ministry of safe at work ^•ontario

7
Ministry of Labour Safe At Work Operations Division Occupational Health and Safety ^•Ontario Field Visit Report Page 1 of 7 OHSCaselD: 03913HWJP184 Field Visit no: 03913HWQR191 Visit Date: 2014-DEC-18 Field Visit Type: INITIAL Workplace Identification: LORETTO ABBEY CATHOLIC SECONDARY SCHOOL 101 MASON BOULEVARD , NORTH YORK , ON, CANADA M5M 3E2 Notice ID: Telephone: (416)393-5510 JHSC Status: Inactive Work Force #: 73 Completed %: Persons Contacted: ANITA BARTOLINI - PRINCIPAL, MICHAEL NICOLAIDIS - TORONTO SECONDARY UNION HEALTH AND SAFETY REPRESENTATIVE, VITO AMADIO - ACTING HEAD CARE TAKER. Visit Purpose: TO COLLECT INFORMATION RELATED TO A COMPLAINT RECEIVED BY THE MINISTRY OF LABOUR. Visit Location: 101 MASON BOULEVARD, TORONTO. DIFFERENT AREAS OF THIS WORKPLACE. Visit Summary: SEE DETAILED NARRATIVE. ORDERS ISSUED. ACCOMPANIED BY THEMINISTRY OF LABOUR INDUSTRIAL HYGIENIST DAVID WINTER. Detailed Narrative: This visit was made in response to a complaint received by the Ministry of Labour on December 11 2014. In general information related to this complaint is as follow: There are health and safety concerns related to mould and worker's mould exposure at this workplace and environmental testing of mould without consultation. These inspectors visited the workplace on December 18, 2014 and met with the workplace parties. The above mentioned health and safety concerns were reviewed, discussed and clarified. FINDINGS 1 .It was indicated that there are approximately 80 workers regularly employed at this workplace. 2. It was explained that there are some ongoing water leakage problems related to foundation of this building. 3. The employer representative was asked to provide a copy of the email from TCDSB to the employer representative related to last environmental assessment done at this workplace by DCS Company on December 10, 2014. Copy of this correspondence (12 pages) has been provided to this inspector. It was explained that this testing has been done to clarify issues related to the mould brought by one of the student's parent, not by a worker. 4. Workplace parties indicated that numerous environmental assessments related to water damage mould at this workplace have been conducted in the last coupfe years. 1' 5. The employer shall provide to the Ministry of Labour environmental reports from November 29, 2uU"to December 18, 2014. REQUIREMENT ISSUED, Recipient Name Title Signature Inspector Data YEVGENLESHCHENKO OCCUPATIONAL HEALTH & SAFETY INSPECTOR PROVINCIAL OFFENCES OFFICER 5001 Yonge Street, Suiie 1600 North York, Oljl M7AOA3 Tel: 647-777-5062 Fax:647-777-5013 Signature Worker Representative Name Title Signature You are required under the Occupational Health and Safety Act to post a copy of this rep representative or the joint health and safety committee if any. Failure to comply wiih an o Occupational Health and Safety Act- You have the right to appeal any order or decision by filing your appeal and request in writing on the appropriate forms with the Ontario Lab contact the Board by phone at (416) 326-7500 or 1-877-339-3335 (toll free), mail or by web* our Relations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may also

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MinistryofLabour Safe At Work

OperationsDivision

OccupationalHealth and Safety

^•OntarioField Visit Report

Page 1 of 7

OHSCaselD: 03913HWJP184Field Visit no: 03913HWQR191 Visit Date: 2014-DEC-18 Field Visit Type: INITIALWorkplace Identification: LORETTO ABBEY CATHOLIC SECONDARY SCHOOL

101 MASON BOULEVARD , NORTH YORK , ON, CANADA M5M 3E2Notice ID:

Telephone:(416)393-5510

JHSC Status:Inactive

Work Force #:73

Completed %:

Persons Contacted: ANITA BARTOLINI - PRINCIPAL, MICHAEL NICOLAIDIS - TORONTO SECONDARY UNION HEALTH AND SAFETYREPRESENTATIVE, VITO AMADIO - ACTING HEAD CARE TAKER.

