Health care sector compliance plan 2019-2020
Inspections will take place at health care and community care workplaces from April 1, 2019 to March 31, 2020. Read about the focus of health and safety inspections and initiatives, and get resources to help workplaces comply with the law.
Overview
Health and safety inspection initiatives are part of the province’s Safe At Work Ontario compliance strategy.
These initiatives are announced to sectors in advance. However, individual workplaces are not identified in advance.
The ministry posts results from provincial initiatives online. The initiatives are intended to raise awareness of workplace hazards and promote compliance with the Occupational Health and Safety Act (OHSA) and its regulations.
Ministry of Labour inspectors are responsible for enforcing the OHSA and its regulations at workplaces across the province. As part of the Safe At Work Ontario strategy, the ministry decides on the focus of initiatives using a risk-based process. This process takes into account:
- injury, illness and fatality rates
- compliance history
- the nature of the work (for example, hazards that come with the job)
- current events
- the vulnerability of the workers
- strategic priorities
- advice from stakeholders
The focuses can be on specific sectors, hazards, issues or topics.
Inspectors are not limited to inspecting only the topics identified in this plan. They can apply the OHSA and its regulations to the situation they find at each workplace they inspect.
Inspectors’ findings may influence how often individual workplaces will be inspected in the future. Inspectors may also refer employers to health and safety associations for assistance and training.
Among the health and safety associations, the Public Services Health and Safety Association works with Ontario’s health and community care sector to provide training, consulting and resources to prevent occupational injuries and illnesses.
High risk traumatic hazards – slips, trips and falls
This initiative is taking place in all sectors (i.e., construction, health care, industrial and mining).
Phase 1: Compliance assistance
Dates: March 18 to July 12, 2019
Partners: Infrastructure Health and Safety Association, Public Services Health and Safety Association, Workplace Safety and Prevention Services and Workplace Safety North
The ministry will partner with the health and safety associations to:
- deliver sector-specific webinars before the focused inspections phase starts
- publish slips, trips and falls compliance assistance resources and packages
- encourage workplaces to stop work for 15 to 30 minutes to have a safety talk about slip, trip and fall hazards specific to their workplace during Falls Awareness Week (May 6 to 10, 2019)
Phase 2: Focused inspections
Dates: April 15 to July 12, 2019
Rationale
From 2011 to 2017, falls were the second highest cause of traumatic fatalities. 73 workers were killed at work due to falls during this time period. Furthermore, slips, trips and falls were the third highest injury event reported to the Workplace Safety and Insurance Board (WSIB) in 2017 and accounted for 20% of allowed lost time claims with the WSIB in 2017.
Due to its impact across all sectors, the ministry and its partners have chosen to hold a campaign focused on slips, trips and falls hazards in spring 2019.
Initiative focus
Inspectors will check that employers have assessed for slip, trip and falls hazards and controlled for them (for example, through posting appropriate signs and good housekeeping practices).
Common hazards are:
- slippery substances like spills, snow and ice
- debris or obstructions in walkways
- improperly maintained equipment (for example, ladders)
- dirty work areas and surfaces
- unsafe use of ladders
- poor lighting
- changes in walkway levels and slopes
- unsecured mats
- unsuitable footwear
Refer to sections 33 through 41 of O. Reg. 67/93: Health Care and Residential Facilities for specific requirements on work surfaces.
Resources and compliance assistance
Find guidelines, fact sheets and other resources in the ministry’s falls page.
Workplace violence prevention
From July 22 to September 27, 2019, the ministry will focus on workplace violence prevention in long-term care, retirement homes and community care workplaces.
Phase 1: Compliance assistance
Dates: July 22 to September 27, 2019
Partner: Public Services Health and Safety Association
To create safe workplaces for all workers in the sector, the Ministry of Labour and the Ministry of Health and Long-Term Care established the Workplace Violence Prevention in Health Care Leadership Table. In the first phase of this initiative, the ministry will continue to work closely with its health and safety partners to promote the recommendations and tools coming out of the Leadership Table.
Phase 2: Focused inspections campaign
Dates: August 19 to September 27, 2019
Inspectors will focus on workplace violence prevention inlong-term care, retirement homes and community care workplaces to raise awareness of workplace hazards and promote compliance with the OHSA.
Rationale
- Promote and raise awareness of the Leadership Table’s tools supporting long-term care, retirement homes and community care workplaces.
- Stakeholders said that workplace violence continues to be a serious hazard in health and community care workplaces.
- The Workplace Safety and Insurance Board show a high number of lost time injuries (LTIs) from workplace violence in long-term care, retirement homes and other community care settings.
- In 2017, workplace violence was the third highest cause of LTIs in the health care sector
- From 2013 to 2017, there has been a significant increase in LTIs in community type settings due to workplace violence.
