Near Miss Form

Access the digital form here.

General Suggestions for the Health and Safety Near Miss Form:

• Detailed instructions on how to access the digital form can be located here.

• If you decide to submit a physical form, please submit it as an attachment via email so there is a time stamp of when the physical form was submitted. 

• A concern is defined as "a potential or existing hazard which presents a risk to the health or safety of employees in the workplace”. A Near Miss Incident is defined as “an event or condition, which, under slightly different circumstances could have resulted in harm to employees.” Health and Safety Concerns/Near Miss Incidents can now be reported online or using a paper copy.

• Be mindful of how the student is described in your summary; keep it neutral and describe the situation without too many adjectives

• If you do not receive a response within 5 working days, please connect with your Health and Safety rep promptly for timely support (their email is located at the bottom of this page).

Caring and Safe Schools Form

Access the digital form here.

General Suggestions for the Caring and Safe Schools Form:

• This document is completed by a worker for incidents involving student(s) that may lead to suspension or possible expulsion.  The common reporting tool ensures that these forms are completed and tracked by prompting the Principal/Vice-Principal to complete the Caring and Safe Schools Incident Reporting Form (Part II) as part of the ‘report back’ process to the staff member who made the initial report AND;

• This form should be completed if staff have become aware of an act of student on student violence or activities that have a negative impact on school climate. See some examples of possible offences here.

• This form can be used independently, or in addition to another Health and Safety form.

• If you decide to submit a physical form, please submit it as an attachment via email so there is a time stamp of when the physical form was submitted. 

Employee's Report of a workplace Violent Incident Form

Access the digital form here.

General Suggestions for the Employee's Report of a Workplace Violent Incident Form:

• Access the specific parameters of the form here.

• An act of violence under the Occupational Health and Safety Act is defined as: “the exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker; an attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker; a statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker”.  

  1. 1. • Note that a Violent Incident Form is also appropriate in situations where you may have been in harm's way (or at risk of violence) by virtue of supporting a student in a violent incident. 

• For no lost time incidents, the Supervisor shall acknowledge and review the incident with the worker within 5 days. 

• For incidents that result in lost time, the worker shall receive a Supervisor’s Workplace Violent Incident Investigation (SWVIIR) within 5 days unless there are extenuating circumstances. If you have not received your Supervisor’s formal investigation, please connect with your Health and Safety rep promptly for timely support (their email is located at the bottom of this page).

Employee's Report of Accident or Injury Form

Access the digital form here. 

General Suggestions for the Employee's Report of Accident or Injury Form:

• The physical form should be submitted to the Disability Case Administrator (dcmsubmissions@tdsb.on.ca) with your Principal & Executive Officer (julius@ett.on.ca) cc'd.

• When asked if you have CPI training, please know that CPI training is a behaviour management training that prepares educators to apply physical interventions in specific scenarios. This is a formal full-day training which you would have received a release day to complete.

• When asked if you have been informed of the risk, please know that this only applies if the child has a safety plan in place. When a student you are working with has a safety plan, the Principal is required to notify the staff working with the student and to keep a record of the notification by asking the member to sign a "Notification of Risk of Injury Form" which includes a copy of the student's safety plan. 

• If you require medical assistance due to the injury, your Principal has an obligation to ensure you are provided safe transportation to the nearest emergency room (e.g., taxi, driving you there directly).

• If you require medical assistance due to the injury, please make sure the you and your treating physician complete the relevant WSIB forms.

• Please consider reviewing this PRS Matters Bulletin on Reporting Workplace Accidents that expands on WSIB Forms.

rEFUSING uNSAFE wORK

Review the steps for Work Refusal here. 

General Suggestions for a Work Refusal:

• The Occupational Health and Safety Act (OHSA) gives a worker the right to refuse work that they believe is unsafe to themselves or another work. A work who believes that they are endangered by workplace violence may also refuse work.

• There is a specific procedure which must be followed in any work refusal. It highly recommended that you connect with your Health and Safety Rep prior to engaging in a work refusal. 

• If you are unsure if a work refusal is appropriate for your circumstances, this ETFO Checklist may be a helpful way to verify this.