Complete With DocuSign 2 TIS Paper - Policy

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PERSONAL INFORMATION – CONSENT & DISCLOSURE
All of the personal information that is collected by TIS is collected only for the following
purposes:
 To establish and maintain your applicant file

 To establish and maintain our employment relationship
 To assist you with your job search
 To assist TIS’s clients with finding skilled workers
 To ensure that TIS complies with legal and contractual obligations owed to TIS clients
Your personal information will not be used for any other purpose, not listed above
without proper consent. TIS may collect, use or disclose personal information without
your consent in exceptional circumstances where such collection, use or disclosure is
permitted or required by law.
Third Party Service Providers & Other Third Parties
TIS’s policy is not to provide personal information to any third party except in the limited
circumstances outlined below.
 Third party Criminal/ Credit Check service provider: TIS utilizes the services of First
Advantage to process criminal reference checks.
 Client Companies: In order to provide client organizations with a superior staffing service
and to assist applicants with their job search, TIS must disclose certain applicant/employee
information to our Clients.
 Provincial Workplace insurance body: In order to legally comply with WSIB accident
reporting procedures, TIS must supply WSIB or similar with information specific to an
individual involved in an accident.
 Emergency Services: In case of an emergency, TIS would disclose the necessary personal
information to emergency personnel.
 Law enforcement agencies: TIS would disclose Personal information in case of

emergencies, for internal security matters or where required by court order or search warrant.
TIS takes all of the necessary precautions to ensure the safeguarding of your information,
whether it is stored electronically or in paper format. Information is stored in secure facilities,
protected from unauthorized access and kept only for the time period it is reasonably required.
An employee may withdraw consent at any time, subject to legal or contractual restrictions and
reasonable written notice. Employees may contact TIS’s Privacy Officer for more information
regarding the implications of withdrawing consent.
Jorge Villarroel Pelizari

I, __________________________ authorize TIS to disclose the following
personal information to internal TIS staff, clients, potential clients or third party
service providers of TIS for the sole purpose of assisting me with my job search
and/or hiring and employing me.
Please initial beside each item to indicate consent.
1. My Name
(Will be disclosed to internal staff, third party service providers & clients)
2. My Address, telephone number & email address (Will be disclosed to internal

staff for the purpose of contacting you & will be
disclosed to WSIB only if you have an accident at work)
3. The Region/City where I prefer to work

(Will be disclosed to internal staff & clients)
4. My Work History, Skills & Test Results

5. My Resume
6. My Current Salary & Future Salary expectations

7. My Education History
8. My Date of Birth
(Will be disclosed to the WSIB during the course of reporting if you have had an
accident at work)
9. The results of my Reference verifications

10. My completed Consent form to conduct a Criminal Reference Check if this is

required for the position in question
(Will be disclosed to internal staff, third party criminal check service provider, and
client where required by client)
11. The results of my Criminal Reference Check only if required for the position I am
applying (Will be disclosed to internal staff & clients)
12. My completed Consent form to conduct a search of my Credit History if this is

required for the position in question
(Will be disclosed to internal staff, third party credit check service provider &
clients)
13. My completed Government of Canada Personnel Screening, Consent and

Authorization form only if applying for positions that require Government
Clearance in order to be placed
(Will be disclosed to internal staff & Government client for processing)
14. My completed direct deposit form and accompanying blank, voided cheque
(Disclosed to internal TIS staff only for the purpose of processing your pay)
15. My completed timesheet & subsequent payroll records (Will be disclosed to inter
nal TIS staff only for the purpose of processing your pay
& client for the purpose of verifying invoices)
16. My Social Insurance Number _____

(Will be disclosed to internal TIS staff only for the purpose of processing your pay
and to the WSIB during the course of reporting if you have had an accident at
work)
17. My responses to interview questions ______

(Will be disclosed to internal TIS staff only)
18. First Aid Medical Documentation: ______

(Will be disclosed to; TIS Staffing Solutions, Workplace Safety and Insurance
Board (WSIB), Workers Compensation Board (WCB), Workplace Health and
Safety Compensation Commission (WHSCC), and La Commission de la santé et
de la sécurité du travail (CSST).)
I have reviewed and fully understand the information provided above.
5/3/2024
x______________________________ __________________________
Signature (Applicant/Employee) Date
Once signed and submitted with a complete application, this document will be considered accepted and signed by Trillium Interim Staffing
CONSENT FORM
Criminal/Credit Check/Education Verification

Deduction
Jorge Pelizari
FIRST NAME: ________________________ LAST NAME ___________________
This is to confirm that I am aware that a Criminal/Credit check/Education verification

will be deducted in my name once a position has been offered to me by Trillium Interim Staffing.
Furthermore, I understand that the total fee for each search is $ 35.00 this amount will be deducted
from my first pay cheque that I received from Trillium Interim Staffing.
5/3/2024
Employee Signature: ___________________________________ DATE: ______________
PAYROLL & AGREEMENT TO DEDUCT PAYROLL FEE – SEC. 13(3) ESA,2000

I ____________________________________ been provided all the information
5/3/2024
regarding payroll policies on the date of ________________________________
YEAR/MONTH/DATE
________ I am responsible for the submission my hours worked during the previous
week unless otherwise stated and have them signed off by my supervisor no later than
Mondays 3:00pm local time.
________ I understand the I must send all request regarding payroll no later than
Monday of each week to my TIS representative or payroll@trilliumhr.com.
________ Any hours that are submitted after payroll is closed end of business day every
Tuesday of each week, will be paid on the following pay period.
________ It is my responsibility to provide correct and current mailing address for

