Background

This page describes some of the hazards and priorities that you may encounter in health care and community care workplaces and employers’ responsibilities under the Occupational Health and Safety Act (OHSA) and its regulations. You can also contact your health and safety association for guidance on controlling hazards.

In general, employers are required under the OHSA to provide information, supervision and instruction to workers to protect their health or safety [clause 25(2)(a)] and to take every precaution reasonable in the circumstances for the protection of a worker [clause 25(2)(h)].

Ministry of Labour (MOL) inspectors proactively inspect health care and community care workplaces to check that they are complying with requirements such as:

  • the internal responsibility system
  • health and safety awareness training
  • competent supervision
  • reporting occupational illnesses and diseases

Inspectors focus on employer compliance with the major hazards and health and safety priorities as described below.

The internal responsibility system and the health care sector

The Occupational Health and Safety Act (OHSA) establishes legal requirements that provide a foundation for the internal responsibility system (IRS). The IRS is a system within an organization in which everyone has a responsibility for workplace health and safety that is appropriate to one’s role and function within the organization. The employer, typically represented by senior management, is responsible for ensuring that the IRS is established and that it functions successfully. Strong leadership by senior executives, managers and supervisors is essential to setting the tone and establishing a corporate culture that nurtures the IRS and safety.

Joint health and safety committees (JHSCs) and health and safety representatives (HSRs) where required, assist in providing greater protection against workplace injury, illness and deaths. JHSCs include representatives from workers and employers and have specific roles and responsibilities under section 9 of the OHSA.

An HSR has specific roles and responsibilities under section 8 of the OHSA and is selected by either:

  • workers at the workplace from workers who do not exercise managerial functions
  • by the union if the workplace is unionized and

This co-operative involvement helps support a well-functioning IRS.

Ministry inspectors continue to look for evidence of a strong IRS and a properly functioning JHSC when required.

Competent supervision is an important part of workplace safety culture and the IRS. The OHSA defines a supervisor as a person who has charge of a workplace or authority over a worker.

Under OHSA clause 25(2)(c), an employer must appoint a competent person when appointing a supervisor.

The OHSA defines a competent person as someone who:

  • is qualified because of his or her knowledge, training, and experience to organize the work and its performance
  • is familiar with the OHSA and its regulations as it applies to the work, and
  • has knowledge of any potential or actual danger to health and safety in the workplace

For more information on a supervisor’s specific duties, see OHSA, section 27 and the ministry’s Guide to the Occupational Health and Safety Act .

All parties in the IRS need to be trained adequately to carry out their duties under the OHSA.

The general duties under the OHSA for employers [section 25], supervisors [section 27] and workers [section 28] also apply with respect to workplace violence [section 32.0.5]. For example, workers are required to report actual or potential hazards in the workplace relating to workplace violence to their employer or supervisor. Workers should know how to report incidents of workplace violence to the employer or supervisor. Supervisors may need additional information or instruction in order to properly follow up on reported incidents or complaints of workplace violence.

Rights under the OHSA

Ontario’s OHSA provides workers with rights and responsibilities. It forbids employers from dismissing, disciplining or otherwise penalizing workers (reprisals) for obeying the law or asserting their rights. Section 50 of the OHSA is intended to enable workers to freely raise health and safety concerns and to fully assert their rights under the OHSA (such as reporting incidents of workplace violence) without fear of reprisal.

Under section 50 of the OHSA, an employer cannot

  • dismiss (or threaten to dismiss) a worker
  • discipline or suspend a worker (or threaten to do so)
  • impose (or threaten to impose) any penalty upon a worker, or
  • intimidate or coerce a worker

because a worker has

  • followed the OHSA and regulations
  • exercised rights under the OHSA, including the right to refuse unsafe work
  • asked the employer to follow the OHSA and regulations

Also, a worker cannot be penalized for:

  • providing information to a Ministry of Labour inspector
  • following a Ministry of Labour inspector’s order, or
  • testifying at a hearing about OHSA enforcement
    • in court
    • before the Ontario Labour Relations Board
    • before the Human Rights Tribunal of Ontario or similar organization
    • at a coroner’s inquest
    • at a grievance arbitration
    • in certain other hearings

Everyone in the workplace has a legal duty and role to play in setting up a strong IRS.

