02 sample application & eligibility requirements

Revised 2013

Board of Canadian Registered Safety Professionals Sample Application & Eligibility Requirements

This application has been completed as sample for you to reference. Please use the “Application” document to complete your application for submission to the BCRSP.

PLEASE READ THE ENTIRE APPLICATION FORM BEFORE YOU BEGIN COMPLETING EACH SECTION

PLEASE COMPLETE AND SUBMIT ORIGINAL AND ONE COPY OF APPLICATION FORM AND ONE COPY ONLY OF SUPPORTING DOCUMENTATION ALONG WITH THE NON-REFUNDABLE

APPLICATION FEE TO:

Board of Canadian Registered Safety Professionals 6519B Mississauga Rd

Mississauga, ON L5N 1A6

FEES: R#100304195 Non-Refundable Application fee (includes first writing of examination) is $525.00 + HST/GST Residents of AB, BC, SK, MB, QC, YT, NT, NU – Add 5% GST ($525.00 + $26.25 = $551.25) Residents of ON, NB, NL – Add 13% HST ($525.00 + $68.25 = $593.25) Residents of PEI – Add 14% HST ($525.00 + $73.50 = $598.50) Residents of NS – Add 15% HST ($525.00 + $78.75 = $603.75) Residents outside of Canada - $525.00 Examination Writing Extension Fee is $100 + HST/GST Supplementary Examination Fee (maximum of three additional) is $125.00 + HST/GST Annual renewal fee is $150.00. An additional $25.00 fee increase has been approved for 2012, 2013, 2014 and 2015 + HST/GST Application Fee Credit Card Payment: Name of Applicant: Robert K. Jones Province of Residence: SK Payment By: [ ] American Express [ ] MasterCard [ ] Visa Card # Cardholder’s Name: Expiry Date: I authorize a $525.00 + HST/GST charge to the credit card noted above. Signature: Payment By: Cheque enclosed made payable to the BCRSP Payment Online: [ ] If you submitted your payment via the BCRSP website, please enclose a copy of the receipt delivered to you via email.

Applications submitted electronically or via facsimile or handwritten submissions will not be accepted. Please do not cerlox bind your submission.

BCRSP Application of 11

Revised 2013

BCRSP Application Requirements Before submitting your application, please ensure that all sections of the application (Parts A, B, C and Factors 1, 2, and 3) are completed in full and the “Declaration” is signed and dated. Supporting documentation must be clearly identified by Factor and attached in the same order as listed on the application. Applications that are not fully completed with documentation attached and in the proper order will be returned to the candidate for resubmission. A $50.00 (+ HST/GST) resubmission fee must accompany the resubmitted application. Chronological resumes should be submitted with your application however, they are not considered official documents but may be used by the Qualifications Review Committee to clarify formal education and employment information and dates.

International Candidates International candidates whose first language is neither English nor French must:

Submit documentation verifying a minimum score of 94-101 on a Test of English as a Foreign Language (TOEFL®) IBT; a band score of 7 on the International English Language Testing Sytem or a score of 785-900 on a Test de français international (TFI™). (Equivalent proof of language proficiency (e.g. a university assessment) will also be accepted)

Foreign credentials must be translated to English or French and be verified by an official translator Foreign credentials must be submitted to a Canadian Credentialing Agency (see below) prior to

application submission.

Foreign Credential Assessment and Evaluation

Alliance of Credential Evaluation Services of Canada (Pan-Canadian) www.canalliance.org/indexe.stm Canadian Association of prior Learning Assessment (Pan-Canadian) www.capla.ca/news.php Canadian Information Centre for International Credentials (Pan-Canadian) www.cicic.ca University of Toronto – Comparative Education Service (Pan-Canadian) www.adm.utoronto.ca/ces International Qualifications Assessment Services (AB, SK, NT)

www.employment.alberta.ca/cps/rde/xchg/hre/hs.xsl/4512.html British Columbia Institute of Technology - International Credential Evaluation Services (BC)

www.bcit.ca/ices Academic Credentials Assessment Service (MB)

www2.immigratemanitoba.com/browse/work_in_manitoba/work-recognition-acas.html World Education Services (ON with pan-Canadian applicability) www.wes.org/ca/employers/index.asp Centre d’expertise sur les formations acquises hors du Québec (QC) www.immigration-

quebec.gouv.qc.ca/en/education/comparative-evaluation/index.html

Reference : The Employer’s Roadmap, Hiring and Retaining Internationally Trained Workers Citizenship and Immigration Canada Foreign Credentials Referral Office C&I-1019-05-09E

www.credentials.gc.ca


Revised 2013

APPLICATION FOR CERTIFICATION

This application has been completed as sample for you to reference. Please use the BCRSP_application document in order to complete your application.