Visit Purpose: TO COLLECT INFORMATION RELATED TO A COMPLAINT RECEIVED BY THE MINISTRY OF LABOUR.Visit Location: 101 MASON BOULEVARD, TORONTO. DIFFERENT AREAS OF THIS WORKPLACE.Visit Summary: SEE DETAILED NARRATIVE. ORDERS ISSUED.

ACCOMPANIED BY THE MINISTRY OF LABOUR INDUSTRIAL HYGIENIST DAVID WINTER.

Detailed Narrative:

This visit was made in response to a complaint received by the Ministry of Labour on December 11 2014. Ingeneral information related to this complaint is as follow:

There are health and safety concerns related to mould and worker's mould exposure at this workplaceand environmental testing of mould without consultation.

These inspectors visited the workplace on December 18, 2014 and met with the workplace parties. The abovementioned health and safety concerns were reviewed, discussed and clarified.

FINDINGS

1 .It was indicated that there are approximately 80 workers regularly employed at this workplace.

2. It was explained that there are some ongoing water leakage problems related to foundation of this building.

3. The employer representative was asked to provide a copy of the email from TCDSB to the employerrepresentative related to last environmental assessment done at this workplace by DCS Company onDecember 10, 2014. Copy of this correspondence (12 pages) has been provided to this inspector. It wasexplained that this testing has been done to clarify issues related to the mould brought by one of the student'sparent, not by a worker.

4. Workplace parties indicated that numerous environmental assessments related to water damagemould at this workplace have been conducted in the last coupfe years.

1'5. The employer shall provide to the Ministry of Labour environmental reports from November 29, 2uU"toDecember 18, 2014. REQUIREMENT ISSUED,

Recipient

Name

Title

Signature

Inspector Data

YEVGEN LESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTOR

PROVINCIAL OFFENCES OFFICER

5001 Yonge Street, Suiie 1600North York, Oljl M7A OA3

Tel: 647-777-5062Fax:647-777-5013

Signature

Worker Representative

Name

Title

Signature

You are required under the Occupational Health and Safety Act to post a copy of this reprepresentative or the joint health and safety committee if any. Failure to comply wiih an oOccupational Health and Safety Act- You have the right to appeal any order or decisionby filing your appeal and request in writing on the appropriate forms with the Ontario Labcontact the Board by phone at (416) 326-7500 or 1-877-339-3335 (toll free), mail or by web*

our Relations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may also

MinistryofLabour Safe At Work

OperationsDivision

OHSCaselD:Field Visit no:

OccupationalHealth and Safety

03913HWJP18403913HWQR191

Field Visit ReportPage 2 of 7

Visit Date: 2014-DEC-18 Field Visit Type; INITIALWorkplace Identification: LORETTO ABBEY CATHOLIC SECONDARY SCHOOL Notice ID:

101 MASON BOULEVARD, NORTH YORK, ON, CANADA M5M 3E26. This inspector asked for any concerns that have been brought to the employer in regards worker's mouldexposure.

7. The worker's representative provided copies of health and safety workplace hazard reports from September2013 to Decembers, 2014 [11 pages) to this inspector as well asTSU health survey conducted in December2014 (21 pages).

8. Different areas of this workplace has been visited and observed for water damage and mould sings.Photographs of water damages and mould signs in different areas of this workplace have been taken.

9. Comments of the MOL engineer Jeffrey Matheuszik:

The radiating units were observed in classrooms 329 and 331. In both classrooms the unshielded radiating unitspresented a tipping hazard whether they were plumbed into the piping system or not.

End of comments.

10. The employer shall take any precautions reasonable in circumstance for protection health and safety ofthe workers from hazard of steam radiator tipping and falling to the floor in different areas and classrooms ofthis workplace. At the time of this visit steam radiators in rooms 215, 331 and 329 have been observed to bestanding on its legs without any brackets and support with two pipes connections at the bottom of theseradiators. ORDER ISSUED.

11 The radiators located throughout the workplace were operating in some cases at high temperatures.Surface temperatures were measured to be approximately 100 degrees Celsius. No barriers or shields werepresent to protect workers from contacting the surface of the radiators. The employer is advised to conduct arisk assessment considering whether installation of shielding may be appropriate in the circumstances.

12. The electrical junction box located in the South East corner of the gym area was observed without cover.All wires have isolation. The employer is reminded to maintain this equipment in good condition and install thecover.

13. Industrial Hygienist Comments:

This field visit was performed to investigate a complaint related to mould growth within various areas of theworkplace. Please note that not all areas of the workplace were inspected during this investigation.