Resources and compliance support

Ministry of Labour

Other resources and information

The awareness training regulation

The occupational health and safety awareness and training regulation (O. Reg. 297/13) under the OHSA came into effect on July 1, 2014.

Employers must ensure that all their workers and supervisors complete a basic occupational health and safety awareness training program. The training must meet the requirements set out in the regulation.

Employers must continue with ongoing training and supervision for workers about workplace-specific hazards.

Resources and compliance support

Ministry of Labour

Others resources and information

The noise regulation

The noise regulation came into effect on July 1, 2016, and applies to all workplaces in Ontario under the OHSA. It helps protect workers from noise-induced hearing loss, a leading cause of occupational disease.

Employers must put into place measures to reduce workers’ exposure to noise. There is a maximum time-weighted exposure limit of 85 dBA over an eight-hour work shift.

Employers must also inform workers about workplace-specific noise hazards and instruct them on how to reduce exposure. Supervisors must ensure they are following the correct procedures.

Resources and compliance support

Ontario Ministry of Labour

Other resources and information

Musculoskeletal disorders (MSDs) involving non-client-handling

MSDs account for the largest percentage of lost time injuries in the health care sector.

Employers:

  • should know their workplaces’ MSD injury record and be aware of MSD hazards
  • must take appropriate action to protect workers from MSD hazards
  • must ensure  equipment is maintained in good condition
  • must inform, instruct and supervise workers on MSD hazards and the protective measures they provide
  • must establish written measures and procedures to protect workers in accordance with sections 8 and 9 of O. Reg. 67/93 – Health Care and Residential Facilities in consultation with the JHSC (or HSR), if the regulation applies to that workplace.

Other sections of O. Reg. 67/93 may also apply to the workplace, such as manual material handling and equipment used for handling, lifting or moving materials.

Resources and compliance support

Ministry of Labour

Other resources and information

MSDs involving client handling

Client handling injuries from lifting, transferring and re-positioning patients or residents account for almost half of all MSDs in the health care sector.

Employers should ensure that workers have equipment to help them move clients, patients or residents when needed. When equipment is provided, employers must ensure that workers are trained to use it.

Employers regulated under O. Reg. 67/93, in consultation with the JHSC or HSR, must establish written measures and procedures for client handling by workers, which may include how to determine mobility status, explaining the proper client handling technique to workers and how to perform it.

Employers must ensure that lifting equipment is properly maintained according to the manufacturer’s instructions.

Employers must take reasonable precautions to protect workers [OHSA clause 25(2)(h)], including the prevention of MSDs related to client handling.

Resources and compliance support

Ministry of Labour

Other resources and information

Slips, trips and falls

Slip, trips and falls account for a large number of injuries in the health care sector.

Employers must:

  • take every reasonable precaution in the circumstances to protect workers
  • provide information and instruction
  • ensure workers properly use or wear required equipment

To decrease the risk of injuries from slips, trips and falls, workplace parties must maintain work surfaces, general housekeeping and safe ladder use, among other requirements in sections 33 through 41 of O. Reg. 67/93.

Resources/compliance support

Ministry of Labour

Other resources and information

Exposure to biological, chemical and physical agents

Hazardous biological and chemical agents in health care workplaces include:

  • viruses
  • bacteria
  • fungal spores/mould
  • nuisance dust
  • asbestos
  • chemicals used for laboratory work
  • sterilizing, disinfecting and cleaning
  • hazardous drugs such as anaesthetic gases and antineoplastic drugs
  • cryogenic gases

Physical agents include:

  • noise
  • ionizing radiation (such as x-rays) and non-ionizing radiation (such as lasers)

Workers can be exposed to these agents when providing medical care and/or during routine activities such as housekeeping and construction.

Under the OHSA, all employers are required to:

  • inform, supervise and instruct workers to protect their health and safety [clause 25(2)(a)]
  • take reasonable precaution to protect workers [clause 25(2)(h)]

This applies to hazardous biological, chemical and physical agents in the workplace.

