Board of Canadian Registered Safety Professionals

CONFIDENTIAL
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191 info@bcrsp.ca
PRACTICE QUESTIONNAIRE
Name of applicant
Name of

employer

client

Name of reference (direct supervisor/client)

References position/title

References credentials

CRSP
CHRP/CHRL
CIH
CMIOSH
CSP
P.Eng.
ROH
Other

References telephone

( )

Email

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

Date:

The Qualifications Review Committee and/or the Regional Screening Centre may contact the reference for
follow up information or clarification as required.
When you have completed the questionnaire, please return it directly to the Board at the address/fax
or email noted above. Do not return the completed questionnaire to the applicant.
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.
Thank you

Board of Canadian Registered Safety Professionals

CONFIDENTIAL
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191 info@bcrsp.ca
PRACTICE QUESTIONNAIRE

ETHICAL PRACTICE
We are seeking to determine the applicants understanding, upholding and promotion of the standard of
ethical OHS practice as defined with the CRSP Rules of Professional Conduct and well as other ethical
codes that may apply.
Do you have any reason to believe that the applicant
has or would act unethically?

Yes
Please provide an
example:

No

Do you have any other reservations about

recommending the applicant for CRSP certification?

Yes
Please explain:

No

Does the applicant have a learning plan for

continuing professional development?

Yes

No
Please explain:

Does the applicants current OHS function encompass greater than 50% (a minimum of 900 hours per year)
of their listed positions duties at a professional level?
Yes
No
If NO, please explain:

Application of OHS Principles

We wish to define and determine the extent to which the applicant applies OHS principles, including,
interpretation, analysis, evaluation and application of recognized models and tools, application of risk
management processes, evaluation of OHS performance, auditing, investigation, training, safety and health
promotion, etc.
Please check []
Does the applicant routinely apply OHS principles
such as interpretation, analysis, evaluation and
application of recognized models and tools,
application of risk management processes,
evaluation of OHS performance, auditing,
investigation, training, safety and health promotion,
etc.?

Yes

No

Board of Canadian Registered Safety Professionals

CONFIDENTIAL
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191 info@bcrsp.ca
PRACTICE QUESTIONNAIRE
Does the applicant routinely deal with solutions
which are difficult and require the development of
new standards, methods, unknown factors,
alternative solutions, or procedures?

Yes

No

Does the applicant require any advanced

knowledge of OHS 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

Comments/Examples:

PRACTICAL EXPERIENCE
We would like you to evaluate the applicants scope and ability to function independently
Please check []
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

Does the applicant demonstrate knowledge and

understanding of codes, standards, regulations and
laws within the context of their position?

Yes

No

Comments/Examples:

MANGEMENT OF OHS PRACTICE

We would like you to evaluate the applicants scope and ability as it relates to the management of OHS
practice
Please check []

Board of Canadian Registered Safety Professionals

CONFIDENTIAL
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191 info@bcrsp.ca
PRACTICE QUESTIONNAIRE
Does the applicant operate effectively within the
context of the business environment?

Yes

No

Is the applicant effective in applying strategies for

analysing and understanding problems? (E.g.
affinity diagrams, flow charts, cause and effect,
system diagrams, etc.)

Yes

No

Is the applicant effective in applying strategies for

defining problems? (E.g. root cause analysis, five
whys, etc.)

Yes

No

Is the applicant involved in project management

(conceptualization, planning, budgeting,
implementation, monitoring and/or evaluation)?

Yes

No

Does the applicant supervise others?

Yes

No

Comments/Examples:

COMMUNICATION SKILLS
We are seeking to determine the applicants scope and ability to communicate within the workplace as it
relates to Occupational Health and Safety (OHS).
Please check []:
Is the applicant responsible either wholly or in part
for the development of written business proposals,
business cases, reports, or recommendations?
Is the applicant responsible either wholly or in part
for the oral presentations (not training)?

Yes

Yes
Please provide an
example of
presentations and
audience:

No

No

Does the applicant provide training?

Not involved in training

New Hires
Managers all levels
Supervisors
Existing staff
Contractors
Others, please specify:

Does the applicant conduct training outside your

organization?

Yes

No

Board of Canadian Registered Safety Professionals

CONFIDENTIAL
6700 Century Ave Suite 100, Mississauga, ON L5N 6A4
905-567-7198 / 1-888-279-2777 / Fax 905-567-7191 info@bcrsp.ca
PRACTICE QUESTIONNAIRE
Does the applicant train trainers?

Yes

What topics does the applicant cover in the training?

Safety & loss control

Fire & emergency preparedness
Accident investigation
Occupational hygiene
Auditing
Environmental management
Standards
Task procedures
Risk evaluation
Ergonomics
Alternate work
Other, please specify:

Does the applicant manage the training function?

Yes

Comments/Examples:

No

No