elements. The
training has been completed within past 2 years. Training documentation is available for review. Operators observed following safe equipment
4.10 handling procedures.
Lock/tag-out training completed. Documentation of lock/tag-out procedures and training available for review. Employees and management
should be able to identify: equipment/machinery that needs to be locked/tagged-out; procedures to follow; and, equipment to use when
4.11 locking/tagging-out equipment/machinery.
Employees, including new employees, have received Robbery Prevention/Response training. Training records available confirming training has
4.12 taken place. Employees should be able to describe procedures to follow to prevent/respond to a robbery situation.
Section 5
5.1 Recent government inspections posted at the H&S Station.
5.2 H&SC's most recent minutes posted.
5.3 H&SC's most recent workplace inspection posted.
5.4 Copy of the Occupational Health & Safety Act posted at the H&S Station.
5.5 Current copy of the Sobeys National H&S Policy posted (expires after 1 year).
5.6 Current list of employees trained in first aid posted at H&S Station.
5.7 Current "Sobeys Emergency Response Plan" and store schematic posted at the H&S Station.
5.8 WHMIS information posted on/near the H&S Station.
MSDS booklet containing current MSDS's for all of the store's controlled products is located at/near the H&S Station. All MSDS's need to have
5.9 been prepared less than three years ago.
5.10 JH&SC - names posted at the H&S Station.
5.11 Emergency #'s are posted & current.
Section 6
6.1 JH&SC representation is in compliance with legislation. Confirm with Committee Co-chair if necessary.
6.2 Certification/training is in compliance with Provincial Regulations. Documentation confirming certification/training should be available for review.
6.3 Meetings are held monthly, minutes being completed, majority attendance. Records of meetings maintained for 2 years and available for review.
The JH&SC conducts a documented workplace safety inspection monthly, worker member of Committee involved in inspection. Records of
6.4 inspections maintained for 2 years and available for review. Confirm with Committee Co-chair if necessary.
6.5 The JH&SC reviews "old/outstanding" business at each meeting. Minutes confirm that Committee's review of "old/outstanding" items.
6.6 The JH&SC reviews recent government H&S inspections/orders. Committee minutes confirm their review of these items.
6.7 Review accident investigations and make recommendations to prevent recurrence. Committee minutes confirm their actions in this regard.
6.8 Committee makes recommendations to improve workplace safety. Minutes confirm Committee's activities in this regard.
The JH&SC promotes a safe workplace through involvement in related activities (i.e. safety talks, department meetings, creating newsletters,
6.9 training, safety awareness initiatives). Materials used/developed to promote safety should be available for review.
Section 7
Store Mgr. ensures dept. safety inspections conducted weekly and acts to support department manager to address issues identified as requiring
7.1 attention. Documentation is available to confirm these activities.
7.2 WHMIS - all employees trained annually. All new hires provided this training before they begin work. Record of training available for review.
7.3 Management replies to all JH&SC recommendations within 21 days. Written responses are available for review.
7.4 Annual fire drill conducted and documented, as per Fire Plan. Record of fire drill available for review.
Store has a Fire Plan, approved by the Fire Dept, that is current, includes training and is located in designated spot (the Fire Plan will state this
7.5 area). Copy of the approved Fire Plan and training records available for review.
Emergency plan (from Sobeys "Emergency Response" booklet) and associated employee training completed. Plan and training documentation
7.6 available for review.
Employees trained in first aid in accordance with Regulations. Training is current. Store has sufficient number of persons trained to ensure at
7.8 least one first aider is present during all shifts.
Store Manager reviews, considers and, as appropriate, acts on issues raised (other than recommendations noted in 7.3) through JH&SC
7.9 meetings and workplace inspections. Record of actions taken available for review.
Management offers modified work to injured employees. Available modified duties suitable to accommodate physical restrictions an employee
7.10 can reasonably be expected to have following a workplace injury. Record of modified work offered to employees available for review.
Store Manager keeps copies, for 2 years, of JH&SC minutes/inspections and her/his responses to their recommendations and actions she/he has
taken to review, consider, and/or address issues raised through JH&SC's minutes and workplace inspections. This documentation available for
7.11 review.
7.12 All workplace injuries/illnesses reported promptly and properly. The store has not received Workers' Compensation late accident reporting fines.
7.13 Employees are disciplined for unsafe work practices. Documentation is available for review.
All Contractors/Subcontractors used at/by the store have current Workers' Compensation coverage. Documentation is available confirming that all
7.14 contractors hired directly by the store have current Workers' Compensation coverage.
7.15 Management reviews safety issues during dept. meetings. Documentation of issues discussed (i.e. notes, meeting minutes) available for review.
Management investigates all workplace accident resulting in injury/ illness. Accident investigation findings used to implement measures to
prevent, or reduce the risk of, recurrence of injury/illness. Documentation of accident investigations and preventative actions available for review.
7.16 Records maintained for 2 years.
All employees have received safe materials handling procedures training. New employees provided this training before they begin work. Training
7.17 records available for review. Both managers and employees able to describe safe materials handling procedures.
Equipment/machinery/building maintenance and repair records available for review. Items that may have maintenance or repair work performed
7.18 include: equipment/machinery: fire prevention/response system: back-up lighting. Records are maintained for 2 years
Section 8
8.1 Garden Centre - free of slips/trips/falls hazards (i.e. hoses, pallets, debris, plants)
Section 9 Interview Store Manager, asking the following questions. Appropriate answers include "bolded" comments below.
How are employees informed of workplace hazards? Manager should be able to describe actions taken to inform employees of workplace
9.1 hazards and, as appropriate, be able to provide supporting documentation.