Employers covered by the O. Reg. 67/93 must:

  • in consultation with the JHSC or HSR, if any, develop, establish and put into effect written measures and procedures to protect workers who may be exposed to hazardous  agents
  • minimize health care workers’ exposure to hazardous agents (including hazardous drugs sterilizing, disinfecting and cleaning chemicals) by complying with all  requirements, including:
    • making Safety Data Sheets available (when applicable)
    • complying with prescribed procedures for safe use, handling and storage of hazardous chemical agents, specified gases and drugs
    • complying with worker education and training requirements
    • complying with appropriate personal protective equipment (PPE), including training in its use, care, selection and limitations
    • developing a respiratory protection program
    • having emergency response procedures available in the event of a worker’s exposure to antineoplastic agents
    • ensuring proper maintenance of anaesthetic gas scavenging systems, including monthly inspection for leakage
    • making available control measures such as biosafety cabinets for the preparation of antineoplastic agents.

For more information, please see the section about antineoplastic and other hazardous drugs.

Other regulations may include:

Resources and compliance support

Ministry of Labour

Other resources and information

Contact with and struck-by-object injuries

Workers can be injured when they are struck by objects or from other types of contact. This can happen during material handling, when machines are not guarded properly or there is a lack of lockout and tagout of equipment and machinery.

Employers must assess the risk to workers and develop and implement measures and procedures that protect workers.

Employers must ensure that workers receive information, instruction and supervision regarding safe work practices and conditions as required by clause 25(2)(a) of the OHSA.

Resources/compliance support

Ministry of Labour

Other resources and information

Workplace violence and workplace harassment

Health care workers are at risk of exposure to workplace violence due to factors such as:

  • working in the community
  • working alone
  • providing direct care to clients, patients or residents with cognitive impairments
  • working with the public

The Occupational Health and Safety Act (OHSA) sets out requirements for workplace violence and harassment in sections 32.0.1 to 32.0.8.

Employers must:

  • establish appropriate workplace violence and harassment policies [OHSA section 32.0.1]
  • conduct a workplace violence risk assessment or re-assessment [OHSA section 32.0.3]
  • develop and maintain workplace violence and harassment programs to implement the policies [OHSA sections 32.0.2 and 32.0.6]
  • provide workers with training on the workplace violence and harassment policies and programs [OHSA section 32.0.5 and 32.0.7]
  • subject to some conditions, provide information, including personal information, to a worker about the risk of workplace violence from a person with a history of violent behaviour [OHSA subsection 32.0.5(3)]

Further information about workplace violence is in the MOL guide, Understand the law on workplace violence and harassment.

Additional information, including new workplace harassment provisions, can be found on the MOL webpages for workplace violence and workplace harassment. Available fact sheets help workers and employers understand their duties. Employers can use the Ministry’s Code of practice to address workplace harassment under the Occupational Health and Safety Act.

For workplaces under the Health Care and Residential Facilities Regulation (O. Reg. 67/93), there are specific requirements to consult with the joint health and safety committee or health and safety representative when they develop written measures and procedures, and worker training and educational programs.

For more information, see sections 8, 9 and 10 of the regulation.

The Workplace Violence Prevention in Health Care Leadership Table, along with PSHSA, has developed many tools for workplace parties to help prevent and reduce workplace violence. Please refer to the PSHSA Violence, Aggression & Responsive Behaviour Project tools below and the Workplace Violence Prevention in Health Care Leadership Table products.

Resources and compliance support

Ministry of Labour

Workplace Violence Prevention in Health Care Leadership Table – information and tools

Violence, Aggression and Responsive Behaviour Project

Transportation hazards (including motor vehicle incidents)

Many health care workers must drive to deliver services in the community. Motor vehicle incidents cause most traumatic fatalities in the health care sector.

All employers must put reasonable precautions in place to protect workers, including the prevention of motor vehicle incidents.

Resources and compliance support

Safety in transition of care

“Transition of care” refers to the progression of patients, residents and clients from one care setting to another as their condition and care changes.

Transition of care among care providers has been identified by the ministry, its system partners and stakeholders as an occupational health and safety issue for health care workers.