delivery of their pay cheques. In the event Trillium must re-issue a cheque due to
inaccurate mailing address, a banking service charge of $35.00 will be applied and
deducted from the new cheque.
________ If an incorrect bank account number is given for direct deposit or bank
account has been close, a manual cheque will then be issued and mailed to the
employee. A banking service charge of $35.00 will be applied and deducted from the
cheque.
Trillium Interim Staffing Inc.
5/3/2024
Employee Signature: ____________________________ DATE: ______________
Human Resources Policies and Procedures
Assignment Employee Rules & Regulations and Policies
The following rules and regulations apply to all assignment employees (and visitors where applicable) within
and outside the premises of Trillium Interim Staffing Inc. and all its affiliated companies and client sites. They
have been created and designated for the safety and health of all assignment employees.
It is your responsibility to cooperate in adhering to these policies, rules and regulations. Failure to comply
with the rules and regulations may result in disciplinary action up to and including termination with cause and
without notice.
1. The assignment employee acknowledges that the employee relationship begins when Trillium Interim Staffing
Inc. and the assignment employee agree whether or not in writing to assign the person to perform work. Any
internal assessment, testing, internal orientation and training are not to be construed as the commencement of
employment.
2. The assignment employee will grant Trillium Interim Staffing Inc. the permission to send all written
communication of temporary assignment details as well as health and safety related correspondence through
email notifications. It is the assignment employee’s responsibility to notify Trillium Interim Staffing Inc. within 24
hours of the verbal agreement should the assignment employee not receive the work assignment details
notification via email communication.
3. The assignment employee understands that they are employed by Trillium Interim Staffing Inc. and not the
client site for which he/she is working and that all assignments are deemed temporary and can end without
notice. There are no guarantees. Some positions may go long term, some may be short term, and in some
cases the assignment employee may be hired on directly by the client’s site.
4. Assignment employee shall not enter any company facility, including the client site, or remain on the premises
unless the assignment employee is on duty or scheduled for work.
5. Assignment employee must provide to Trillium Interim Staffing Inc. in writing any changes of personal
information (i.e.: telephone number, address, bank account, direct deposit information, email and record of
employment request).
6. Assignment employees are not permitted to post any notices anywhere at a client site without prior written
approval.
7. Refrain from using company’s electrical communication devices without proper authorization.
8. Assignment employees are not permitted to disclose their hourly pay rate with anyone other than Trillium
Interim Staffing Inc. ‘s consultant.
9. Assignment employees are responsible for obtaining authorized timesheets and must follow the direction of the
consultant at Trillium Interim Staffing Inc.
10. If an assignment employee commences working in an office setting (identified as a restricted area) on modified
work, they will be required to comply with the following regulations:
• Confidentiality/secrecy agreement.
• To only discuss the claim details with the claims manager and not the office staff.
• To conduct oneself in a courteous and non-disruptive manner to visitors, staff, and management.
• To comply with the Modified – Early and Safe to Work Program.
Availability Policy and Procedures
It is our policy that all assignment employees are required to notify Trillium Interim Staffing Inc. of their work availability on
a weekly basis (before noon on Mondays). We will assume that the assignment employee is no longer available and that
the employment relationship with Trillium Interim Staffing Inc. is no longer active if Trillium Interim Staffing Inc. does not
receive any updates regarding the assignment employee’s work availability status for three consecutive weeks.
Health & Safety Rules and Protocol
The following rules and protocols have been developed to promote and maintain a safe workplace environment.
Any violation of these Health and Safety Rules and Protocols could result in immediate termination with cause and
without notice.
Trillium Interim Staffing Inc. will strive to do all in its power to prevent workplace injuries and illnesses.
Workplace prevention is a collaborative effort therefore every assignment employee must accept his/her
personal share of the responsibility to help create & maintain a safe working environment. Familiarizing and
adhering to Trillium Interim Staffing Inc.’s rules and regulations will ensure success in our accident prevention
endeavours.
1. Assignment employee shall conduct himself/herself in a safe manner and shall comply with all company/client site
rules, policies and procedures. Any unsafe hazard or conditions must be reported immediately to his/her on-site
supervisor and Trillium Interim Staffing Inc.‘s consultant.
2. All accidents or injuries, whether being a first aid, near miss, or medical aid required, must be reported immediately to
the on-site supervisor and to Trillium Interim Staffing Inc.’s consultant. In the event of a potential lost-time injury, refer to
the Early and Safe Return to the Workplace policy.
3. Every assignment employee is responsible for keeping the area clean and free of debris. Assignment employees must
remove any objects or debris that may cause accidents or injuries.
4. When entering or leaving the company property in a personal vehicle, the speed shall not exceed 20km/hr (or less if so
posted).
5. Upon arrival at every new assignment, all assignment employees must acquaint themselves with the client’s site
emergency procedures, eye wash station, first aid box location and the names of the workers holding authorized first aid
certificates.
Our Early and Safe Return to Work Program is offered and available at no wage loss. Participation in this program
assists injured workers in their return to gainful employment as soon as medically authorized. The assignment employee
is expected to report to the closest office for 8AM the following day for suitable work within the medical restrictions at no
wage loss. If the assignment employee seeks medical attention, a doctor’s note or Functional Abilities Form is required.
Prohibited Acts
The following acts are prohibited. Any violation could result in immediate termination with cause and without notice.
Some of the following prohibited acts may result in legal action.
1. Bringing cameras, firearms, or weapons of any kind, including any size of knife, onto company property, whether at the
client site or the Trillium Interim Staffing Inc. offices.
2. Any use of personal electrical devices (i.e. cell phones, iPods, MP3 players, Blackberry and etc.), is prohibited during
company work hours. Electrical devices that are given for business functions shall be used for business purposes only.
Any personal use of these devices on company time can result in immediate termination due to breach of security.
3. Be in possession of or under the influence of or dealing or selling of any controlled substance, including alcohol and
drugs, is strictly forbidden.
4. Falsifying any report or records, including personnel, absence, sickness, and production records, or falsifying time
sheets and punching any time card except one's own.
5. Misusing or removing from the premises, without proper written authorization, company property, another worker’s
(assigned employee) personal property, records, or other materials. Theft or defacing of company property or any
employee's property. This also includes abuse or destruction of company property, tools, or equipment, including
vandalism of any kind.
6. Unauthorized absence or lateness - Assignment employees must notify Trillium Interim Staffing Inc. prior to starting
time if they are unable to work their shift. Assignment employees who accept assignments are expected to report to work
on time and adhere to our lateness policy. In case of any clock discrepancy, the time is verified by the supervisor or
manager.
7. Immoral conduct or indecency on the company property, including harassment, violent behavior, threats, yelling, rude
gestures or use of profanity towards any worker, supervisor, or manager, either on the client’s site or the agency, is strictly
prohibited and not tolerated (this includes fighting or the use of profanity on company property). All assignment employees
are expected to conduct themselves in a courteous and professional manner.
8. Insubordinate conduct or refusal to follow supervisor’s orders (except in the case that qualifies for right to refuse unsafe
9. Gambling in any form, excluding licensed lottery activity. scheduled breaks - NEVER during work hours or company time.
Smoking is only permitted in designated areas and only on scheduled work breaks. Smoking is also not permitted in company vehicles.
Human Resources Policies and Procedures

Harassment, Dignity and Respect Policy
Trillium Interim Staffing Inc. enforces a zero tolerance policy regarding harassment. In accordance with the Ontario
Human Rights Code, every person has a right to be free from harassment in the workplace by reason of race, ancestry,
place of birth, colour, ethnic origin, citizenship, creed, age, record of offenses, marital status, family status, handicap, sex,
or sexual orientation.
Harassment is any behaviour found to be offensive by one or more co-workers, and includes behaviour where the
harasser ought reasonably to know that it is unwelcome. Furthermore, every assignment employee has a right to be free
from sexual harassment, unwelcome sexual advances, or solicitation.
Incidents related to the above should be reported immediately to your supervisor and your consultant and/or
management. All reported breaches will be investigated confidentially and appropriate action taken.
Obscene gestures or use of profanity directed at a consultant, staff member, or assignment employee can be a violation
of the dignity and respect policy, and be grounds for termination with cause & without notice.
(Failure to observe and follow the above rules will result in disciplinary action, up to and including termination without
notice)
Employee Discipline Policy

(Refer to the expanded policy in Section 3 of the manual)
A progressive discipline program can effectively ensure the administration of health and safety work rules. Except for
cases of gross misconduct, progressive discipline allows employees the opportunity to correct their behaviour.
Progressive discipline involves explaining to the assignment employee what the problem is via verbal or written warning,
what modified behaviour is required, and that a progressively higher level of discipline will be applied to subsequent
infractions.
In general terms, the discipline steps are (i.e. for lateness):

