crsp practicequestionnaire_0

Board of Canadian Registered Safety Professionals CONFIDENTIAL6700 Century Ave, Suite 100, Mississauga, ON L5N 6A4905-567-7198 / 1-888-279-2777 / Fax 905-567-7191

PRACTICE QUESTIONNAIRE

Name of applicant

Name of employer client

Name of reference (direct supervisor/client)

Reference’s position/title

Reference’s telephone ( )

Email

I declare that the information contained in this practice questionnaire is complete and accurate to the best of my knowledge.

Reference’s Signature: Date:

NOTE TO APPLICANT: The person completing this Practice Questionnaire, your immediate supervisor or current client if you are an independent consultant, may NOT submit a Reference Questionnaire on your behalf.

NOTE TO REFERENCE: The applicant named above, a practicing OHS professional within your sphere of influence, is applying to become certified as a Canadian Registered Safety Professional (CRSP)®. The Practice Questionnaire will assist the Board in evaluating the applicant.

This format has been designed to allow you to complete the form in a minimum amount of time. Please complete the questionnaire as fully as possible by checking everything that applies and making any appropriate comments.

When you have completed the questionnaire, please return it directly to the Board at the address/fax noted above. Do not return the completed questionnaire to the applicant.

Thank you

Does the applicant‘s current OHS function encompass greater than 50% of their listed position’s duties? (i.e. – a minimum of 900 hours per year)

Yes No

If NO, please explain:

Do you have any reservations about recommending the applicant for CRSP certification?

Yes No

If YES, please explain:



SKILL TEACHING CAPABILITY

We are seeking to determine the applicant’s scope and ability to plan, prepare and conduct training sessions for company personnel dealing with the subject areas involved with Occupational Health and Safety (OHS).

Please check [] all appropriate categories:

Does the applicant train: New HiresManagers – all levelsSupervisorsExisting staffContractorsOthers, please specify:

Does the applicant conduct training outside your organization?

Yes No

Does the applicant train trainers? Yes No

What topics does the applicant cover in the training?

Safety & loss controlFire & emergency preparednessAccident investigationOccupational hygieneAuditingEnvironmental managementStandardsTask proceduresRisk evaluationErgonomicsAlternate workOther, please specify:

Does the applicant develop material that is specific to the company?

OR is the material “off-the-shelf”?

Yes

Yes

No

No

Does the applicant manage the training function?

Yes No

Does the applicant conduct needs analyses? Yes No

Does the applicant manage the training budget?

Yes No



Does the applicant teach any oh&s credit courses at any post-secondary institution– college or university?

Yes No

Comments:

PROBLEM SOLVING CAPABILITY

We wish to define and determine the applicant’s ability to apply problem-solving techniques, to develop and recommend solutions and/or strategies, and to stimulate action within the organization. The depth of the problem solving will depend on the degree of (a) analysis required – personal observation or scientific; (b) creativity – uniqueness of the solution; (c) synthesis – formation of an action plan and audit methodology to be used; (d) decisions – based on the results; (e) factors in the work environment – union(s), geographical location, etc.

Please check [] most appropriate category

Does the applicant apply routine solutions based on past experience, practice and knowledge?

Yes No

Does the applicant routinely go beyond the scope of past experience or experience to deal with solutions which are difficult and require the development of new standards, methods, unknown factors, alternative solutions, or procedures?

YesPlease provide an example:

No

Does the applicant require any advanced knowledge of oh&s principles and practices with a high degree of judgement to define the problem e.g. define a solution based on data not reaction?

Yes No

Does the applicant have the ability to perform and/or interpret any testing that may be required?

YesPlease provide an example:

No

Comments:

INDEPENDENT ACTION

We would like to have you evaluate the candidate’s ability to function as an independent oh&s professional.

Please check [] most appropriate category



Does the applicant accomplish work objectives with only occasional direction/approval from his/her supervisor?

Yes No

Is the applicant able to take action without requiring approval?

Yes No

Does the applicant develop objectives with the supervisor and accomplish them with little direction from the supervisor?

Yes No

Does the applicant work independently with developed objectives and is he/she accountable for achieving those objectives within budget?

Yes No

Comments:

DOMAINS

The CRSP is a generalist certification. If the applicant is approved to write the certification examination (CRSPEX), he/she will be tested in eleven subject areas (domains). To the best of your knowledge, please indicate the OHS areas of responsibility of the applicant’s position.

Please check [] all that apply

Accident TheoryEnvironmental PracticesErgonomicsFire Prevention and

Protection

Health and WellnessHSE AuditingLaw and EthicsOccupational Hygiene

Occupational Health Safety And Environment Systems

Risk ManagementSafety Techniques and

Technology

The Qualifications Review Committee and/or the Regional Screening Centre may contact the reference for follow up information or clarification as required.

crsp practicequestionnaire_0

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