Occupational health and safety related issues include:

  • workplace violence and/or harassment
  • MSD risks from client lifting and transferring
  • infection prevention and control

Effectively communicating with and training staff who provide care is essential to ensure patient, resident and client safety, and also worker safety. Priority areas include:

  • employee training and orientation
  • developing and implementing standard processes to pass along information

Resources and compliance support

Needle and sharps safety

Under Ontario Regulation 474/07 - Needle Safety, with some exceptions, hollow-bore needles must be safety-engineered needles when used in:

  • hospitals
  • long-term care homes
  • laboratories
  • specimen collection centres

and for all workplaces when used on a person for purposes that are:

  • therapeutic
  • preventative
  • palliative
  • diagnostic
  • cosmetic

Hollow-bore needles that are safety- engineered are designed to eliminate or lessen the risk of a skin puncture or needlestick injury to the worker.

Health care workers can be injured by other sharp medical devices (sharps) such as:

  • scalpels
  • solid needles
  • medical instruments

Employers must put suitable controls in place when workers use, handle and dispose of needles and sharps in the workplace.

In workplaces covered by O. Reg. 67/93 (Health Care and Residential Facilities), employers must have written measures and procedures for disposing of waste materials and sharp objects, such as needles (sections 8 and 9). These must be developed with the participation of the JHSC (or HSR).

See sections 112 to 114 and section 116 of the regulation for more information about safe disposal of sharps.

Resources and compliance support

Infections and infectious diseases

Health care workers may become ill if exposed to:

  • infectious materials
  • blood and body fluids
  • contaminated medical supplies/equipment
  • contaminated environments

Transmission of infectious diseases can happen due to injuries from sharps, direct or indirect contact and by droplet and airborne exposures.

Under the OHSA, occupational illness includes infections in workers that happen because of workplace exposures. The illness must be reported to the ministry, JHSC (or HSR) and trade union (if any). Besides isolated cases of worker infections, workers can be affected when there are larger outbreaks of disease. “Occupationally acquired infections” are a concern in the health care sector since they often occur.

In workplaces where O. Reg. 67/93 applies, measures and procedures to control infections must be developed with the participation of the JHSC or HSR (sections 8 and 9).

Resources and compliance support

Ministry of Labour

Other resources and information

Occupational illnesses and diseases

In Ontario, occupational disease accounts for more occupational fatalities than all traumatic workplace injuries combined.

Exposures to chemical, biological and physical agents are among the five most serious hazards in health care according to an analysis of WSIB injury data by the Public Services Health and Safety Association.

Work-related issues include:

  • noise
  • asthma
  • skin disease (dermatitis)
  • occupational infections

Work-related asthma is caused or triggered by inhaling one or more substances in the workplace.

There are two types of work-related asthma:

  1. Occupational asthma is caused by a substance at work. It results from lengthy exposure to chemicals, or from a sudden chemical spill or leak. Health care workers are at risk of developing asthma from sensitizers in the workplace such as latex, certain drugs, sterilizing agents, disinfectants, glutaraldehyde and formaldehyde.
  2. Work-exacerbated asthma occurs when asthma worsens because of irritants or other exposures/factors in the workplace like dust, smoke and cold temperatures.

Contact skin diseases are often seen in health care workers. Irritant contact dermatitis is more common and may be caused by wet work/frequent hand washing and glove use. Health care workers can also develop allergic contact dermatitis from sensitizers in rubber gloves.

Health care workers can contract occupational infections in the workplace such as influenza, tuberculosis, hepatitis and gastroenteritis.

One way to control exposure to hazardous agents is to use substitutes that are less hazardous.

Employers must report occupational illnesses in accordance with clause 52(2) of the OHSA and applicable regulations.

Resources and compliance support

Ministry of Labour

Other resources and information

Reporting occupational injuries and illnesses

Under OHSA sections 51 and 52, an employer must notify the ministry, the JHSC (or HSR) and the trade union (if any) of any workplace injuries or illnesses. This includes the following deadlines:

  • providing immediate notice of any critical injuries or fatalities
  • within 48 hours, providing a written report regarding critical injuries or fatalities
  • within four days of the employer learning of the illness, providing a written report of any occupational illness (including occupational infections)

Also, the employer must notify the JHSC (or HSR) and the union (if any), within four days of an accident, explosion, fire or incident of workplace violence if a worker is disabled from performing his or her work or requires medical attention, and no one dies or is critically injured.