• First or verbal warning (may be sent home with 3 hours paid at minimum wage)
• Written warning (may be sent home with 3 hours paid at minimum wage)
• Suspension (between 1 and 5 days, no pay)
• Dismissal with cause
Grounds for immediate termination with cause are a result of any of the following behaviour or activity: violation of dignity
and respect policy, gross misconduct, gross safety violation, reporting for work under the influence of a controlled
substance, theft, or 3 lates (4th is termination). The list is not exclusive to the grounds for cause (see Trillium Interim
Staffing Inc. Rules, Regulations and Policies).
Please note that it is acknowledged that the assignment employee may be removed from an assignment with 3 days of
absence and they may be considered for other positions upon their return to the staffing firm.
Payroll Policies
Direct Deposit: TIS’s method of payment is direct deposit, with pay statements provided electronically. All assignment employees
will provide TIS with a voided cheque or a completed bank-printed deposit slip if and when I accept my first assignment with TIS
Payroll Documents: Paystubs, T4 and other such statements can be viewed/copied/printed at workforcenow.adp.com. All
assignment employees shall recieve instructions via email prior to their first pay to setup their account for payroll system.
Assignment employees understand that there may be delays in receiving theirpay for reasons such as statutory holidays, acts of
God, electronic failures and TIS or bank errors. Assignement employees are responsible for contacting their bank to verify
deposits prior to trying to withdraw money. TIS will not be responsible for any overdrafts on any account, and assignment
employees release TIS from any liability associated with the availability of funds, including but not limited to bank fees, penalties,
interest charges or other costs.
In case of overpayment (or error in payment), assignment employyes authorize TIS to either withdraw funds from their bank
account or withhold any monies from future payments . If the foregoing is not possible, assignment employee agree to promptly
repay TIS. Assignment employees also authorize TIS and my bank to communicate about the foregoing.
Right to Refuse Unsafe Work Policy
Trillium Interim Staffing Inc. accepts its responsibilities and is committed to complying with all the requirements of
applicable Health and Safety legislation. To this end, we shall endeavour to ensure that management, the Health
and Safety Committee, and assignment employees are knowledgeable with those sections of the applicable health
and safety legislation that directly affects them.
Right to Refuse Work as per Occupational Health and Safety Act Section 43 (3).
"A worker may refuse to work or do particular work where he or she has reason to believe that:
a) Any equipment, machine, device or thing he is to use or operate is likely to endanger himself, herself or another
worker;
b) The physical condition of the workplace or the part thereof in which he or she works or is to work is likely to
endanger himself or herself; or
c) Any equipment, machine, device or thing he or she is to use to operate or the physical condition of the
workplace or the part thereof in which he or she works or is to work is in contravention of this ACT or the
regulations and such contravention is likely to endanger himself or herself or another worker."
Guidelines for All Employees:
• Are educated about the rights and responsibilities regarding workplace hazards and unsafe work.
• Must report hazardous working conditions to the client site manager and Trillium Interim Staffing Inc. consultant.
• Must stop working and advise the client site manager and a staff member from Trillium Interim Staffing Inc.
Immediately when exercising their right refuse unsafe work.
Right to Refuse Unsafe Work Procedures
Stage 1:
The assignment employee shall report the circumstances of the work refusal to his/her on-site supervisor and a
representative from Trillium Interim Staffing Inc. They shall then investigate the report in the presence of the
assignment employee, a Health and Safety committee member and/or a worker selected by the workers.
a) If agreement is reached the assignment employee returns to work.

b) If agreement is not reached and the assignment employee has reasonable grounds to believe that the work is
still likely to endanger himself/herself or other assignment employees, the next steps will follow.
Stage 2:
The assignment employee continues to refuse and remains in a safe place, or, if appropriate, is assigned to
reasonable alternative work or given other directions pending investigation and decision.
a) The employer notifies a Joint Health and Safety Committee (JHSC) Representative.
b) The assignment employee or employer notifies an MOL Inspector. During this refusal, the disputed machine,
workplace, or assignment is not to be used or undertaken pending investigation and decision.
c) The MOL Inspector conducts his/her investigation in the presence of the assignment employee, employer and
worker representative.
d) The MOL Inspector shall give his/her decision in writing to the assignment employee, employer, or worker
representative as soon as possible.
Assignment Employee Acknowledgement
I have read the information in this document and understand my right to refuse unsafe work. I have reviewed the
policies and the procedures for work refusal related to unsafe work. I have asked all questions and I am satisfied with
the explanations given to me. I understand that I have the opportunity to refer to the Occupational Health and Safety
Act and Regulations at Trillium Interim Staffing Inc. at any time and may request a copy of the policy and procedure
I understand that I am responsible for reporting to Trillium Interim Staffing Inc. when I am assigned a task at the workplace
that does not match with the original job description provided by Trillium Interim Staffing Inc. I will not perform this work
without prior authorization from Trillium Interim Staffing Inc. Furthermore, I will not perform any work that includes:
operating machinery, power equipment, forklift, vehicles; work that is hazardous; or work for which I have not been
properly oriented or trained or assigned by Trillium Interim Staffing Inc. at time of placement.
I acknowledge and agree that by completing certain pre-hire documents including agreeing to the terms herein, I have
not commenced employment with TIS. I further acknowledge and agree that TIS’s discussions with me about my
qualifications or my suitability for an assignment with a client will not constitute an agreement by TIS to assign me to a
client. I understand that when a suitable assignment has been identified, I will be contacted, and only on the first day
of my assignment will my employment with TIS commence. Any such employment will end on the date indicated by
TIS at the start of my assignment (or any extensions thereof), unless terminated earlier in accordance with this
Agreement. I agree that if I wish to resign from my employment prior to an assignment end date, I will give TIS one
week’s written notice.
I agree that upon my assignment to a client, I shall become an employee of only TIS and not of the TIS client to which I
am assigned .I acknowledge that as an employee of TIS, I will not be entitled to participate in any client employee
benefit plans or any other entitlements that client employees may receive.
TIS will take into account any work limitation or preference information provided by me. It is my responsibility
to provide TIS with this information and to provide updates, if necessary.
Applicable to assignments in Ontario ONLY: If I do not contact TIS in a given week and confirm that I am
available, I will be deemed to be unavailable for that week for the purposes of the Employment Standards Act,
2000. If I am unavailable for 12 weeks, I will be deemed to have abandoned my employment and/or there will be
just cause for termination of my employment and I will not be entitled to any notice of termination, nor pay in lieu
of such notice or severance pay (if applicable) under applicable provincial employment standards legislation,
contract law or the common law. Similarly, subject to applicable law, if I turn down 3 assignments or shifts in a
row, there will be just cause for my employment to become inactive with TIS and I will not be entitled to notice of
termination nor pay in lieu of such notice or severance pay (if applicable) under applicable employment standards
legislation, contract law or the common law.
Applicable to assignments in British Columbia, Alberta and Manitoba ONLY: I acknowledge that the nature of
my employment with TIS shall be temporary and that I will have complete discretion to elect to work when I
choose by accepting or declining assignments when presented to me without any negative consequences or
penalty. As such, I understand that I am not entitled to any notice of the termination of my employment with TIS
or pay in lieu of notice.
Applicable to assignments in Saskatchewan, Ontario, Quebec, Nova Scotia, New Brunswick, Newfoundland
and PEI: If I become entitled to receive notice of termination of employment with TIS, I understand and agree
that, in the absence of just cause, TIS may terminate my employment by providing me with only my notice
entitlement and, if applicable, severance payment pursuant to the applicable employment standards legislation.
All temporary assignment associates working in the province of Quebec for Trillium Interim Staffing will be
subject to Province of Ontario Payroll deductions. Any notice entitlement and, if applicable, severance payment,
in addition to TIS’s fulfilling any other statutory obligations, represents my complete entitlement on termination,
including all statutory and common law entitlements. The length of my employment for the purpose of
determining the foregoing entitlement will be based solely on my most recent period of employment and not any
prior periods unless required by applicable legislation. If successive periods of employment are deemed to be
continuous under applicable legislation, I agree that the terms of this Agreement will continue to apply
throughout my deemed continuous employment.
I confirm that I am eligible to work in Canada and will provide proof if requested
At the end of any assignment, I will return to TIS or its client, as instructed, any property belonging to TIS
or its client, in good condition.
I have reviewed and fully understand the information provided above.

