PSAC PRAIRIE REGIONAL HEALTH & SAFETY CONFERENCE, December 1 – December 3, 2023

Deadline for REGISTRATIONS is September 29, 2023 – 4:00pm MDT

OBJECTIVES: We will cover a wide variety of current and relevant topics in an interactive manner to provide and gather that will resonate with, inspire and motivate participants.

We will strengthen the capacity of workplace health and safety activists through the review and discussion on concepts involving; empowering committees, the duty to accommodate, the long term disability claims process, among others. Along with this, topics to be covered will be generated through responses and recommendations to come from this application process. This will be accomplished through a focus on supporting all of those with an active role in advocating for the health and safety of our members.

WHO SHOULD ATTEND?

The Conference is primarily designed to provide assistance and resources to PSAC members who are active in Workplace Health and Safety. Priority will be given to those that illustrate their activism in resolving workplace issues and are in a position to apply what they have gathered from the conference and share with others. The conference is not strictly limited to those holding a formal position; however that will form part of the criteria for selection. Please note that this Conference is not designed to function as the basic training tool on Health and Safety Rights and Responsibilities. Rather we will be expanding the knowledge range and confidence of those working in the field and already knowledgeable on the issues at hand. There are a limited number of spots available and therefore selection will be based on this criterion.

The conference will begin on Friday, December 1 and end on Sunday, December 3. Participants will be expected to attend the full duration of the conference. Should a selected participant no longer be able to attend the full conference, another participant may be selected by the selection committee. AGENDA: Details will be finalized, based in part on participant needs.

Application - Select all that apply. NOTE: With this application, I authorize use of the information above for the Participants List, to be distributed at the Regional Health, Safety Conference. (Please indicate any special requests in this regard.) *

• I am a PSAC Prairies member in good standing

Personal Information

Name *

First

Last

Email *

(Personal email, not employer email)

PSAC ID number *

Cell phone number *

(or home phone number if no cell)

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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Workplace Information

Component/DCL *

Local/Branch number *

Worksite address - City only *

Local President Name: Please provide the name, email address and personal phone number of your Local President - so we can confirm your active role in Workplace Health and Safety. Local Presidents and RVP's/NVP's can indicate "not applicable". *

First

Last

Personal or Cell Phone

Email *

Participant Profile

Have you attended past Union Health and Safety Conferences? *

• National H&S Conferences?
• Regional H&S Conferences?

Health and safety Events and Conferences attended in the past: *

Current Health and safety Role? *

• Are you a Workplace Health and Safety Committee Member?
• Are you a Workplace Health and Safety Representative?
• Are you a Member of a Policy Committee?
• Are you a Union Health and Safety Committee member?

Please provide any other relevant union experience below: *

Please identify any Health and Safety training received: *

PSAC Health and Safety Committee Member/Rep. Course, Dates? Employer or Joint H&S Committee Member/Rep. Course, Dates? Other, Please specify:

1. What are some of the current Health and Safety issues in your Workplace? (200 words or less) *

Please describe your challenges in resolving these issues *

3. Tell us why it is important for you to attend this conference *

Travel, Loss of Salary and Accommodations

Travel arrangements will be in accordance with the PSAC Travel Policy. Approved participants will be contacted individually regarding travel arrangements.

Will you be claiming loss of salary OR leave with pay as specified by the Treasury Board collective agreements? *

• Yes
• No

Please provide your expected hours of work and the dates: *

If selected as a participant, I will require an advance for expenses associated with the event *

• Yes
• No

Accommodations

Approved participants in travel status will have a room reserved

Accommodation for disabilities

The PSAC Accommodation Policy strives to ensure that PSAC courses are barrier-free for members with disabilities. Members will be asked to specify their accommodation needs in order to facilitate their participation at this course.

Check off if applicable

• I am a member with a disability and require accomodation

Accommodation Requirements:

Please let us know the nature of any disability and the type of accommodation you might require - so we can create an inclusive event for all.

Emergency contact - Name *

First

Last

Emergency contact - Phone number *

Equity Self-Id (check off all that apply)

• I am 35 years of age and under:
• I am a member of the 2SLGBTQIA+ community:
• I am an Indigenous person: An Indigenous person is a member of a First Nation, a Métis or an Inuit community.
• I am racially visible: A racially visible person in Canada is non-white in colour or race, regardless of place of birth.
• I self-identify as a woman:
• I am a person with a disability: For equity purposes, "person with disabilities" means persons who experience barriers arising from impairments of a physical, mental, sensory, psychiatric or learning nature.
• I agree that the PSAC may use the information provided in the Self-ID section for administrative purposes: This could include seeking your participation in equity/diversity committees, conferences, and conventions and sending you information about PSAC equity/diversity initiatives.

ACKNOWLEDGEMENT: With this application, I agree that, if selected, I will attend and participate in all sessions of the Health and Safety Conference. Prior to the conference I will review the policies on human rights and harassment to be provided and understand my responsibilities in accordance with them *

• Yes

If you have any questions about the Health and Safety Conference, please contact Clint Wirth- Regional Health and Safety Representative. Clint is located at the Winnipeg Regional Office, email wirthc@psac-afpc.com. Deadline for receipt of application: Friday, September 29, 2023. Questions?

Is there any other relevant information would like to add to your application that will assist in the selection process?

Observer Status

In the event that you are not selected as a full delegate to the event, would you be interested in an opportunity to be on site, in "Observer Status"? Information on the observer process will be shared after the selection process has been completed.

Possible Observer Status

• Yes
• No

Submit