Regulations Made Under Part II of the Canada Labour Code Respecting Occupational Safety and Health of Employees Employed on or in Connection with Exploration or Drilling for, or the Production, Conservation, Processing or Transportation of, Oil or Gas in Canada Lands, as Defined in the Canada Oil and Gas Act
Version of the schedule from 2025-03-26 to 2025-12-10:
SCHEDULE II(Subsection 16.7(2))
 | Employment and Social Development Canada | Emploi et Développement social Canada | PROTECTED B WHEN COMPLETED |
Reporting Year:
EMPLOYER’S ANNUAL HAZARDOUS OCCURRENCE REPORT (Regular/Offboard)
Instructions on how to complete the form can be found at Canada.ca/workplace-health-safety-annual-reports
| Employer’s legal name | Business number | |
| Employer’s operating name (if different from above) | ||
| Mailing address | ||
| Name of contact person | Business telephone | |
| Mailing address | ||
| Signature | Date | |
| Work Place Information | Injury Data | Employment Data | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Work Place ID | Work Place Name | Headquarters (Y/N) | Work Place Reference Number | Address (Street, City, Province, Postal Code) | Number of Disabling Injuries | Number of Deaths | Number of Minor Injuries | Number of Other Hazardous Occurrences | Total Number of Hours Worked | Total Number of Employees | Number of Office Employees | In Operation (Y/N) | Date Ceased YYYY-MM-DD |
| Comments: | |||||||||||||
| Comments: | |||||||||||||
| Comments: | |||||||||||||
| Comments: | |||||||||||||
| ESDC-NHQ LAB1009 E |  |
- SOR/94-165, s. 66
- SOR/2025-79, s. 23
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