Jorge Villarroel Pelizari 5/3/2024
________________________ ____________________________ ____________________
Assignment Employee Name (please print) Signature of Assignment Employee Date
Assignment Employee Acknowledgement
I have read and understood the Trillium Interim Staffing Inc. policies as on pages above. I have asked all the questions
I had and I am satisfied with the explanations given to me. I understand that I have the opportunity to refer to the
Occupational Health and Safety Act and Regulations at any given time.
I have access to the Health and Safety Operations Manual to review any policy in full. I will evaluate the hazards of each
assignment with the consultant and employer site supervisor prior to commencing an assignment. I understand that I am
an assignment employee and agree to be governed under the Employment Standards Act as such.
I understand that my length of service or assignments are considered temporary. As an assignment employee, my
assignment may be terminated at any time without advance notice or pay in lieu of notice. In the event that my
employment is terminated, I will be paid in accordance with but limited to the Employment Standards Act.
I acknowledge that any internal assessment, testing, internal orientation and training are not to be construed as the
commencement of the employment relationship. I am aware and understand that the employee relationship begins when
Trillium Interim Staffing Inc. and I agree to be assigned to perform work.
I acknowledge that all the information given on my application form or resume is true and accurate. I give the employer
permission to verify all statements and call any employer for reference information. Failure to provide accurate information
may result in termination with cause.
I acknowledge that I reviewed and fully comprehend the following: (Please Initial)
Rules and Regulations and Policies (Health and Safety Protocol/Prohibited Acts)
Availability Policy and Procedures
Harassment Policy, Dignity & Respect Policy/Employee Discipline Policy/Lateness Policy (Under Prohibited Acts)
Payroll Policy
Right to Refuse Unsafe Work
Accident Reporting / Early and Safe Return to Work Program/ First Aid Procedures
Assignment Employee Acknowledgment
Transportation (where applicable)
Your Employment Standard Rights: Temporary Help Agency Assignment Employees
I have been provided all information about Trillium Interim Staffing Inc.
I have been provided all the details of assignment
I grant permission for Trillium Interim Staffing Inc. to send me all written communications via email. I further acknowledge
and confirm that it is my preferred method of communication venue by providing my email address below.
villarroelpelizarij@gmail.com
_____________________________
Email Address (Please Print)

_______________________________________ ____________________________ ______________________
Name of Assignment employee (Please Print) Signature of Assignment Employee Date
Ontario Safe at Work Employee Handbook Acknowledgement Form
I, the undersigned, acknowledge that I have received and read this Handbook and will
adhere to the policies set forth in this Handbook. I have had an opportunity to clarify any
questions, which I may have concerning the provisions of this Handbook.
I understand that Trillium Interim Staffing and it’s workplace partners adhere to the
policies and guidelines outlined in the Ontario Safe at Work initiative and that failure to
follow such guidelines may result in immediate termination of my employment
relationship at any time with or without cause.

NAME: ________________________________ Date:___________________
(Please Print)
SIGNATURE: _______________________
Agreement to Work Excess Hours

Please review and respond to the following questions below in accordance with
requirements set out by the Ontario Ministry of Labour.

Name: Date:
By signing the below I agree to the following:
• I consent to work hours in excess of 8 hour per day and 48 hours per week
up to a maximum of 60 hours per work week and I agree to work such
hours as are scheduled. I understand that this Agreement is permitted by
the Employment Standards Act, 2000.
• I acknowledge that I have received and read the most recent information
sheet entitled: “Information for Employees about Hours of Work and
Overtime Pay” as produced by the Director of Employment Standards for
Ontario.
• I understand that I can revoke this agreement in writing with 2 weeks’
notice at any time after the agreement has been made. I understand that
Trillium Interim Staffing may revoke this agreement after reasonable
notice in writing to me.

Recruiter: __________________________ Employee: _____________________
Signature: __________________________ Signature: _____________________
SIN:
Ministry of Labour
Information for Employees About Hours of

Work and Overtime Pay
Disclaimer: This resource has been prepared to help employees and employers understand some of
the minimum rights and obligations established under the Employment Standards Act, 2000 (ESA)
and regulations. It is not legal advice. It is not intended to replace the ESA or regulations and
reference should always be made to the official version of the legislation. Although we endeavor to
ensure that the information in this resource is as current and accurate as possible, errors do
occasionally occur. The ESA provides minimum standards only. Some employees may have greater
rights under an employment contract, collective agreement, the common law or other legislation.
Employers and employees may wish to obtain legal advice.
These are the general rules in Ontario about hours of work and overtime pay. There are
exceptions and special rules for some employees under the Employment Standards Act, 2000
(ESA). To see if your occupation or the industry you work in is subject to special rules or
exemptions see the Guide to Employment Standards Special Rules and Exemptions available at
Ontario.ca/ESAtools.
Your employer cannot intimidate you, fire you, suspend you, reduce your pay, punish you in
any other way or threaten any of these actions for exercising your ESA rights.
Hours of work
The maximum daily and weekly limits on hours of work are:
• 8 hours a day (or the number of hours in your regular work day, if it is more than 8),
• 48 hours a week.
Rest periods and eating periods
Your employer must give you at least:
• 11 consecutive hours off work each day (a “day” is a 24-hour period – it does not have to
be a calendar day);
• 8 hours off work between shifts (unless total time worked on the shifts is 13 hours or less,
or you and your employer have otherwise agreed in writing, including electronically); and
Ministry of Labour
• 24 consecutive hours off work each work week (or 48 consecutive hours off every two work
weeks).
• a 30-minute eating period after no more than five hours of work. You can agree with your
employer to split this eating period into two shorter breaks.
Overtime payment
For every hour you work over 44 hours a week, your employer must pay you at least 1½ times your
regular rate of pay (“time and a half”). You can also have a written agreement with your employer to
get paid time off for any overtime hours you work. If you have such an agreement, the employer
would have to provide you with one and one-half hours of paid time off for each hour of overtime
that you work.
Excess hours of work and overtime averaging
You do not have to but if you choose to, you can agree with your employer to:
• work more than 8 hours a day (or the number of hours in your regular work day, if it is more
than 8),
• work more than 48 hours a week, and / or
• average the hours you work over periods of two, three or four weeks when calculating
overtime pay.
You cannot work more than the number of hours shown in your written agreement. Also, your hours
of work cannot be averaged over a period that is greater than four weeks when calculating your
overtime pay – four weeks is the maximum.
You can cancel an agreement to work excess daily or weekly hours by giving your employer two
weeks’ written notice. Your employer can also cancel an agreement by giving you reasonable
notice.
Overtime averaging agreements for employees not represented by a union must have a start date
and an expiry date. The agreement can be no longer than two years from the start date and cannot
be cancelled unless both you and your employer agree.
Generally, if you are represented by a union, your union would make agreements with your
employer on your behalf.
For more information or to file a claim

If you have questions about the ESA call the Ministry of Labour’s Employment Standards
Information Centre at 416-326-7160, toll free at 1-800-531-5551, or TTY 1-866-567-8893.
Information is available in multiple languages.
More information on hours of work and overtime pay can be found in Your Guide to the Employment
Standards Act, 2000 available at Ontario.ca/ESAguide. You may also wish to try the Hours of Work
and Overtime Tool available at Ontario.ca/ESAtools. To file a claim, you can access the
Employment Standards Claim Form online at Ontario.ca/ESAforms.
v. April/19 2
Ministry
of Labour
Your Employment Standards Rights –

Temporary Help Agency Assignment
Employees
Disclaimer: This resource has been prepared to help employees and employers understand some of
the minimum rights and obligations established under the Employment Standards Act, 2000 (ESA)
and regulations. It is not legal advice. It is not intended to replace the ESA or regulations and
reference should always be made to the official version of the legislation. Although we endeavor to
ensure that the information in this resource is as current and accurate as possible, errors do
occasionally occur. The ESA provides minimum standards only. Some employees may have greater
rights under an employment contract, collective agreement, the common law or other legislation.
Employers and employees may wish to obtain legal advice.
This information sheet gives a summary of the Employment Standards Act, 2000 (ESA) rights for
assignment employees of temporary help agencies. The ESA is a law that sets minimum
standards in most Ontario workplaces, such as the minimum wage, limits on hours of work,
overtime pay, vacations, and job-protected leaves from work for certain reasons. Special rules and
exemptions may apply depending on what kind of work you do. For more information visit
Ontario.ca/ESAguide.
Assignment employees of a temporary help agency

