The Ministry of Labour, Immigration, Training and Skills Development (MLITSD) enforces the Occupational Health and Safety Act (OHSA). They do this by sending inspectors to visit workplaces to ensure the OHSA is being followed.
An Inspector will complete a Field Visit Report for each site visit and list orders given to the workplace parties to ensure compliance. Although all field visit reports will contain a reason or purpose for the visit, they frequently do not have orders. Because the Ministry enforces the OHSA, they are sometimes referred to as the external responsibility system (ERS). They are the external authority a Joint Health & Safety Committee (JHSC) member will call to complain, when the employer is contravening the OHSA and putting the safety of workers at risk.
Peterborough Regional Health Centre
This employer was failing to provide notices to the JHSC and the trade union as required by section 52 2 of the act and section 5 of the Healthcare Regs. That is now covered by the new notices regulation for sections 51-53 of of the OHSA regulation which went into effect July 1, 2021, titled O. Reg. 420/21: Notices and reports under sections 51 to 53.1 of the Act – Fatalities, Critical Injuries, Occupational Illnesses and other incidents.
The employer was required to provide all the information required by section 52 (2) and section 5 of the Healthcare Regs.
Early in the pandemic, certain employers were refusing to provide names of the workers who were infected with COVID-19. This was a clear violation of section 5 of the Healthcare Regulations. This order confirmed that the employer had to comply with section 5 of the Healthcare Regulations.
Eatonville Care Centre
Eatonville was one of the hardest hit long-term care (LTC) homes in the first wave of the pandemic. It was one of the homes covered by the Justice Morgan decision. As ONA was escalating the health and safety issues, the SEIU was doing the same. The ongoing inspections of Eatonville were part of a settlement of an SEIU appeal for a failure to issue orders.
The management co-chair was chairing all the Joint Health and Safety Committee (JHSC) committee meetings. The order required that the workers select a co-chair of their own and that the chair of the meetings rotates between management and worker co-chairs.
There were multiple issues with occupational illness reports. There were 106 total reports, but the Ministry only received 104. The order required the missing reports be shared with the Ministry. The occupational illness reports were not being shared with the committee. The order required the occupational illness reports go to the JHSC. The inspector also ordered the Public Health Ontario Outbreak checklists, all Form 7s from WSIB for COVID-19, and the minutes from the COVID-19 committee.
In the first wave Ministry inspectors were only going to LTC homes if there was a work refusal. It was not surprising that as soon as an inspector set foot in a home that had a bad outbreak (106 occupational illness cases is an extremely bad outbreak), we saw meaningful orders.
The inspector using their powers to review documents like the Public Health Ontario checklist was important. ONA would have liked to see the Ministry extend this to requiring exposure reports go to the Joint Health and Safety Committee but unfortunately, we have had to fight the Ministry on this issue since very early on in the pandemic.
Extendicare, Laurier Manor
The employer was requiring reuse of procedural masks on the 5th floor.
The employer was required to cease the practice of requiring staff to reuse contaminated procedural masks.
Providing workers with a limited number of masks was a major issue for ONA and other unions in LTC in the spring of 2020. Even though this was a widespread problem in LTC, particularly for members of other unions, it was rare we saw orders issued.
London Health Sciences Centre – Victoria Hospital
Inadequate measures and procedures (pre-screening, identifying safe and hazard zones, appropriate training, proper signage) related to MRI protocols.
The inspector ordered that the Employer must:
- Establish appropriate measures and procedures and complete them in writing to ensure there is appropriate pre-screening before entering the MRI zone,
- Ensure appropriate training to pre-screen prior to entry is completed as we; as appropriate training for staff to enter the zone safely,
- That safe and hazard zones are identified with appropriate signage to warn of the restricted area.
A thorough investigation and comprehensive list of orders were issued as well as interim orders to ensure the safety of all entering the restricted zone.
Guelph General Hospital
A critical injury (to a CUPE member) resulted after a slip on the OR floor.
Due to exposure of risks from wet/damp floors (OR department), the employer was ordered to ensure workers are wearing slip resistant soles.