If required by the inspector, this notice must also be given to a director of the Ministry of Labour.

OHSA sections 51 and 52 specify that the notice must include certain details that are named in each sector’s regulations. Section 5 of O. Reg. 67/93 lists what to report for health care and residential facilities.

Employers must:

  • be aware of their reporting obligations
  • take suitable action to make sure reporting requirements are met

Ministry inspectors can check that employers are complying with the law to report illnesses, injuries and deaths, and prevent further occurrences.

Resources and compliance support

Ministry of Labour

Other resources and information

Workplace Hazardous Materials Information System

The Workplace Hazardous Materials Information System (WHMIS) is a Canada-wide system that gives employers and workers information about hazardous materials used in the workplace.

WHMIS has changed to adopt new international standards that classify hazardous chemicals and provide information on labels and safety data sheets. These new international standards are part of the Globally Harmonized System for the Classification and Labelling of Chemicals (GHS) and are being phased in across Canada between February 2015 and December 2018.

During the transition period, the old requirements are called “WHMIS 1988” and the new requirements are called “WHMIS 2015.” Both the OHSA and the WHMIS Regulation (Ontario Regulation 860) have been amended to meet the new WHMIS requirements. For further details, see: Workplace Hazardous Materials Information System.

The WHMIS regulation (Regulation 860) contains three sections: labels, safety data sheets and worker education.

Section 42 of the OHSA requires employers to provide workers with:

  • instruction and training that has been developed and implemented in consultation with the JHSC (or HSR)
  • periodic review of the training and instruction

Resources and compliance support

Ministry of Labour

Other resources and information

Antineoplastic and other hazardous drugs

Antineoplastic drugs are a group of specialized drugs used primarily to treat cancer and some non-cancerous conditions. Health care workers may be exposed to antineoplastic drugs during handling, such as transporting, preparing, administering and disposing of waste and contaminated materials.

Employers covered by O. Reg. 67/93 must have written measures and procedures to protect workers who may be exposed to antineoplastic agents or to material or equipment contaminated with antineoplastic agents (section 97). This must be done in consultation with the JHSC (or HSR), if any.

Resources and compliance support

Personal protective equipment

Under the OHSA, employers must ensure that personal protective equipment (PPE) that is provided is maintained in good condition and used as required by either the employer or regulations. Workers have a legal responsibility to use the protective clothing, equipment or devices required by the employer.

For workplaces covered by O. Reg. 67/93 employers must also ensure that PPE is:

  • properly used and maintained, properly fitted, inspected for damage or deterioration
  • stored in a convenient, clean and sanitary location when not in use

Employers must instruct and train workers on PPE care, use and limitations before they wear or use it for the first time and regularly provide further instruction and training.

Employers must have written measures and procedures for workers to use, wear and care for PPE and understand its limitations. This must be done in consultation with the JHSC or HSR, if any.

Personal protective equipment includes:

  • respirators
  • head protection
  • eye protection
  • foot protection
  • protective aprons
  • protective collars
  • gowns
  • gloves
  • fall arrest systems

Resources and compliance support

Ventilation maintenance and monitoring

Ventilation is important to ensure that the workplace is a healthy environment, free from contaminants that may be a hazard to workers. Mechanical ventilation is an engineering control and must be properly maintained.

Employers covered by O. Reg. 67/93 must follow sections 19 and 20 and ensure that mechanical ventilation systems are inspected at least every six months by a person who is qualified. A report of the inspection must be provided to the employer and the JHSC (or HSR).

Legionella bacteria is of special concern. Mechanical ventilation systems, such as a cooling tower, must have regular preventative maintenance to control Legionella bacteria.

Even employers not covered by O. Reg. 67/93 must take all reasonable precautions to protect their workers, as required by OHSA clause 25(2)(h), including ventilation system upkeep.