Initiative focus
Demonstrated commitment and strong leadership by senior executives and other managers is important to set the tone and make workplace violence prevention a strategic priority. Ministry inspectors will look for commitment and support from senior leadership for the internal responsibility system.
Ministry inspectors will also check that:
- employers are training workers on their workplace violence policy and program
- employers are completing risk assessments and putting measures and procedures in place to control identified risks
- workers can summon immediate assistance when workplace violence occurs
- employers are providing workers with information and instruction related to a risk of workplace violence from a person with a history of violent behaviour
- employers have measures and procedures in place on reporting incidents of workplace violence; the measures and procedures should also explain how the employer will investigate and deal with violent incidents
- employers provide appropriate detail in the written notification of a workplace injury, including the steps taken to prevent reoccurrence
Resources and compliance support
Read more about inspector focuses and resources on workplace violence in health care settings.
Healthy workers in healthy workplaces – musculoskeletal disorders and respiratory diseases
This initiative is taking place in all sectors (i.e., construction, health care, industrial and mining).
Phase 1: Compliance support and awareness campaign
Dates: September 1 to December 27, 2019
Partners: Infrastructure Health and Safety Association, Public Services Health and Safety Association, Workplace Safety and Prevention Services, Workplace Safety North and Occupational Health Clinics for Ontario Workers
The ministry and the Public Services Health and Safety Association will jointly raise awareness about health and safety laws and educate workplace parties about MSDs and respiratory hazards, prevention and compliance assistance resources.
Phase 2: Focused inspections campaign
Dates: October 1 to December 27, 2019
Musculoskeletal disorders
Musculoskeletal disorders (MSDs) are the top lost time injury at work reported to the WSIB in Ontario. In 2017, MSDs represented approximately one-third of all accepted WSIB lost time claims. There were over:
- 19,000 claims
- 462,000 days lost from work
- $72 million in direct WSIB costs
Initiative focus
MSD hazards such as high forces, awkward postures and repetitive motions are commonly found when workers are required to lift, carry, push, pull or lower materials or even other people. This may lead to the development of MSDs, which can be painful and debilitating. This initiative will focus on hazards that may lead to MSDs during manual materials handling and client handling activities, and helping workplaces eliminate or control those hazards.
In health and community care workplaces, inspectors will focus on client handling activities associated with lifting, transferring and repositioning of clients, patients or residents. These activities commonly cause MSDs among caregivers in health and community care workplaces across Ontario.
To prepare for the initiative, employers should:
- identify and assess MSD hazards
- implement controls to reduce workers’ exposure to MSD hazards
- advise and train workers about MSDs and client handling hazards in their job and workplace
- encourage workers to participate in their workplace’s health and safety program through early reporting of MSD symptoms or concerns to their employer/supervisor
- follow up to ensure preventive measures are working
Inspectors will check that:
- equipment is available for workers to assist them in moving clients, and that workers are trained in using them
- client handling equipment is being used where required
- lifting equipment is properly inspected, serviced and maintained as stated in the manufacturer’s instructions
- employers have written measures and procedures on:
- each individual lift, transfer and reposition
- client mobility assessments and documentation of status
- use of mechanical assists
- safe storage and maintenance of lift equipment and other mobility devices
- pre-use inspection of mechanical devices
- workplaces have reviewed the measures and procedures that apply
- employers have provided training to workers on client handling
Employers in workplaces under the health care and residential facilities regulation must establish written measures and procedures in consultation with the joint health and safety committee.
Resources/compliance assistance
- The ministry’s ergonomics in the workplace page explains occupational health and safety laws related to ergonomics and includes resources and guidance on ways to address hazards from poor ergonomics
- The MSD Prevention Guideline for Ontario includes fact sheets, step-by-step guidelines on organizing a workplace program to prevent MSDs, a risk assessment tool, quick summaries of basic MSD hazards and a large resource library.
- Read more about inspector focuses and resources on client handling MSDs in health and community care settings.
Respiratory hazards
Rationale
Between 2008 and 2017, long latency illnesses – illnesses in which there is a long delay between exposure to a disease-causing agent and the appearance of disease symptoms – accounted for the largest proportion of allowed WSIB benefit costs. 70% of allowed long latency illness claims over the past 10 years come from: lung cancer, pleural plaques, mesothelioma, asbestosis and chronic obstructive pulmonary disease, which are all associated with respiratory exposures.
Cancer Care Ontario and the Occupational Cancer Research Centre estimate that exposure to asbestos, diesel engine exhaust, crystalline silica and welding fumes cause approximately 1,300 cancer cases a year in Ontario.
Initiative focus
In health care and community care workplaces, inspectors will focus on work processes that generate aerosols (for example, dusts, fumes and vapours) and the controls that should be in place to minimize the risk of workers being exposed to hazardous substances that may result in occupational illness.