This order requires that the employer ensure that workers wear slip resistant soles. In this bargaining unit, ONA members are not reimbursed or provided an allowance for footwear. Reimbursement of sole resistant footwear is an issue that could be addressed bargaining.
William Osler Health System – Brampton Memorial Hospital Campus
All aspects of OHSA were not being applied during the pandemic, including workplace inspections.
Employer was ordered to put measures & procedures in writing and restart monthly inspections.
OHSA was not displaced or suspended during the pandemic. These orders required the employer to maintain their statutory obligation to permit monthly inspections, as well as putting measures and procedures (including IPC initiatives) in writing.
Arnprior Regional Health Centre
Denial of an N95 respirator following a point of care risk assessment.
The employer was ordered to provide the N95 respirator.
This was an early order requiring the employer comply with Directive 5.
Anson Place Long-Term Care
The LTC home had a COVID-19 outbreak which prompted an investigation by the Ministry. At the time of inspection, there were 34 workers and 44 residents who tested positive for COVID-19. There were several safety issues found during the inspection, including the employer’s failure to follow public health guidance regarding physical distancing and screening, not following measures and procedures regarding Aerosol Generating Medical Procedures, failing to have an established Joint Health and Safety Committee, and failing to instruct workers on how and where to properly store their PPE when they take their breaks.
This home had nine orders issued. The inspector was thorough in their investigation and compliance dates were quick to ensure that violations of the OHSA were corrected ASAP. The inspector issued orders that required the employer ensure for proper physical distancing and personal protective equipment during screening and to ensure all required questions were asked on the Ministry of Health’s screening tool. There was also an order for the Employer to provide the information and instruction to protect the health and safety of workers regarding COVID-19.
A number of orders were written regarding Personal Protective Equipment. One order was written for the instruction and training of workers regarding PPE because not all staff were aware of the need to wear an N95 respirator when caring for a patient on a CPAP machine and to keep the door of the residents’ room closed. An order was written to ensure workers are instructed in the care and use of the PPE so it can be properly stored when on break. The employer was also required to ensure that the PPE is stored in a clean and sanitary location when not in use. Employers are responsible to ensure that employees are properly trained on the care use and limitations of personal protective equipment (PPE).
The employer was also required to establish and provide training in consultation with the JHSC on measures relevant to the worker’s work; not all workers were aware of the process to get additional PPE during off shifts. The inspector asked for copies of the JHSC inspection reports, and it was noted that the last one was done in February 2020. This is a violation of OHSA and an order was written to require the Employer to ensure the JHSC is established and functioning according to the Act.
Due to the nature of the COVID-19 virus, it is important to ensure that health and safety measures are in place to protect the workers. Workers (i.e., screeners) were putting themselves and others at risk by not asking all of the required screening questions since they were not properly informed or trained by their employer. These orders ensure that workers are aware of the precautions that need to be implemented in order to ensure for safety; the orders also recognize that instruction and training are an important element to ensuring for worker safety.
It was evident that the JHSC was not functioning at this workplace in accordance with the OHSA. One of the core functions of the JHSC to help identify hazards in the workplace and make recommendations to resolve them. If inspections are not done, hazards can’t be identified, and workers are left at risk. The inspector identified gaps in knowledge and use of personal protective equipment, including how to access it, which puts workers at risk for their health and safety during a COVID-19 outbreak.
North Bay Regional Health (Hospital)
Workers providing direct care to COVID-19 suspected patients were being instructed to reuse procedural masks after breaks and lunches.
The employer was required to ensure that, once a mask is removed after treating a COVID-19 patient, it should not be reused.
It confirms that employers have a duty to provide a safe working environment and ensure that staff are not put at risk. This order stopped the reuse of masks which increased the risk of transmission to the worker of COVID-19 infection.
Baycrest Health Sciences
A nurse was denied N95s in a COVID Assessment Centre despite completing a point-of-care risk assessment (PCRA).
Inspector ordered employer to provide PPE as per a nurse’s PCRA.