You are an assignment employee of a temporary help agency if you and the agency have agreed
that it will place or try to place you on temporary work assignments with a client business (or client
businesses) of the agency. You have an employment relationship with the agency even when you
are not on an assignment with a client business of the agency.
Right to public holidays and public holiday pay

Ontario has nine public holidays. Generally, if you are on an assignment and the public holiday
falls on a day when you would ordinarily be working, you have a right to take the public holiday off
work and to be paid public holiday pay for that day. Public holiday pay is generally your gross
regular wages earned plus vacation pay payable in the four work weeks before the work week that
Ministry of Labour
includes the public holiday, divided by 20. A different calculation applies for public holidays
between January 1, 2018 and June 30, 2018.
If you agree in writing, including electronically, to work on the holiday, you then have the right to
public holiday pay plus premium pay (at least one and one-half times your regular rate of pay), or
your regular rate of pay plus a substitute day off with public holiday pay.
For further information on public holidays, please see the “Temporary Help Agencies” chapter in
Your Guide to the Employment Standards Act, available at Ontario.ca/ESAguide.
Right to notice of termination and severance pay

If you have been employed by a temporary help agency for at least three months, you generally
have a right to receive notice of termination if the agency ends (terminates) your employment
relationship. You may get notice while you are working, pay instead of working notice, or a
combination of both. Generally, the minimum notice you must get ranges from one week (if you
have been employed for at least three months but less than one year) to eight weeks (if you have
been employed for eight years or more). Your notice entitlement is determined by how long you
are employed by the agency, not the length of time you have been working on assignments at the
agency’s client business(es).
Different rules apply to a mass termination when 50 or more assignment employees are
terminated within the same four-week period.
If you have been an employee of an agency for five or more years, you may also have a right to
severance pay if the agency ends (severs) your employment.
For further information on notice of termination, mass termination and severance pay, please see
the “Temporary Help Agencies” chapter in Your Guide to the Employment Standards Act, available
at Ontario.ca/ESAguide.
Right to notice of termination of assignment

Termination of assignment – which differs from termination of employment – occurs when an
assignment employee has his/her assignment with a client terminated, yet remains employed with
the temporary help agency.
Generally, a temporary help agency is required to provide an assignment employee with either
one week’s written notice of termination of assignment, termination of assignment pay or a
combination of both if:
1. the assignment employee is assigned to perform work for a client;
2. the assignment had an estimated term of three months or more at the time it was
offered to the employee; and
3. the assignment is terminated before the end of its term.
2
Ministry of Labour
For further information on termination of assignment, please see the “Temporary Help Agencies”
chapter in Your Guide to the Employment Standards Act, available at Ontario.ca/ESAguide.
An agency cannot charge you certain fees

An agency cannot charge you a fee for being its employee or for helping you find an assignment. It
cannot charge you a fee for giving you information or advice on how to write a resume or prepare
for an interview, even when the information or advice was provided at your request.
If a client business of an agency wants to give you a job reference or

hire you to be its employee
An agency cannot prevent a client business from giving you a job reference.
An agency cannot prevent its client business from hiring you directly if the client business wants to
do so. If the agency places you on an assignment with a client business, it can charge the client
business a fee for hiring you, but only in the six-month period beginning on the day you first
started working for the client business.
If a client business of an agency wants to hire you to be its employee, an agency cannot tell you
that you cannot take the job. An agency cannot charge you a fee if a client business wants to hire
you.
Information must be provided about the agency

The agency must give you the agency’s legal name and contact information. This information must
be provided, in writing, as soon as possible after you become an assignment employee.
Information must be provided about assignments

When the agency offers you an assignment with one of its client businesses, it must give you the
client business’ legal name and contact information; the wage rate and benefits (if any); the hours
of work; a general description of the work; the estimated term of the assignment (if known); and
the pay period and pay day. If the agency gives you this information, but does not provide it in
writing when the offer is made, the agency must provide it in writing as soon as possible.
Information must be provided about the ESA

The agency is required to provide you with a copy of this information sheet as soon as possible
after you become an assignment employee.
If your first language is not English, the agency must find out if the information sheet is available in
your first language, and if so, the agency must supply both the English version and the translated
document to you. Multilingual resources are available at Ontario.ca/employmentrights.
The agency must also provide you with a copy of the Employment Standards Poster published by
the Ministry of Labour within 30 days of the date you become an employee.
3
Ministry of Labour
If you request a copy of the poster in a language other than English and the ministry has published
a version in that language, the agency must provide the translated version in addition to the
English copy. The poster is available at Ontario.ca/ESAposter.
You cannot be punished for asking about or exercising your ESA

rights
If you ask about your rights under the ESA or ask that you be given your rights, the agency or the
client business cannot punish you in any way, including by ending your assignment. You also have
the right not to be punished by your agency or by the client for asking about or exercising your
ESA rights.
The agency and client business must keep records

An agency must record the number of hours an assignment employee worked for each client in
each day and each week. The client(s) must also record the number of hours the assignment
employee worked for them in each day and each week.
The agency and client may both be liable for your wages
If you perform work for a client business or client businesses and the agency fails to pay you some
or all of the wages owed for that pay period, the client business(es) may be jointly and severally
liable for some or all of those unpaid wages. Specifically, client businesses may be held liable for
unpaid regular wages, overtime pay, public holiday pay and public holiday premium pay. If more
than one client business is liable in a pay period, each client business is jointly and severally liable
with the agency for a share of the total wages owed in proportion to the hours worked for that
client business.
If you have a question or want to file a claim

If you have questions about the ESA call the Ministry of Labour’s Employment Standards
Information Centre at 416-326-7160, toll free at 1-800-531-5551, or TTY 1-866-567-8893.
Information is available in multiple languages.
To file a claim, you can access the Employment Standards Claim Form online at
Ontario.ca/ESAforms.
4
Emergency Telephone Numbers

Ambulance 911
Fire Department 911
Police Department 911
Ontario Provincial Police 1-800-265-7191
Poison Information Centre 1-800-268-9017
Environment Spill Action Line 1-800-268-6060
Company Contact Numbers
After Hours #: 1-800-335-9668 ext. 310

After Hours Email: afterhour2@trilliumhr.com
Branch Office Phone #:
First Aid Representative:
Branch Health & Safety Representative:
Brach Office Address Is:
Revised January 2024 1

Health & Safety

Manual
Please review the following

information very carefully
2 Revised January 2024

Health And Safety Programs And Policies
Welcome to Trillium Interim Staffing Inc. We hope that you enjoy

your assignment(s) with us.
Attached are outlines of our policies and procedures with regards

to health and safety in the workplace. These must be followed
and adhered to by all employees of Trillium Interim Staffing Inc.
These policies are posted on a Health & Safety Board in every
branch office for your review at any time, and provide further
details with respect to your role as an employee for Trillium
Interim Staffing Inc.
Trillium Interim Staffing Inc. complies with safety rules and

regulations as outlined in the Occupational Health & Safety Act,
Employment Standards Act and applicable Workers Compensation
Acts.
Deviation from any of the attached policies can be cause for

immediate dismissal. At Trillium Interim Staffing Inc. we take the
health and safety of our employees very seriously.
Please take your time in reading each and every page. If you have
any questions as to the content of anything, please ask for
clarification. You may contact the Health and Safety Manager
confidentially:
Phone: 1 800 335 9668 ext. 225

Email: safety@trilliumhr.com
Fax #: 416-497-8491
Yours truly,
Trillium Interim Staffing Inc.