Part A: Personal Information

Salutation Mr (Please select via drop down list)

Last Name Jones

First Name Robert K.

Employer

(Current employer information

must be completed)

ABC Manufacturing Co.

Your Position/Title HSE Coordinator

Business Address 500 Main St

City Saskatoon

Province SK

Postal Code S7K 5B2

Business Telephone (306) 555-1234

Email [email protected]

Home Address 14 Queen St S

City Saskatoon

Province SK

Postal Code S5N 7K3

Home Telephone (306) 555-5678

Preferred Mailing Address Business Home

It is the applicant’s responsibility to keep the Board informed of any changes to the above information.


Revised 2013

Part B: Reference Questionnaire (RQ)

Please provide the name, title, employer, telephone number and email address of your reference. When selecting your reference, be sure this individual has knowledge of the OHS work you have done and the degree of responsibility you have in the administering of your employer’s OHS program. You may not use anyone as a reference over whom you have supervisory responsibilities. It is not necessary that your reference be a Canadian Registered Safety Professional (CRSP)®. The completed reference is NOT to be returned to the applicant, but sent directly to the Board. A Reference Questionnaire included with an application will not be considered and a new reference will be requested.

Contact Information for the Individual Completing the Reference

Name James R. Mason

Title OHS Coordinator

Employer Government of Saskatchewan

Telephone (with area code) (306) 555-1278


Part C: Practice Questionnaire (PQ)

Please provide the name, title, employer, telephone number and email address of your immediate supervisor. If you are a private consultant, the Practice Questionnaire may be completed by a current client. The completed Practice Questionnaire is NOT to be returned to the applicant, but sent directly to the Board. A Practice Questionnaire included with an application will not be considered and a new practice questionnaire will be requested.

Immediate Supervisor/Client Completing the Questionnaire

Employer Client

Name Roger J. Best

Title VP Human Resources

Employer (only if client) ABC Manufacturing Co.

Telephone (306) 555-1234


The same individual may not complete both the Reference Questionnaire and the Practice Questionnaire on behalf of the candidate.


Revised 2013

Factor 1 : Formal Education Minimum points required = 50; maximum points available = 100

Minimum requirement: a one year college/university certificate/diploma in OHS OR a two year college/university non OHS certificate/diploma. Institutions that have made submission to the Board and received approval for their OHS programs are posted to the Board’s website. If your program is not listed, it may still be eligible for points. Applicants who completed formal education above the minimum requirement (e.g. undergraduate degree or college diploma in any discipline) meet the formal education requirements for certification. All completed post-secondary education programs may be claimed to a maximum of 100 points as follows:

The highest level of completed formal education will be awarded the maximum number of points as per the matrix below

Each additional level of completed formal education will be awarded 50% of its point total Specialty certificates/diplomas/degrees within the scope of OHS practice should be claimed as non OHS

programs (i.e. kinesiology, ergonomics, environment, etc). OHS programs must be generalist in content reflecting the CRSP generalist designation as outlined in the Examination Blueprint.

Formal Education Value

OHS

**One year OHS college or university certificate or diploma 50

Two year OHS college or university certificate or diploma or one year post diploma 70

Three year OHS college or university certificate, diploma or degree 80

Four year OHS college or university diploma or degree 100

Post graduate OHS degree 100

NON-OHS

**Two year non-OHS college or university certificate or diploma 50

Three year non-OHS college or university certificate, diploma, degree or one year non-OHS post diploma 60

Four year non-OHS college or university diploma or degree 70

Post graduate non-OHS college or university degree 80

Example #1 Candidate has a 4-year, undergraduate, non-OHS university degree and a 1-year, OHS university certificate. 4-year, undergraduate, non-OHS degree 70 points 1-year, OHS certificate (50% of 50 points) 25 points Total Factor 1 95 points


Revised 2013

Factor 1 : Formal Education Minimum points required = 50; maximum points available = 100

Example #2 Candidate has a 3-year, OHS college diploma and a 2-year, college non-OHS certificate. 3-year, OHS college diploma 80 points 2-year, non-OHS certificate (50% of 50 points) 25 points Total Factor 1 100 points (maximum allowable) To receive Factor 1 credit, candidates must request granting institution to provide a final sealed transcript. Transcripts that have been photocopied or scanned will NOT be accepted.

Candidates who have not graduated from college/university but who have successfully completed some OHS credit courses may claim these courses under Factor 2, Category B.

Program length is based on full-time attendance. If you are enrolled as a part-time student and it takes two to three years to complete what is a one year program for a full-time student, you must claim it as a one-year program.