Inspectors will check that:
- all workers who handle hazardous chemicals (such as cleaning agents and preservatives) have been trained on how to use and dispose of them safely
- there are appropriate measures and procedures for the safe handling of hazardous chemicals
- there are suitable measures and procedures on managing spills of hazardous chemicals and drugs, and that spill kits are accessible and maintained
- areas where hazardous chemicals or dusts are used or generated have adequate ventilation and environmental controls to minimize worker exposures
- workers who require the use of personal protective equipment (PPE) for respiratory and facial protection:
- are trained on its use (including putting on and taking off PPE, disposal, equipment maintenance and hand hygiene)
- can freely access such equipment when required
- know when to access it
- health care workplaces that have asbestos-containing materials maintain a record as required under Ontario Regulation 278/05, section 8(3)
Resources and compliance assistance
- Learn about best practices for environmental cleaning in health care settings, including how to protect workers who are using chemical cleaning agents
- The Public Services Health and Safety Association has developed a free short e-learning module on community care chemicals that gives an overview of how to safely handle cleaning products and sharps
- The Canadian Centre of Occupational Health and Safety’s page on sanitation and infection control for cleaning staff contains guidance for protecting community care workers who are using chemical cleaning agents
Group homes
From January 20 to March 13, 2020, the ministry will conduct an initiative on group homes. “Group homes” are primarily engaged in providing residential care for people who require care or support, including people with developmental disabilities, mental health disabilities or substance abuse problems. They include intensive supported residences, supported group living residences and other facilities that provide support to clients and residents in residential settings.
Phase 1: Compliance assistance
Dates: January 20 to March 13, 2020
Partner: Public Services Health and Safety Association
The ministry and the Public Services Health and Safety Association will provide compliance assistance resources to educate stakeholders and workplace parties impacted by the group homes initiative.
Phase 2: Focused inspections
Dates: February 3 to March 13, 2020
Rationale
- The ministry has not had a heightened focus on group homes over the last 5 years.
- A large number of potentially vulnerable workers, including developmental services workers and personal support workers, work in this sector.
- Since group homes are both homes and worksites, they have unique risk management challenges since they have both home-related hazards and health care-related hazards. Group homes also share the same challenges many community care workplaces do – workers often work alone without direct supervision.
Initiative focus
Inspectors will focus on the following key priorities:
- the internal responsibility system, including engaging senior leadership to strengthen leadership accountability and compliance with their legislated duties under the OHSA
- workplace violence
- musculoskeletal disorders
- exposures to hazardous biological, chemical and physical agents/infection prevention and control issues
The internal responsibility system and senior management engagement
There is a need to focus on the internal responsibility system in group homes to address issues of information and training to workers
Read more about the internal responsibility system in community care settings.
Workplace violence
Workers in group homes are at increased risk of exposure to workplace violence since they are often:
- working in the community
- working alone
- providing direct care to clients or residents with cognitive impairments
Read more about inspector focuses and resources on workplace violence in community care settings.
Musculoskeletal disorders (MSDs)
According to 2017 WSIB data, 21% of long-term injuries in group living residences and other facilities consist of musculoskeletal disorders due to non-client handling while 8% consist of musculoskeletal disorders from client handling.
Non-client handling activities in group homes include:
- food preparation
- doing laundry
Read more about inspector focuses and resources on non-client handling MSDs in community care settings.
Client handling activities in group homes include:
- repositioning clients
- lifting clients
- transferring clients
Read more about inspector focuses and resources on client handling MSDs in community care settings.
Exposures
Workers in group living residential programs are often exposed to infections.
Infections can pass to the worker from:
- clients
- other visitors to the workplace
- animals, including cats, dogs and rats
Workers can also get infected through exposure to:
- spills of blood or body fluids
- environmental surfaces that have been contaminated such as needles, soiled linen or surfaces in washrooms
Inspectors will check that employers:
- have developed and put in place infection prevention and safe work practices
- follow current established recognized practices for the prevention of infections
- provide training and education to all workers based on established infection prevention and control safe practices
- provide safety engineered needles if the worker is required to do work on a person with the needle
- ensure that medical sharps are properly handled and disposed of. An appropriate sharps disposal container must be available as close as possible to where the sharp is used
Employers in workplaces under the health care and residential facilities regulation must establish written measures and procedures in consultation with the joint health and safety committee.
Read more about duties and resources on infections and infectious disease in community care settings.
Resources and compliance support
The Public Services Health and Safety Association has many health and safety resources that may apply to group homes, including a health and safety resource manual, checklists and hazard-related materials.
Other inspection focuses
Out-of-hospital premises
From February 1 to March 21, 2020, inspectors will be conducting proactive inspections at out-of-hospital premises. These are non-hospital medical clinics where physicians perform procedures that require certain types of anaesthesia (such as cosmetic surgery or endoscopy). Hazards present in these clinics may be similar to the hazards that are present in hospitals.
Inspectors, accompanied by the ministry’s infection control consultants or medical consultants, will check requirements related to:
- infection prevention and control
- the internal responsibility system