Recipienf

Name

Title

Signature

Inspector Data

YEVGEN LESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTOR

PROVINCIAL OFFENCES OFFICER

5001 Yonge Street^uite 1600North York, ON p/A OA3

Tel: M7-777/5062

Fax: 647-777-5013

Signature

Worker Representative

Name

Title

Signature

You are required under Ihe Qccupafional Health and Safely Ac! lo post a copy of Ihis repaff in a conspicuous place at the workplace and provide a copy to the health and safetyrepresentative or the joint heallhdnd safety committee if any, Failure to comply with an aitih, decision or requirement of an inspector is an offence under Section 66 of theOccupational Health and Safety Act. You have the right to appeal any order or decision wijhin30days of the date of the order issued and lo request suspension of the order or deoisionby filing your appeal and request in writing on the appropriate forms with the Ontario Labjiur Relations Board, 505 University Ave.. 2nd Floor, Toronto, Ontario M5G 2P1. You may alsocontact the Board by phone at [416] 32fr7500 or 1-877-339-3335 [toll free), mail or by websti at http://www.oirb.gov.on.ca/english/homepage.htm for more information.

Ministry

Labour Safe At Work r>>P^u

Operations OccupationalDivision Health and Safety

OHSCaselD: 03913HWJP184Field Visit no: 03913HWQR191

ntarioField Visit Report

Page 3 of 7

Visit Date: 2014-DEC-18 Field Visit Type: INITIALWorkplace Identification: LORETTO ABBEY CATHOLIC SECONDARY SCHOOL Notice ID:

101 MASON BOULEVARD, NORTH YORK, ON, CANADA M5M 3E2It was discussed that historic and current foundation and water infiltration issues have led to mould growth andwater damage in some areas of the workplace. In addition, peeling paint is present in various areas of thebuilding, where water infiltration is occurring or has occurred in the past. Given that the building was built inapproximately 1928 it is very likely that the paint may be lead containing. As such, appropriate precautionsmay be required during removal of this material. Refer to the Ministry of Labour Guideline Lead onConstruction Projects for additional information.These inspectors were informed that currently an independent engineering company has been retained toinvestigate foundation and drainage issues at this workplace. It was indicated that a report with remedialrecommenddtions will follow this assessment and is expected to be delivered within the next few weeks.Currently various areas of the workplace have been shut down as an interim measure due to mouldcontamination. These areas included, but were not limited to, the Youth Worker Office, Computer Classroom,Custodians Office, and various other rooms.The employer is in the middle of their investigation into the source of the water infiltration issues, which are likelyrelated to the mould growth identified. The employer representative agreed to provide a copy of the reportsrelated to the foundation investigation to this inspector.Given that water infiltration and mould growth issues are present the employer shall provide to the Ministry ofLabour a compliance plan related to the issues of water infiltration and mould growth at this workplace.ORDER ISSUED. The employer shall continue to implement interim precautionary measures until such time thatremediation of the water infiltration and mould growth can be completed.The compliance plan should include, but may not be limited to, interim precautionary measures to beimplemented to address to the hazard of mould growth, including personal protective equipment potentiallyrequired for workers required to be in these areas; remediation of potential foundation and drainage issues;mould remediation of the various locations where mould growth is identified and related remediation such aslead paint and asbestos removal [if present and required based on the scope of work to be determined);proposed timelines for completion of the remediation work required.The employer should consider performing a comprehensive environmental/mould assessment of theworkplace to identify all potential areas of remediation if this has not been completed already. Thisassessment should be a component of the compliance plan if not already performed.The employer is advised that mould remediation, which may disturb building materials may require thatasbestos abatement procedures [Ontario Regulation 278/05) be implemented if materials which may berequired to be removed are found to be asbestos-containing.