Level Completed College/University Program Name Year Graduated/ Completed

QRC Use Only

One year OHS college or university certificate or diploma

Two year non-OHS college or university certificate or diploma

35 (50% of 70) 70 (full points) Maximum 100 Points Awarded

Two year OHS college or university certificate or diploma or one year post diploma

Three year non-OHS college or university certificate, diploma, degree or one year non-OHS post diploma

Northern Alberta Institute of Technology

Occupational Health & Safety Diploma

2006

Three year OHS college or university certificate, diploma or degree Four year non-OHS college or university diploma or degree

University of British Columbia

Arts 2002

Four year OHS college or university diploma or degree

Post graduate OHS degree

Post graduate non-OHS college or university degree


Revised 2013

Factor 2 : Professional Development Minimum points required = 15; maximum points available = 100

List all OHS-related training courses/seminars/conferences you have completed beginning with the most recent. To obtain credit, you must attach a copy of the course/seminar/conference outline and a copy of any certificate received or furnish equivalent proof of completion such as a letter from the organization presenting the course/seminar/conference. The documentation must specify the duration of the course and demonstrate proof of completion. Professional development credits will not be granted without documentation. Documentation must be attached for each course/seminar/conference in the same order as listed on the application. If you do not have supporting documentation, do not list the professional development activity on your application. In-house training will be considered, however, candidates must provide verification from their employer of course dates, content and successful completion. Orientation training to meet job requirements may not be claimed in Factor 2.

Activity Value

A1. OHS courses/seminars/conferences of a minimum one day (6 hours) duration

1 point/day

A2. Non OHS course/seminars/conferences of a minimum of one day (6 hours) duration

1 point/day (to a maximum of 5 points)

B. College/university OHS credit course (not part of formal education – Factor 1)

10 points/course

A1. OHS courses/seminars/conferences, minimum of one day (6 hours duration) completed in the last five years.(60 months from date application received by BCRSP).

Course Provider Title of Course / Seminar / Conference

Total Hours

Start/Finish Dates QRC Use Only 1 2 2 2 3

Alberta Construction Safety Association

Confined Space Awareness

7 Mar 16/2010


Leadership for Safety Excellence

14 May 16-17/2010

St John Ambulance Standard First Aid 14 June 8-9/2010

University of Alberta Managing Contractor Safety Performance

14 Sept 15-16/2010

University of Alberta H&S Legislation 21 Feb 18-20/2009


Revised 2013

Factor 2 : Professional Development Minimum points required = 15; maximum points available = 100

ABC Manufacturing Accident Investigation 4 Apr 7, 2009 0 (not min 6 hrs) 1 Total: 11 2 5 MAXIMUM 5 POINTS AWARDED A1 +A2 Total: 17


Back Injury Prevention

7

Sept 4/2008

A2. Non OHS courses/seminars/conferences, minimum of one day (6 hours duration)., to a maximum of 5 points completed in the last five years. (60 months from date application received by BCRSP).

Course Provider Title of Course / Seminar / Conference

Total Hours

Start/Finish Dates

Excel Group Development Real Time Coaching 14 Dec 11-12/2008

Dale Carnegie Customer Service 35 Mar 6-10/2007

B. College or university credit courses having a duration of one semester or a minimum of 35 hours. College/university transcript must be attached in order to receive credit. Do not include courses completed for formal education programs claimed in Factor 1.

QRC Use Only 10 10

College/University Course Total Hours

Start/Finish Dates

University of Alberta Occupational Hygiene 39 Nov 19-28/2012

University of Alberta Hazard Recognition 39 Feb 6-13, 2012

IMPORTANT: The time limit for Category A1 and A2 professional development activities is five (5) years or 60 months. (The 5 years (60 months) is calculated from the date the application is received by BCRSP.) There is no time limit for Category B OHS credit courses. Online Courses: Points may be awarded based on technical contact time as identified by the course provider, not the actual contact time for the applicant completing the activity. If the course provider cannot provide contact time for the activity, no points will be awarded.


Revised 2013

Factor 3 : Professional Practice (Related Experience) Minimum points required = 50; maximum points available = 100

While the Board recognizes the value of specialists within the broad parameters of OHS, the CRSP is a generalist designation. Candidates are expected to demonstrate knowledge in the eleven domains identified in the Examination Blueprint.