Resources and compliance support

Asbestos

Many older buildings may have asbestos-containing materials (ACM). In Ontario, O. Reg. 278/05 – Asbestos on Construction Projects and in Buildings and Repair Operations applies to working around asbestos. It requires:

  • implementing an asbestos management program in buildings containing ACMs and in other specific circumstances
  • the building owner to keep a record of the location and condition of actual or suspected ACMs
  • updating the record at least once annually and whenever the owner is aware of new information about the ACMs
  • safe work measures and procedures that employers and workers must follow when performing work (e.g. Type 1, Type 2 and Type 3 operations) that involves ACMs.

Resources and compliance support

Ministry of Labour

Other resources and information

Common industrial hazards in health care workplaces

Common industrial hazards in health care workplaces can include:

  • entanglement, pinch and “struck-by object” hazards involving machines and equipment (for example, conveyors, forklifts, lawnmowers)
  • confined spaces and restricted spaces
  • falls related to working at heights (for example, ladders, scaffolds, loading docks)
  • electrical, pneumatic, hydraulic or kinetic stored energy hazards with insufficient lockout/tag out systems

All employers should identify workplace hazards and assess the risks to workers. The employer must:

  • take all reasonable precautions to protect workers [OHSA clause 25(2)(h)]
  • have measures and procedures to control the hazards
  • provide workers with appropriate information and instruction

Resources and compliance support

Loading dock safety

Workers can be exposed to hazards when working indoors or outdoors at loading docks in health care workplaces. Serious injuries can happen due to slips, trips and falls, hazardous materials, poor lighting and equipment safety. Hazards at loading docks can also lead to the development of musculoskeletal disorders (MSDs).

Resources and compliance support

Construction hazards

Construction projects in health care workplaces, including renovations, structural maintenance, and new construction, are common. Employers must protect workers from construction hazards and have a comprehensive plan to keep them safe during a construction project. Construction areas should be clearly marked and separated by fencing or other measures to prevent access.

The Ministry of Labour’s construction health and safety inspectors enforce the OHSA and its regulations at construction projects across the province. This includes projects located in health care workplaces.

Health care workplaces covered by O. Reg. 67/93 must have written measures and procedures in place to protect health care workers’ health and safety. These include:

  • pre- and post-construction hazard risk assessment plan
  • hazard communication procedures
  • infection prevention and control measures
  • appropriate procedures to be taken during construction
  • controls limiting interaction between the construction work and health care staff
  • controlled access and egress (entries and exits) in construction areas

Employers must develop written measures and procedures in consultation with the JHSC (or HSR) for the protection of workers, as well as training and education for workers.

Resources and compliance support

Vulnerable workers (including new and young workers)

Under the OHSA, employers must train, instruct and supervise workers to protect their health and safety.

The Ministry of Labour considers new workers to be those who, regardless of age, have been on the job for less than 6 months or been assigned to a new job. Anyone between the ages of 14 and 24 is considered to be a young worker. Employers in workplaces covered by O. Reg. 67/93 must develop education and training programs with the joint health and safety committee (JHSC) or health and safety representative (HSR).

Resources and compliance support

Ministry of Labour

Other resources and information

Emergency management (preparedness, response and recovery)

Every employer must:

  • take every reasonable precaution in the circumstances to protect workers from hazards at all times, including during an emergency
  • provide information, instruction and supervision to workers to protect their health and safety, including information about emergencies

For workplaces covered by O. Reg. 67/93:

  • develop and implement written measures and procedures for worker health and safety, including training and educational programs
  • conduct a risk assessment to develop emergency measures and procedures

Resources and compliance support

Substance use and impairment

The Ministry of Labour (MOL) has guides to help workplace parties understand their obligations under the OHSA when dealing with workplace impairment from substance use. This includes legal, illegal, and prescription substances.

See: Impairment and workplace health and safety.

Cannabis

Under the OHSA, employers must protect workers and this includes protecting them from passive exposure to cannabis smoke/marijuana smoke.

Controls are needed to reduce the risk of passively inhaling cannabis smoke in health care workplaces. This includes reducing the risk of exposure at the source, along the path and by the worker.

Resources and compliance support