Further information on mould and list of related resources may be found in:The Ministry of Labour Alert "Mould in Workplace Buildings" at:http://www.labour.gov.on.ca/english/hs/pubs/alerts/a20.phpThe EPA document on "Mold Remediation in Schools and Commercial Buildings":

Recipient

Name

Title

Signature

Inspector Data

YEVGEN LESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTOR

PROVINCIAL OFFENCES OFFICER

5001 Yonge StreetfSuife 1600North York, Oiy M7A OA3

Tel: 647-777-5062Fax: 647-7(77-5013

Signature

Worker Representative

Name

Title

Signature*—f

You are required under the Occupational Health and Safety Act to post a copy of this rrepresentative or the joint health and safety committee if any. Failure to comply wilh ar/orjOccupational Health and Safety Act You have the right to appeal any order or decision voy filing your appeal and request in writing on the appropriate forms with the Ontario Lhbccontact the Board by phone at (416| 326-7500 or 1-877-339-3335 (toll free), mail or by wabsi

ill^r, .—-nspicuous place at the workplace and provide a copy to the health and safetytr, dec|sion or requirement of an inspector is an offence under Section 66 of the

ithin 30 days of the date of the order issued and to request suspension of the order or decisionur Relations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may alsoe at http://www.olrb.gov.on.ca/english/homepage.htrn for more information.

Ministry

Safe At Work

OperationsDivision

OHS Case ID:Field Visit no:

OccupationalHealth and Safety

03913HWJP18403913HWQR191

Field Visit ReportPage 4 of 7

Visit Date: 2014-DEC-18 Field Visit Type: INITIALWorkplace /denhT/caf/on: LORETTO ABBEY CATHOLIC SECONDARY SCHOOL Notice ID:

101 MASON BOULEVARD , NORTH YORK , ON, CANADA M5M 3E2http://www.epa.gov/mold/mold_remediation.html=Guidelines on Assessment and Remediation of Fungi in Indoor Environments. New York City Department ofHealth:www.nyc.gov/html/doh/html/epi/moldrpti.shtmlHealth Canada: Funga! Contamination in Public Buildingswww.hc-sc.gc.ca/ewh-semt/pubs/air/fungal-f ongique/index_e.html

14. The workplace parties are reminded that the responsibility for workplace occupational hedlth and safety isshared between the employer and the workers. This concept is referred to as an internal responsibility system(IRS) and is based on the principle that the workplace parties themselves are in the best position to identifyhealth and safety problems and to develop solutions. Ideally, the IRS involves everyone, from the companychief executive officer to the worker. The IRS means everyone in the workplace has a role to play and a dutyto actively ensure workers are safe. Every worker who sees a health and safety problem such as a hazard inthe workplace has a duty to report the situation to management. Once a hazard has been identified, theemployer and supervisor have a duty to look at the problem and address any hazard that could injure workers.To ensure that the IRS functions it is imperative that workers, who determine that equipment or protectivedevices are not working properly, see or sense there is a hazard in the workplace that could cause injury, or ifthey know that Ontario's health and safety laws are not being followed, report the circumstances to theirworker's JHSC member, supervisor or employer as soon as possible to allow the workplace IRS to function asintended.

15. The employer was advised under section 50 of the Occupational Health and Safety Act for reprisal.

50. [1) No employer or person acting on behalf of an employer shallfa) dismiss or threaten to dismiss a worker; employer(b) discipline or suspend or threaten to discipline or suspend aworker;(c) impose any penalty upon a worker; or(d) intimidate or coerce a worker,because the worker has acted in compliance with this Act or the regulations or an order made thereunder,has sought the enforcement of this Act or the regulations or has given evidence in a proceeding in respect ofthe enforcement of this Act or the regulations or in an inquest under the Coroners Act. R.S.O. 1990, c. O.I, s. 50

C).

16. Although the employer has been allowed time to comply with the orders issued in this report, it is theemployer's responsibility to implement interim precautions to protect workers before orders are fully complied

Recipient

Name

Title

Signature

Inspector Data

YEVGEN IESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTOR

PROVINCIAL OFFENCES OFFICER

5001 Yonge Street Suite 1600North York, ON/M7A OA3

Tel: 647-777-5062Fax: 647-777-5013

r I

Signature

Worker Representative

Name

tit le

Signature

You ore required under the Occupational Health and Safely Acl to post a copy of this reportrepresentative or the joint health and safety committee if any. Failure to comply with anOccupational Heaith and Safety Act. You have the right to appeal any order or decisionby filing your appeal and request in writing on the appropriate forms with the Ontario LaboVirconlact the Board by phone at [416] 326-7500 or 1-877-339-3335 (toll free), mail or by websit

n a conspicuous place at the workplace and provide a copy to the health and safetyr, decision or requirement o! an inspector is an offence under Section 66 of theiln 30 days of the date of the order issued and to request suspension of the order or decisionRelations Board, 505 University Ave., 2nd Hoor. Toronto. Ontario M5G 2P1. You may alsoat http://www.olrb.gov.on.ca/english/hornepage.htm for more information.