How do you ensure employees are trained in safe work practices? Manager should be able to describe the system in place at the store to ensure
9.2 that all employees are trained in safe work practices and provide documentation to confirm the system functions effectively.
How do you respond to a serious injury? Manager should be able to identify the steps to follow, and persons to contact, in the event of a serious
workplace injury (i.e. medical attention for injured person, protecting the accident scene, notifying supervisor and H&S dept, accident
9.3 investigation, notifying H&S Committee).

How are accidents investigated and what actions are taken once investigation completed? Manager should be able to describe: actions taken to
investigate accidents (i.e. interviewing parties involved, examining equipment/machinery); when investigation should take place (i.e. as soon as
safely possible after the occurrence); who is involved in the accident investigation (i.e. department manager, member of H&S Committee); and,
actions taken following completion of an investigation (i.e. informing employees that may be exposed to similar hazards, implementing measures
to prevent recurrence, notifying the H&S Committee, notifying H&S Dept.). Documentation is available confirming accident investigation
9.4 procedures described are followed.
How do you promote workplace safety? Manager should be able to describe actions he/she has taken to promote workplace safety. Supporting
9.5 documentation should be available for review.
How do you ensure employees are trained prior to being assigned a new task? Manager should be able to describe the system in place to
ensure employees trained before being assigned new tasks. Confirmation of system effectiveness should be confirmed through discussions with
9.6 employees.

What do you do when new equipment/machinery is installed/delivered to the store? Manager's response should include: inspecting item ensuring
properly installed and its placement does not create hazard for employees/customers; having item tested to ensure functions properly; ensuring
owner's manual provided; confirming safe operating signage affix on, or if appropriate, posted at location visible to operator; confirming item
equipped with guards and/or other safety devices that prevent employees from accessing moving parts or other potentially hazardous elements;
identifying hazards associated with the item; ensuring processes (i.e. guarding, use of PPE) in place to protect against the hazard; and, ensuring
employees made aware of hazards associated with item, procedures to follow to protect against the hazards, and are trained in its safe use prior
9.7 to being required to use it. Confirmation of system effectiveness should be confirmed through discussions with employees.
How do you ensure equipment/machinery is in proper working order? Manager's response may include: review of weekly dept. safety inspections;
9.8 spot checks of items; discussions with employees re: items' operational soundness.
How are Safety Alerts communicated/acted on? Manager should be able to explain how Safety Alert information is communicated to appropriate
persons and/or how the issues are acted up on. Confirmation of system effectiveness should be confirmed through review of associated
9.9 documentation and/or discussions with employees.