Employer denied or did not provide PPE for protection against aerosol transmission contrary to Directives 3 & 5. The Ministry ordered compliance with the directives. The order was made under OHSA – Duties of employers, Sec 25(2)(h) to every reasonable precaution in the circumstances for the protection of workers.
Michael Garron Hospital
ICU Nurses were denied N95s.
Inspector ordered employer to provide PPE as per nurses’ PCRA.
Employers denied or did not provide PPE for aerosol transmission contrary to Directives 3 & 5. The Ministry ordered compliance with the directives.
Region of York
Public Health – Measures & Procedures – employer was not controlling access to workplace to reduce risk of COVID-19
Employer to develop measures and procedures for the entrance of the work area. Employer should document all workers/visitors to the workplace.
The employer did not have active screening before entry to the workplace. The Ministry ordered compliance with public health measures to reduce the transmission of COVID-19 by implementing screening before entry to the workplace. Although no order was written, the employer was reminded that a worker co-chair must be selected in accordance with the Act (Sec. 9(8)).
William Osler Health Centre – Brampton Civic Hospital
During two separate visits, the inspector noted several hazards with how items were being stored (i.e boxes on the floor, chairs in hallway.) He also noted that work surfaces were damaged (i.e. holes in walls, damaged countertops.)
- Materials, articles or things are to be stored in a manner that will not cause a hazard.
- The employer shall ensure that a work surface shall be kept free of obstructions & hazards that may endanger a worker.
- Employers shall ensure that equipment, materials, and protective devices provided by the employer are maintained in good condition.
During workplace inspections, JHSC worker reps note clutter and improper storage of items/equipment, as well as holes in the wall, damaged work surfaces and damaged ceiling tiles on their reports. Employers often dismiss these as hazards as they consider them cosmetic issues; these orders validate that these are health and safety issues
Hamilton Health Sciences – Juravinski Hospital and Cancer Centre
Technical grade ethanol was used instead of food grade alcohol causing adverse skin reactions. The Procedure related to new products was maintained in the purchasing department and not the health and safety department.
The employer shall ensure that, at least once a year, the measures and procedures for the health and safety of workers shall be reviewed and revised in the light of current knowledge and practice. At the time of investigation, the new or trial product approval at the workplace had not been reviewed since 2016 and did not consider the current pandemic situation.
The employer remains accountable for coordinating with other departments to maintain health and safety and uphold their own policies for annual review.
Grand River Hospital
The MLTSD was called because the workers were concerned about new gloves being introduced that were “not fit for medical use”. The JHSC was not consulted about this. Previously used gloves were on site but were not made available to staff. While the employer did do further assessment on the new gloves, and the gloves could be acceptable to use in some areas, the JHSC was not consulted.
The employer, in co-operation with the JHSC, shall review and revise measures and procedures that may affect the health and safety of a worker with respect to implementing the change in personal protective equipment (gloves). At the time of the visit, it was established there was no consultation with the JHSC.
The employer was not appropriately involving the JHSC. Regardless of having a substitute (previous gloves) available, the MLTSD still identified that the employer must consult with the JHSC.
William Osler Health Centre – Fletcher Assessment Centre
This inspection was the result of a complaint to the MLTSD over the lack of precautions in place at a relatively newly opened assessment centre run by William Osler. There were several health and safety issues that were addressed by the inspector.
The orders addressed both physical and occ illness hazards as well as the establishment of a JHSC for the centre.
The inspector ordered active screening of patients to be implemented.
The inspector ordered that protective eyewear be required within 2 meters of a patient.
The inspector required physical distancing to be maintained in the lunchroom while unmasked.
The inspector required the employer provide lighting be installed in the walk-in tent where patients were being assessed after dark.
The employer required tripping hazards (chords) be removed.
The inspector required tables that were not in use to be stored safely.
Finally, and most importantly the inspector required the establishment of a JHSC.
This set of orders is quite long. The inspector did a good job of inspecting the assessment centre as a whole. This in person assessment allowed the inspector to write orders.