Health And Safety Policy

A safe and healthy working environment for all Trillium Interim Staffing
Inc. employees is of primary importance to Senior Management, Divisional
Management, Supervisory staff, and all our personnel.
To this end, Trillium Interim Staffing Inc. has produced this written
Health and Safety (H&S) Policy, which underlines the commitment we have to
the prevention of occupational illness and injury to Trillium Interim Staffing Inc.
employees in the workplace.
It is the clear and unconditional responsibility of each and every Trillium

Interim Staffing Inc. employee to work safely and report immediately all unsafe
and/or unhealthy conditions in the workplace.
It is the clear and unconditional responsibility of Trillium Interim Staffing

Inc.’s Managers and Supervisors to ensure that:
(a) all Trillium Interim Staffing Inc. employees are aware of

their responsibilities as outlined in this handbook, and that;
(b) all Trillium Interim Staffing Inc. employees are in fact
working in a safe manner within a safe and healthy environment.
It cannot be stressed strongly enough the importance Trillium Interim

Staffing Inc. places on the development, implementation, and maintenance of
safe and healthy working habits and environments for all employees. Trillium
Interim Staffing Inc. therefore will not allow under any circumstances any
deviations or exceptions to the H&S Policy.
I count on the full support of all Trillium Interim Staffing Inc. employees
to commit their utmost effort in achieving the goal of safe and healthy working
environments so that all employees can work without fear of the tragic and costly
consequences of occupational illness or injury.
Thank you for your commitment and efforts in achieving our joint goal. Together
we will make Trillium Interim Staffing Inc. a safe place to work.
Sincerely,
Poonam Kathuria
President & CEO

Propane Handling Policy
Trillium Interim Staffing Inc. Branch Managers will ensure that all employees are
aware of their Right to Refuse unsafe work. Also, branch managers will ensure
that all employees have had proper training, to ensure that they fully
understand the Right To Refuse procedure accurately.
Lift truck operators must also receive a practical evaluation at the client location
by a competent person, on any vehicles they will be operating. This evaluation
must include the Pre-start check, both physical and operational, that the
operator successfully followed the directions of the evaluator in completing the
practical evaluation of their ability to operate the equipment as well as having
the operator demonstrate the Propane exchange procedure to the evaluator,
which was covered in their theory training.
The operator must present verification of their last formal training certificate to
the client to support that they have received their training within the last two
years.
Propane Handling Certificates are no longer required however, the employer

must be able to prove that the above pre-employment conditions were
satisfied and they have records to support that the evaluation was completed
satisfactorily. Branch Managers shall ensure that copies of the evaluations are
forwarded to them from the client to support the Due Diligence requirements of
Trillium Interim Staffing Inc. and it’s employees.
Trillium Interim Staffing Inc.’s commitment to the health and safety of our
workers must be reflected in our continued diligence with respect to informing
workers of potential hazards and procedures in handling actual hazards as well
as potential hazards.
If at any time yourself or another worker is unsure as to the proper procedures

to be followed, please contact the Health and Safety Manager
TEL: 1 800 335 9668 EXT. 225

safety@trilliumhr.com

Health & Safety

Work Refusal Policy
In compliance with legislation, a worker may refuse to work or do particular

work where he or she has reason to believe that,
1. Any equipment, machine, device or thing the worker is to use or

operate is likely to endanger himself, herself or another worker;
2. The physical condition of the workplace or the part thereof in which
he or she works or is to work is likely to endanger himself or herself;
or
3. Any equipment, machine, device or thing he or she is to use or
operate, or the physical condition of the workplace or the part thereof
in which he or she works or is to work, is in contravention of any Act
or Regulation and such contravention is likely to endanger himself,
herself or another worker.
Upon refusing to work or do particular work, the worker shall promptly report
the circumstances to their Trillium Interim Staffing Inc. representative or
supervisor who shall forthwith investigate the report in the presence of the
worker and in the presence of a member of Trillium Interim Staffing Inc.’s
Committee or Safety Representative who shall be made available and without
delay.
Until the investigation is completed, the worker shall remain in a safe place near
his or her workstation. It is the responsibility of every Trillium Interim Staffing Inc.
manager, supervisor, and staffing services representative to rectify any situation
that, in their opinion does constitute unsafe working conditions. This includes, but
is not limited to, resolution of the circumstances by working with the client and/or
where necessary, terminating services to the client.
If the worker still maintains that the circumstances in the above mentioned
situations (1, 2 or 3) remain unchanged, the worker may refuse to work or refuse
to do the particular work, and Trillium Interim Staffing Inc. shall cause the proper
persons to be notified thereof.
An inspector shall investigate the refusal to work in the presence of a member of

Trillium Interim Staffing Inc.’s Committee or a Safety Representative, representing
Trillium Interim Staffing Inc., and the worker.

The inspector shall, following the investigation, decide whether the situation or
thing is likely to endanger the worker or another person. This decision shall be in
writing to the client, Trillium Interim Staffing Inc., and to the worker.
Pending the investigation and decision of the inspector, no worker shall be

assigned to use or operate the equipment, machine, device or thing, or to work in
the workplace or in the part of the workplace being investigated, unless the worker
has been informed of the investigation and the reasons for it.
A person shall be deemed to be at work and Trillium Interim Staffing Inc. shall pay
him/her at the regular rate for time spent by the person(s) carrying out the duties
required in an official investigation.
Personal Protective Equipment Policy
All employees are required, at all times, to wear the Personal Protective
Equipment (“PPE”) required at each site. At each light Industrial site you are
required to wear CSA approved steel shoes/boots; additional PPE may be
required; PPE required for each site will be advised during initial hire orientation
and prior to each placement. This includes Hearing Protection, Safety Glasses,
Face Shields, High Visibility Vests or any other equipment supplied/required by
Trillium Interim Staffing Inc. or its clients.
This Trillium Interim Staffing Inc. Policy is in compliance with OHS Regulations
and includes the following:
Worker's responsibilities
(1) A worker who is required to use personal protective equipment must
(a) use the equipment in accordance with training and instruction,
(b) inspect the equipment before use,
(c) refrain from wearing protective equipment outside of the work area where it
is required if to do so would constitute a hazard,
(d) report any equipment malfunction to the supervisor or employer.

Footwear: General requirement
(1) A worker's footwear must be of a design, construction, and material

appropriate to the protection required.
2) A worker must wear the appropriate footwear and ensure that it is in a

condition to provide the required protection.
High visibility apparel
A worker exposed to the hazards of vehicles traveling at speeds in excess of 30

km/h (20 mph) must wear high visibility apparel meeting the safety standard.
A worker whose duties on the work site result in exposure to the hazards of
mobile equipment must wear high visibility apparel meeting criteria.
Trillium Interim Staffing Inc. employees working in an environment where they

are exposed to the hazards of operating mobile equipment such as forklifts will
at all times while on the warehouse/production floor wear a Hi – Vis Vest and
Steel Toe shoes. This will assist the forklift operators to see the worker and
therefore assist in the prevention of accidents such as a forklift operator
colliding into a worker or running over a workers feet.
Trillium Interim Staffing Inc. Branch Managers and Staffing Specialists will
ensure that every Trillium Interim Staffing Inc. worker both internal and
external understand the hazards of not wearing appropriate PPE. Trillium
Interim Staffing Inc. Branch Managers will ensure that every Trillium Interim
Staffing Inc. worker understands all of their responsibilities regarding PPE, it is
mandatory that they wear STW shoes/boots and when exposed to the hazards
identified they will wear hi-vis vests, and will sign advising such knowledge.
Any employees not conforming to the above noted policies will be warned and
removed from the client location until they have acquired the required PPE.
Non-compliance with PPE requirements will result in disciplinary action and
may result in immediate dismissal.
Trillium Interim Staffing Inc. will not deviate from legislated

requirements with regards to Personal Protective Equipment and will
enforce the above to ensure the protection of all of its workers.