MinistryofLabour

OperationsDivision

Safe At Work

OccupationalHealth and Safety Field Visit Report

Page 5 of 7OHSCaselD: 03913HWJP184Field Visit no: 03913HWQR191 Visit Date: 2014-DEC-18 Field Visit Type: INITIALWorkplace Identification LORETTO ABBEY CATHOLIC SECONDARY SCHOOL Notice ID:

101 MASON BOULEVARD, NORTH YORK, ON, CANADA M5M 3E2with. If the employer cannot provide interim precautions, then the equipment or area where its located mustnot be used.

^TAKE NOTE=

A COPY OF THIS REPORT SHALL BE POSTED IN THE WORKPLACE.

UPON COMPLIANCE OF ORDERS, THE ATTACHED NOTICE OF COMPLIANCE FORM SHALL BE RETURNED TO THEMINISTRY OF LABOUR OFFICE, FAX NUMBER LISTED BELOW, WITH THE APPROPRIATE SIGNATURES OF WORKPLACEPARTIES.

IT IS A RESPONSIBILITY OF THE EMPLOYER AND WORKPLACE PARTIES TO ENSURE ONGOING AND CONTINUOUSCOMPLIANCE TO THE OCCUPATIONAL HEALTH AND SAFETY ACT AND ITS ASSOCIATED REGULATIONS. FAILURE TOCOMPLY WITH THE ACT, OR AN INSPECTOR'S ORDER, IS AN OFFENCE UNDER SECTION 66 OF THE OCCUPATIONALHEALTH AND SAFETY ACT AND MAY CAUSE FURTHER ACTIONS TO BE TAKEN BY THE MINISTRY OF LABOUR.

<END>

Recipient

Name

Inspector DataYEVGEN LESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTORPROVINCIAL OFFENCES OFFICER

5001 Yoncje Street, Suite 1600North York, OhtfM7A OA3

Worker Representative

Signature

Tel: 647-77Fax:647-75

Signature

-50627-5013

Name

Title

Signature

You are required under the Occupational Health and Safety Act lo post a copy of this re|representative or the joint health and safety committee if any. Failure to comply with an oVd.Occupational Health and Safety Act. You have the right to appeal any order or decision Ivitby llling your appeal and request in writing on the appropriate forms with the Ontario Labbucontact the Board by phone at [416) 326-7500 or 1-877-339-3335 (toll free), mail or by webslle

n a conspicuous place at the workplace and provide a copy to the health and safety. decision or requirement of an inspector is an offence under Section 66 of thein 30 days of the dale of the order issued and to request suspension of the order or decisionDelations Board, 505 University Ave.. 2nd Floor, Toronto, Ontario M5G 2PI. You may alsoit http://www.olrb.gov.on.ca/engli5h/homepage.htm for more Information.

MinistryofLabour Safe At Work

OperationsDivision

OccupationalHealth and Safety Field Visit Report

Page 6 of 7

OHSCaselD: 03913HWJP184Field Visit no: 03913HWQR191 Visit Date: 2014-DEC-18 Field Visit Type: INITIALWorkplace Idenrtficafforc LOREHO ABBEY CATHOLIC SECONDARY SCHOOL Notice ID:

101 MASON BOULEVARD, NORTH YORK, ON, CANADA M5M 3E2Order/sJ /Requirement(s) Issued Jo:

To:TORONTO CATHOLIC DISTRICT SCHOOL BOARD

Mailing Address:1196 COLLEGE ST, TORONTO, ON, CA M6H 1B8

Org/lnd RolePrimary Employer

Orderfs) /Requirements] Description:You are required to comply with the orderfs) /requirement(s) by the dates listed below.

No TypeCode

AcfReg Year Sec. Sub ClauseSec.

Text of Order/Requirement Comply by Date

1 Rqmt OHSA 1990 5403913HWQS192

2 Time QHSA 1990 2503913HWQH93

3 TimeU QHSA 1990 2503913HWQT194

The employer shall provide to the Ministry ofLabour environmental reports related to waterdamage and mould at the Loretto AbbeySecondary School from November 29, 20l4JoDecember 18, 2014. fij&>

The employer shall take any precautionsreasonable to protect health and safety of theworkers from the hazard of steam radiator tippingand falling to the floor in classrooms. At the time ofthis visit steam radiators in rooms 215, 331 and 329have been observed to be standing on its legswithout any brackets and support with two pipesconnections at the bottom of these radiators.