As COVID-19 is transmitted by aerosols we do not agree that distancing is enough in and off itself in a lunchroom, but the orders made it clear that the employer had to comply with the public health Ontario guidance that was in place.
The main thing that was important about these orders was requiring a new JHSC so that Hazards could be addressed. We were very happy to see a JHSC ordered as the lack of a JHSC in these instances can hamper the quick resolution of things such as the physical hazards identified by the inspector.
Grand River Hospital
The MLTSD was called because the workers were concerned about the masks provided to workers. They were arriving in different, unnamed boxes and some workers were having reactions. The Employer was failing to provide the product information, including test results. After a number of calls to MLTSD on this issue due to the Employer’s continued failure to provide the information to the JHSC, orders were issued.
The employer was to afford assistance and co-operation to the JHSC specifically providing information regarding potential hazards of face masks currently being used.
In consultation with the JHSC, the employer will develop, establish and put into effect health and safety measures and procedures respecting reporting of defective face masks and evaluation of replacement masks.
The employer was not appropriately involving the JHSC and lacked appropriate measures and procedures to protect workers. The MLTSD did a follow up visit to ensure compliance.
Southlake Regional Health Centre
The employer hired an external company to investigate a complaint of harassment; worker was not provided the summary of the investigation.
The employer shall provide in writing the results of the harassment investigation and any corrective action that has been/will be taken as a result of the investigation to the person alleging workplace harassment and the alleged harasser.
Workers (victims and accused) have the right to know the results of investigations of harassment and particularly the employer’s corrective actions that they have committed to implement as a result.
Sault Area Hospital
Transfer of Care – Code Silver.
Police brought a patient to ED but did not accompany the patient. The patient escalated, and a Code Silver was called. However, this hospital had numerous instances of Workplace Violence in the Emergency Department.
The employer will provide workplace violence training.
The employer will provide Pinel restraint training.
The MLTSD generally does not write specific orders. However, in this instance, the inspector ordered the employer to provide workers with workplace violence training (CPI) and Pinel restraint training.
Collingwood General and Marine Hospital
OPP had to return to hospital due to increase in violence with the patient and security unable to respond appropriately to patient.
Room where patient was placed was inappropriate to house patients who pose a risk of violence.
Measure and procedure for controlling risk of contraband.
Placement of violent patient in Emergency.
Procedure to identify/control contraband.
Work surfaces not free of obstruction or hazards.
The employer shall include measures and procedures within the workplace violence program to include when further staffing is required when dealing with patients who may be a at risk of workplace violence. The employer did not have any measures/procedures in place for increase in staffing and police transfer of care within their workplace violence program.
Employer shall ensure that Room 13 in the Emergency Room is appropriate for patient use. Patient was put in a room that had no camera or window for observation and the lock was on the inside of the door.
The employer shall ensure that the violence program includes measures and procedures to control the risks of contraband in Room 12 in the Emergency Room. No measures or procedures in place to control risk of contraband, including no accounting of materials coming into or out of the patient’s room.
The employer shall ensure that a work surface is kept free of obstructions and hazards. In this case, a decontamination shower was obstructed by garbage bins and other materials.
Violence can occur at any time of the day. Ensuring that there are enough staff is crucial to dealing with situations that may arise from a violent incident.
When a patient becomes violent, a safe area/room to hold the patient for further investigations is needed as well as a police transfer protocol to ensure staff are safe when police leave the patient in the care of the hospital.
Staff are at risk if patients entering the Emergency Department are not checked for contraband and/or weapons. A policy/procedure needs to be in place.
All work surfaces must be free of obstructions, hazards and anything that might endanger a worker.
Hamilton Health Sciences
The MLTSD received an anonymous complaint alleging workplace violence and harassment from family members of ICU/CICU patients.
The worker will be informed of the results of the investigation and any corrective actions taken, or that will be taken.
The employer shall reassess the risks of workplace violence as often as is necessary.