Trillium Interim Staffing Inc. Committee or Safety Representative
All employees shall be advised of the existence of the Trillium Interim

Staffing Inc. Committee, the names of the committee members or safety
representative for the applicable branch office, and how to contact them.
All employees shall be advised of the location of the Health and Safety
board located at the applicable branch office that has the above
information posted.
Trillium Interim Staffing Inc. First Aid Certified Persons
All employees shall be advised of the Certified First Aid person(s) for the
applicable branch office and how to contact them. All employees shall be
advised of the location of the first aid kit at the applicable branch office
and advised of the location of the Health & Safety Board that has the
above information posted.
Modified Return to Work Policy and Procedures
When injury/illness/incident occurs, immediately notify onsite

supervisor and go to First Aid if necessary.
Call your Trillium Interim Staffing Inc. Staffing Consultant to notify

them of your injury as soon as you are able.
If no further is Medical Required:

Return to your regular job and ensure to keep in contact with your supervisor
and Trillium Interim Staffing Inc. office if there are any changes in your status
or if you have concerns.
If further Medical is required:

You must immediately call the Trillium Interim Staffing Inc. office and attend as
soon as you are able. You will be required to fill out the Accident Investigation
Report and pick up a Functional Abilities Form to bring to your practitioner. You
will also be required to sign off on the official offer of modified duties, available
to start the day after your injury in the Trillium Interim Staffing Inc. office.

1. Review and sign the “WSIB Worker’s Claim/Consent Form” or
“Employees Authorization for Release of Information” form.
2. Take the “WSIB Functional Abilities Form” or “Abilities Assessment Form”

to the person who will be treating you.
*Your Health Care Professional will complete this Form, which will provide
your Branch Office with your physical restrictions.
3. Return all forms to your Branch Office immediately after seeing your
Health Care Professional.
Selective Light Employment will be made available to you starting

the day after your injury and will continue to be available to you on
an ongoing basis until you reach your pre-injury level of employment
or modified duties are no longer required.
Ontario WSIB Policy 19-02-02 regarding temporary modified return to work

programs. Workers and employers (the workplace parties), and if possible,
health care practitioners, are responsible for resolving return to work issues in
the workplace. The workplace parties must co-operate and be self-reliant in
achieving an early and safe return to work (ESRTW).
Suitable work – is work that:
• is within the worker's functional abilities

• the worker has, or is able to acquire, the necessary skills to perform
• does not pose a health or safety risk to the worker or coworkers, and
• if possible, restores the worker's earnings.
Available work - is work that:
• exists with the accident employer at the pre-injury worksite, or at a

comparable worksite arranged by the employer.
To determine whether a worksite is comparable to the pre-injury worksite the

decision-maker considers whether:
• travel or assignment to different worksites is normal practice in the

industry
• travel or assignment to a worksite other than the injury site forms part
of the employment contract

• the worker normally accepts employment assignments in various
geographic areas, and
• Traveling to the proposed job is within the normal parameters of travel
expected of a worker.
Selective/Light Employment will be customized based on the worker’s individual

medical restrictions, physical limitations and abilities.
If, While Performing Modified Duties you experience difficulty: You

must immediately notify the Supervisor and your Trillium Interim Staffing Inc.
office of any difficulty, problems, or concerns you may have while performing
your duties. Modified duties will then be assessed and if necessary customized
to address any concerns.
Medical Re-Evaluations:
If you are required to attend follow up visits with the practitioner or clinic you
must ensure to keep in contact with Trillium Interim Staffing Inc. and notify the
Trillium Interim Staffing Inc. office of your appointment(s) detailing the time,
doctor’s name, and location of clinic in advance.
Prior to going for any re-evaluation with the doctor you must have Trillium
Interim Staffing Inc. fax over a Functional Abilities Form to your doctor, or pick
up one up from the office.
This will ensure that modified duties are continually within your limitations and
also will keep you, Trillium Interim Staffing Inc., and WSIB up to date
regarding your progress and will also ensure an efficient return to pre-injury
level of employment.
If you have any questions or concerns regarding this Policy please

notify your local Trillium Interim Staffing Inc. branch office.

Disciplinary Health & Safety/Return-to-Work Policy
The Disciplinary Health & Safety/Return-to-Work Policy has been developed to

ensure each Trillium Interim Staffing Inc. branch complies with the Health &
Safety/Return-to-Work regulations in their specific province. The Policy creates
consistent parameters for Trillium Interim Staffing Inc. to follow when
documenting non–compliance, in order to protect the health & safety of all
workers and ensuring all workers are accountable for their responsibilities in
the workplace.
Trillium Interim Staffing Inc. will ensure all Branch Managers and internal
staff receive the basic guidelines regarding the steps involved in the
Disciplinary Health & Safety/Return-to-Work Policy.
The Parameters of the policy advise, that if a worker is found to be non-

compliant with the Trillium Interim Staffing Inc. Health & Safety Policies,
Workers Compensation Regulations & Return-to-Work Procedures, they
will receive a written warning to be signed by the worker and witnessed by
a Trillium Interim Staffing Inc. Supervisor or Branch Manager.
After receiving three written warnings a worker will be subject to termination.
Branch Managers will ensure all new and existing hires will be asked to sign off
that they are aware and have understood the parameters regarding the
disciplinary policy.
Branch Managers and internal staff will ensure that all external staff
are orientated and sign off that they understand the Disciplinary Health
& Safety/Return-to-Work Policy.
Branch Managers will ensure all Disciplinary Health & Safety/Return-to-Work

Policy actions are documented properly on file and a copy is forwarded to
the Corporate Health & Safety Department.
The full support of all Trillium Interim Staffing Inc. employees is paramount
in achieving a safe workplace. This Policy will help to ensure that the policies
as well as safe work practices are being followed. All non compliance will be
seriously dealt with and documented.

Hazard Reporting Policy and Procedure
Legislation states that employers are required to ensure that all employees have
a safe work environment.
To this end, Trillium Interim Staffing Inc. welcomes all employees to report any
type of hazard or potential hazard directly to their branch office, the Health and
Safety Manager or to their supervisor at the client location they are working at.
Whenever possible, Trillium Interim Staffing Inc. shall conduct an investigation

of the hazard with the client or our branch (whichever is applicable). Trillium
Interim Staffing Inc. shall attempt to ensure that every reasonable precaution is
taken for the protection of the worker while at the client/branch location.
In the event that any employee feels that they cannot continue to perform their
regular duties without chance of injury to his/her person they are required to
immediately report the problem to their supervisor. If for any reason the
supervisor does not rectify the problem they are required to immediately contact
the branch office.
The branch office shall attempt to resolve the issue with the client and will call,
when required, the Trillium Interim Staffing Inc. Health & Safety Manager for
further direction.
Thank you for your commitment to, and efforts in achieving our joint goal for a
safe and healthy environment for all employees.