Full-time OHS related experience Value

Minimum 36 months (3 years) 50

37-60 months (3 years - 5 years) 65

61-84 months (5 years - 7 years) 80

85+ months (7+ years) 100

Credit will be given for each year of continuous OHS employment to a maximum of eighty-five months (seven years). The minimum requirement for registration is thirty-six months (three years). The Qualifications Review Committee evaluates each job position using the criteria below to determine whether it is accepted as professional practice. Failure on any one means that the position is not accepted. 1. The position must be full time. This could include job-sharing. 2. The professional OHS function must be greater than 50% of the listed position’s duties, (i.e. – a minimum of 900 hours per year) The position’s responsibility must be the prevention of harm to people, property, and the environment, rather than the responsibility for responding to harmful events. Duties could include systems analysis, preventive methods, risk management, and audit functions. Collateral duties in OHS are not considered the primary function. 3. The position must be at a professional (engaged in an OHS occupation for pay or livelihood) level. This is determined by evaluating the responsibilities, activities, and reliance by peers, employers, or clients on the applicant’s ability to defend analytical approaches used in professional practice and the recommendations made for controlling hazards through engineering and/or administrative approaches. 4. The position must have a broad scope of duties. This is determined by evaluating the variety of hazards about which a candidate must advise and the range of skills involved in recognizing, evaluating, and controlling hazards. Examples of skills are analysis, synthesis, design, investigation, planning, administration, and communication. NOTE: University/college/co-op work terms may not be applied to professional practice.

YOU MUST ENCLOSE YOUR OFFICIAL JOB DESCRIPTION (ON COMPANY LETTERHEAD AND/OR VERIFIED/SIGNED BY HR OR SUPERVISOR) FOR YOUR CURRENT AND ANY PREVIOUS POSITIONS

CLAIMED UNDER FACTOR 3.

PLEASE ALSO ENCLOSE A CURRENT RESUME WITH YOUR APPLICATION.

If you do not have a formal job description, you must provide a detailed outline of your OHS responsibilities on company letterhead and have those responsibilities verified by a company official (e.g. HR department, immediate supervisor).


Revised 2013

Employer Job Title Dates Employed (Month/Year to Month/Year) Do not overlap months

QRC Use Only 100 (85+ months)

Current Employer ABC Manufacturing Co.

HSE Coordinator Mar/05-Current

1st previous employer

Premier Oil & Gas Ltd.

Safety Supervisor Sep/02-Feb/05

2nd previous employer

3rd previous employer

If time in current position is less than 36 months, you must provide a job description and confirmation from previous employer(s) confirming the 50% OHS content of your previous position(s) and employment dates for the 36 months immediately prior to application submission. Note: Gaps in employment due to parental leave, LTD, returning to school full-time, unemployment, etc, to a maximum of 12 months will not negate the 36-month continuous employment requirement but must be identified on the application. Employment gaps of more than 12 months will be assessed on a case-by-case basis.

Factor 3 Matrix Applicants must complete the following matrix to support the job description in outlining the percentage of their duties and responsibilities spent in the listed domain areas. Not including “General administrative duties” and “Other”, candidate position duties must include responsibility for at least four (4) domains, one of which MUST be Safety Techniques and Technology (STT). Percentage for minimum four (4) domains must total at least 50% of position duties.

Domain Mandatory Part of position duties?

Explanatory Notes QRC Use Only Yes (%) No

Safety Techniques and Technology (e.g. inspections, investigations, analysis, facilities management, safety operations, safety performance) please refer to the Examination Blueprint for details) Yes 40%

Environmental Practice No 10% Ergonomics No 5% Fire Prevention and Protection No 5%

HSE Auditing No % X External contracted function

Health and Wellness No % X HR Function Occupational Hygiene No 15% Risk Management No 5% General administrative duties No 20% Other (identify) No % X

Total 100% Please note: CRSPEX Domain areas of Accident Theory, Law and Ethics, Occupational Health Safety and Environment Systems are not required categories.

DECLARATION


Revised 2013

I certify that the information contained in this application and all documents attached thereto, are factual and accurate to the best of my knowledge and hereby request assessment by the Qualifications Review Committee. If approved to proceed with the certification process, I agree to present myself at a Regional Screening Centre of my choice for interview. If approved to write the certification examination (CRSPEX). I understand that the examination is a computer based test (CBT) based on the Examination Blueprint and administered at third party test centres contracted by the Board. I agree to abide by the Board’s Code of Ethics and understand that the Governing Board shall be the sole authority as to who shall and who shall not be approved for certification.

Signature: Robert Jones

Date: January 24, 2011

Application Assessment

The final determination of the acceptability of an applicant to proceed to a Regional Screening Centre interview is made by the Qualifications Review Committee. Candidates should not assume that their assessment of points awarded in Factors 1, 2 and 3 will be the same as that of the Qualifications Review Committee. A minimum total of 150 points from all three Factors is required for a candidate to proceed in the certification process. Candidates must obtain a minimum of 50 points in Factor 1 (Formal Education), 15 points in Factor 2 (Professional Development), and 50 points in Factor 3 (Professional Practice).

02 sample application & eligibility requirements

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