At the time of the MLTSD field visit, there were many gaps in the employer program. There had been inadequate training for workers, security and supervisors. The orders issued addressed immediate gaps and also ensured for ongoing compliance.
Southlake Regional Health Centre
Southlake Regional Health Centre submitted an investigation report related to an incident of workplace violence that occurred in the Inpatient Cancer area on December 30th 2020. The Ministry of Labour (MoL) investigated and specifically referenced two current and ongoing investigations of workplace violence.
The inspector identified and was critical of supervisor competency, lack of maintenance or diligence regarding functional personal safety devices, and gaps in the flagging policy. His closing paragraph is worthy of repeating:
“In closing, the writer is fully cognizant of the gravity of the orders issued in this report. However, given the extended attempts that this Ministry has made over the years at SRHC including through the courts to succeed in having this employer proactively address and resolve the long ongoing and outstanding issues regarding protecting workers from the inordinate amount of violent/assaultive incidents at this workplace, the writer sees no other option than to issue more prescriptive direction to protect the workers at Southlake Regional Health Centre.”
The inspector wrote the following orders pursuant to OHSA Sec. 25(2)(h) – Every reasonable precaution:
“The employer shall ensure that ALL assessments for SRHC patients regarding a history of or currently presenting with violent behaviours are documented by means of a permanent record that is effectively communicated and readily accessible to workers tasked with providing care/comfort to those patients.
The employer shall ensure that conspicuous visual indicators required based on the permanent record of SRHC patient assessments that indicate a history of or currently presenting with violent behaviours are in place and visible to workers at the point of patient location at all times.
The employer shall ensure that the Personal Safety Response System devices (Versus Pendants) provided to workers by the employer are maintained in good operating condition by establishing and maintaining documented verification that the devices provided are in good operating condition…”
The inspector concluded with this order: OHSA 32.0.3 (1) – Assess risks of Workplace Violence:
“The employer shall assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work. The employer shall conduct a violence risk assessment for the Inpatient Cancer area of the workplace.”
The orders require the employer to implement stronger flagging procedures, enhanced oversight of their personal safety devices (pendants), and a risk assessment for violence. These orders should encourage
Southlake to proactively consult with the JHSC and union to reduce workplace violence and create a safer workplace for all staff.
There is a lack of measures and procedures to ensure agency sitters are provided with information about violence risk from patients with a known history of violent behaviour in which they may encounter.
These workers are to be provided information and instruction related to the flagging process.
With the increased use of agency staff/nurses, this is something we need to consider because their lack of knowledge about flagging policies as well as other employer H&S policies may result in our members being exposed to violence. It can also be expanded to volunteers and students as well.
London Health Sciences
Employer is using unconventional spaces for patient care; serious incidents involving violence have occurred in these spaces. No violence risk assessments or re-assessment have been done.
Employer ordered to conduct a violence risk re-assessment following a violent incident
With the requirement to accommodate more patients, spaces not traditionally intended for patient care need to be assessed for the risk of violence prior to being used for patient care activities and re-assessed following incidents of violence.
Orillia Soldiers Memorial Hospital
The safe handling and disposal of cytotoxic drugs departed significantly from the employer’s old policies and procedures for cytotoxic drugs
The employer shall update and annually review its cytotoxic drug policies.
The employer shall provide training and supervision for workers handling cytotoxic drugs.
Policies and Procedures for safe handling and storage of cytotoxic drugs must be reviewed and updated annually to close gaps in the use.
Elizabeth Centre – Nursing Home
This Employer has a cytotoxic policy that they weren’t following. They didn’t provide Nitrile gloves for safe handling of cytotoxic medications, no signage to alert care providers of the precautions and no red biohazard garbage bags to dispose of PPE
Employer shall ensure measures & Procedures are followed.
Employer shall implement an emergency procedure for exposure to antineoplastic drugs.
The Employer shall provide training to workers who may be exposed to cytotoxic drugs/waste.
The use and preparation of Cytotoxic drugs in Long Term Care are increasing. Employers must be aware of and protect their workers when administering such medications, including waste.