The employer shall take every precautionreasonable in the circumstances for protection ofthe health and safety of the workers at thisworkplace from hazard of mould exposure.At the time of this visit visible mould was observedin various areas of this workplace, including butnot limited to, the computer room (106A),basement telephone room and room 103.

2015-JAN-05

2015-JAN-05

Recipient

Name

Title

Inspector Data

YEVGEN LESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTOR

PROVINCIAL OFFENCES OFFICER

5001 Yorige StreeA Suite 1600

Worker Representative

North York, Of

Signature

Tel: 647-77 P-5062Fax: 647-7/7-5013

Signature

/M7A OA3

Name

Title

Signature

You are required under the Occupational Health and Safely Act to post a copy of this repirepresentative or the joint health and safety committee it any. Failure to comply with an ordOccupational Health and Safety Act. You have the right to appeal ony order or decision wtby filing your appeal and request In writing on the appropriate forms with the Ontario Labou,contact the Board by phone at (4161 326-7500or 1-877-339-3335 (toll free], mail or by website

n a conspicuous place at the workplace and provide a copy to the health and safety, decision or requirement of an inspector is an offence under Section 66 of then 3D days of the date of the order issued and to requesl suspension of the order or decisiondelations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may alsoit http://www.olrb.gov.on.ca/english/homepage.htm for more information.

MinistryofLabour Safe At Work

OperationsDivision

OccupationalHealth and Safety

OntarioField Visit Report

Page 7 of 7OHSCaselD: 03913HWJP184Field Visit no: 03913HWQR191 Visit Date: 2014-DEC-18 Field Visit Type: INITIALWorkplace /denflf/cafiorr LORETTO ABBEY CATHOLIC SECONDARY SCHOOL Notice ID:

101 MASON BOULEVARD, NORTH YORK, ON, CANADA M5M 3E2Order(s) /Requirements) Issued To:

To:

TORONTO CATHOLIC DISTRICT SCHOOL BOARD

Mailing Address:1196 COLLEGE ST, TORONTO, ON, CA M6H 1B8

Org/lnd RolePrimary Employer

Order(s) /Requirement(s) Description;You are required to comply with the order(s) /requirement(s) by the dates listed below.

No TypeCode

ActReg Year Sec. Sub ClauseSec.

4 Plan OHSA03913HWQT195

1990 57

5 Time OHSA 1990 2503913HWQT196

Text of Order/Requirement Comply by Date

The employer shall submit to the Ministry of Labour 2015-JAN-16a compliance plan prepared in the manner andincluding such items as required by the ordern?

The employer shall ensure that cover above theventilator located on the window in room 102 A ismaintained in good conditions and installed onthis ventilator.At the time of this visit this ventilator was observedwith cover removed and hanging on electricalcord allowing access to the moving ventilator.

2014-DEC-19

Recipient

Name

Title

Inspector Data

YEVGEN LESHCHENKO

OCCUPATIONAL HEALTH & SAFETY INSPECTOR

PROVINCIAL OFFENCES OFFICER

5001 Yonge Strdet, Suite 1600North York, CN M7AOA3

Worker Representative

Signature

Tel: 647-5

Fax: 647-:

Signature

7-5062

77-5013

Name

Title

Signature

You are required under Ihe Occupational Health and Safely Act to post a copy of this ripor the joint health and safety committee it any. Failure to comply with anpr

Occupational Health and Safety Act. You have the right lo appeal any order or decisioiby filing your appeal and request in writing on the appropriate forms with the Ontario Lacontact the Board by phone at [416] 326-7500 or 1-877-339-3335 (toll free), mail or by websj

rt in a conspicuous place at the workplace and provide a copy to the healfh and sofelyer. decision or requirement of an inspector is an offence under Section 66 of thehin 30 days of the dale of the order issued and to request suspension of the order or decisionr Relations Board, 505 University Ave., 2nd Floor, Toronto, Ontario M5G 2P1. You may alsoj at http://www.olrb.gov.on.ca/engll5h/homepage.htm for more information.