What are contractor/subcontractor responsibilities?.... What do you do if they perform work unsafely? Manager should be able to explain that
contractors are required to: work in a safe manner; implement measures to protect employees/customers from hazards associated with work
performed; work in compliance with OH&S legislation and Sobeys Safety Standards; provide store with MSDS's for any hazards brought into the
workplace. Manager should know to bring safety concerns associated with contractors' work to the attention of contractor's site supervisor (NOT
THE WORKER INVOLVED) for correction, or to contact appropriate others (i.e. Sobeys head office, contractors' head office) to report unsafe work
9.10 by contractor/subcontractor.

How do you support work of JH&SC? Manager should be able to explain what actions he/she has taken to support work of JH&SC.
9.11 Confirmation JH&SC is provided appropriate management support should be confirmed through discussions with JH&SC Co-Chair(s).

Do employees/contractors work above 3 meters (10 feet)? If so, Manager should be able to explain what fall protection equipment and training is
9.12 required. Effectiveness of fall protection system should include review of documentation and discussions with applicable employees.
Who is on modified work and what are their modified duties? Manager should be able to answer these questions and provide supporting
9.13 documentation re: modified work assignments.
Who is on a Workers' Compensation claim? Manager should be able to answer this question and explain actions being taken to facilitate the
9.14 employee(s)' return to work.
 What are the financial costs of Workers' Compensation claims and late accident reporting? …. What impact have they had on your store?
9.15 Manager should be able to explain costs of Workers' Compensation claims and late accident reporting and their impact on his/her store.
Store Name:_____________________ Store Number: ________________ Store Manager Name: ______________________________ Store Manager Signature: _________________________________

RETAIL HEALTH & SAFETY AUDIT

COMPLIANCE ACTION PLAN
The Compliance Action Plan:
> is to be completed by the Store Manager and submitted to the Health & Safety Department (copy to District Manager) two weeks after receiving the audit results; and,
> needs to detail the Store Manager's plans to address all items noted as non-compliant in the audit, with priority attention given to the highlighted areas marked with an asterisk.
Once all items included in your Compliance Action Plan have been completed, you must send a copy of the completed Action Plan and Confirmation of Completion (below) to the Health & Safety Department and your District Manager.

Actual
Date to be Completion
ITEM # Department Description of Item Corrective Action Task Assigned To Completed Date Comments

CONFIRMATION OF COMPLETION
THIS "CONFIRMATION OF COMPLETION" IS TO BE SIGNED BY THE STORE MANAGER AND JH&SC CO-CHAIRS AFTER ALL THE CORRECTIVE ACTIONS INCLUDED IN THE COMPLIANCE ACTION PLAN HAVE BEEN COMPLETED.

Store Manager: This comfirms that all Corrective Actions noted in the above Action Plan have now been completed: _______________________________________________________ __________________________
Store Manager Signature Date
JH&SC Co-Chairs: We have reviewed and can confirm that all of the above noted Corrective Actions have been completed:

______________________________________________ ________________ _________________________________________ _____________

JH&SC Co-Chair Representing Employees - Signature Date JH&SC Co-Chair Representing Employer Date
 Store Manager's Post-Audit Checklist

Review audit results with JH&SC and Department Managers (keep record).

Prepare Compliance Action Plan to correct audit items noted as "Non Compliant". Give priority
to highlighted items marked with asterisk (i.e. * ).

Send copy of Compliance Action Plan to Health & Safety Dept. and District Mgr. within two
weeks of receiving audit results.

Implement all items you included in your Compliance Action Plan.

Have JH&SC Co-chairs review and confirm all Compliance Action Plan items completed.

Store Manager and JH&SC Co-chairs sign "Confirmation of Completion" (included at bottom of
Compliance Action Plan form).

Send completed Compliance Action Plan and Confirmation of Completion to Health & Safety Dept.
and District Manager.