Workplace Hazardous Materials Information

System Policy
Trillium Interim Staffing Inc. recognizes our legislative responsibilities and

endeavors to comply with the Occupational Health Safety Act and applicable
Provincial regulations. Trillium Interim Staffing Inc. has set a standard to
recognize the Workplace Hazardous Materials Information System (WHMIS).
Trillium Interim Staffing Inc. shall provide WHMIS information and instruction
to a worker prior to placement. Trillium Interim Staffing Inc. will also endeavor
to ensure that all employees exposed to or likely to be exposed to a hazardous
material or a hazardous physical agent receives from the client instruction and
training, as prescribed specific to the client location.
Trillium Interim Staffing Inc. shall provide basic information and instruction to
all employees to protect the health and safety of the worker.
The instruction/training to be given shall be developed and implemented by the

employer or client in consultation with the committee or health and safety
representative for the applicable workplace.
Trillium Interim Staffing Inc. shall review, in consultation with the committee or
health and safety representative for the workplace, the basic awareness training
and instruction provided to a worker as well the worker's familiarity at least
annually.
The review described above shall be held more frequently than annually if;
• Trillium Interim Staffing Inc., on the advice of the committee or health

and safety representative for the workplace, determines that such
reviews are necessary.
• There is a change in circumstances that may affect the health or safety

of a worker.
This being noted, Trillium Interim Staffing Inc. shall ensure that employees
receive WHMIS awareness training and that copies of tests are kept with
employees' application files for review at anytime.
If the employee is to be sent to a client where a known controlled product is in

place, Trillium Interim Staffing Inc. management will attempt to ensure that
Material Safety Data Sheets are up to date, in clear view and accessible by all
employees. Trillium Interim Staffing Inc. management will also attempt to ensure
that any such employees will receive further detailed client specific training and
obtain records of training.
Thank you for your commitment to, and efforts in achieving our joint goal.
Together we will make Trillium Interim Staffing Inc. a safe place to work.
Health and Safety

Worker’s Responsibilities
A worker shall:
I Work in compliance with the applicable Health and Safety

Acts and/or regulations.
I Use or wear any equipment, protective devices or clothing

required by the employer.
I Report to the Trillium Interim Staffing Inc. supervisor any

known missing or defective equipment or protective device
that may be hazardous.
I Report any known workplace hazard to the Trillium Interim

Staffing Inc. supervisor.
I Report any known violation of the Act or regulations to the

Trillium Interim Staffing Inc. supervisor.
I Not remove or make ineffective any protective device

required by Trillium Interim Staffing Inc. or by the regulations.
I Not use or operate any equipment or work in a way that may

endanger any worker.
I Not engage in any prank, contest, feat of strength,

unnecessary running or rough and boisterous conduct.

Not be under the influence of any prescription drug or
alcohol substance while at work with either Trillium Interim
Staffing Inc. or any client.
JUST A REMINDER
“PREVENTION IS A PRIORITY”
If you are injured or have an accident in the

workplace please remember the following:
1) Notify your supervisor immediately.

2) Notify the Trillium Interim Staffing Inc. Branch office
immediately.
3) If First Aid is received, please complete an incident
report.
4) If further medical treatment is necessary please call the
Trillium Interim Staffing Inc. Branch office immediately so
that an accident report can be completed.
**Failure to complete the above steps could result in a delay

in the processing of your claim.
Health and Safety

Worker’s Rights
The Right to Know:

> As an employer, we are required to inform all workers about anything
in their job that can hurt them. We must also make sure that they are
provided with the information they need to work safely. This includes
safe operating procedures which have pre-identified hazards and
controls included.
The Right to Participate:

> Workers have the right to take part in keeping the workplace healthy
and safe. They have the right to be part of the Joint Health & Safety
Committee or be a Health & Safety Representative.

The Right to Refuse Unsafe Work:

> If our worker believes the job is likely to endanger them, they have the
right to refuse the work without risk of reprisal (from us or anyone that
they are working for).
Passport to Safety Program.

All workers should be advised a program and be encouraged to visit the
website: www.passporttosafety.com
Some of the Challenges We Face in our Industry Include:
> Client changing the position without notifying us.

> Client altering the duties without notifying us.
> Workers being asked to perform unsafe acts.
> Actual duties to be performed are not outlined clearly.
> Asking for assistance under the “General Duties” category, which is not
clear or specific to the actual work that will be performed.
Some of Our ‘Wish List’ Items:
> Obtaining copies of all client specific testing/orientation/training

provided.
> Attend the client’s orientation/testing session.
> Detailed job descriptions and training requirements.
> Complete, client/job specific, job demands analysis.
All branch managers shall ensure that all new temporary workers are given the
opportunity to receive additional young/new worker orientation. Branches will
be provided with a video/orientation package that includes a safety quiz and an
additional health and safety handout for young/new workers.

Lock Out/Tag Out Policy

Lock Out/Tag Out legislation requires that all machinery be shut down at all
power sources before performing any type of repair, cleaning, or clearing of a
jammed product. No employee shall attempt to fix, clear jams, or in any other
way service a machine that has not been completely shut down without chance
of operation (including accidental start up).
Ensure that you understand the procedure for Lock Out/Tag Out at the client
location that you are assigned to, if you do not, you are required to obtain
training from a supervisor at the client location.
Branch Managers shall ensure that all employees are aware of their Right to
Refuse unsafe work and that all employees receive client specific training on
any equipment they will be required to work with or near. Your client must
make the proper Lock Out/Tag Out procedures clear and ensure our employees
understand their responsibilities under the procedure.
Also, our employees who will be working with or near the equipment must meet
with inspectors during inspection. Employees must be told that there is limited
protection provided by the Lock Out/Tag Out and that they are not to remove a
Lock Out/Tag Out device.
If at any time you or a worker is unsure as to the proper procedures, please

contact the Health and Safety Manager at Corporate office in Mississauga for
further direction.
Working Alone Policy

Branch Managers should establish rules that ensure the safety of internal staff
and temporary employees who work for Trillium Interim Staffing Inc. outside the
normal working hours or alone.
These rules should be designed for the specific needs of a Branch Office, and/or
the Client and must take into consideration the potential risks.
Employees generally should not work alone:
 Where there is a risk of injury from the work being carried

out.

> In areas where power tools or hand tools that could cause
injury are used.
> Area(s) where moving machinery is used.
Where it is necessary, however, for employees to work alone in such areas, the
Branch Manager must ensure that the employee(s) are fully qualified and trained
in the use of any equipment, and put appropriate mechanisms into place to
ensure that employees comply with this requirement.
In this respect, advice and assistance is available from Trillium Interim Staffing
Inc.’s Health and Safety Manager.
When employees must work alone, a means of communication to gain assistance

in an emergency must be available. Additionally, arrangements should be made
for other staff or students to check regularly on the welfare of person(s) working
alone.
When is a person considered to be working alone?

A person is working alone when:
> He or she cannot be seen or heard by another person.
Trillium Interim Staffing Inc. and Violence in the Workplace
Trillium Interim Staffing Inc. is committed to providing a safe and healthy work
environment for our employees. Violence in the Workplace is a serious health &
safety issue and will not be tolerated.
Workplace Violence Includes:
> Threatening Behaviour - such as shaking fists, destroying property or

throwing objects.
> Verbal or Written Threats - any expression of intent to inflict harm.
> Harassment - any behaviour that demeans, embarrasses, humiliates,
annoys, alarms or verbally abuses a person and that is known or would
be expected to be unwelcome. This includes words, gestures,
intimidation, bullying, or other inappropriate activities.
> Verbal Abuse - swearing, insults or condescending language.
> Physical Attacks - hitting, shoving, pushing or kicking.

DO NOT enter into any situation or location where you feel threatened
or unsafe. If you do find yourself in a situation where you feel
threatened; we recommend that you do not attempt to “handle” the
situation by yourself.
Preventative Measures include:
> Ensure that you remain calm at all times even if person becomes
adversarial.
> Use the "buddy system", especially when you feel your personal safety
may be threatened.
> Do not attempt to restrain a person.
> If necessary call 911 and request the assistance of Police.
> Report to Trillium Interim Staffing Inc. office any incidents that you
witness or our affected by.
Employees are encouraged to report all incidents involving threats,

harassment, abuse or attacks without fear of reprisal. Please follow
the Complaint process documented in the Employee Handbook to
report any incident of Workplace violence.
Important Trillium Interim Staffing Inc. Violence Forms
Employees should be aware and knowledgeable of the following Trillium Interim

Staffing Inc. Violence Forms:
1. Violent Incidence Report Form – This report form must be filled

out EVERY time a violent incident occurs. This form allows us to
effectively report, and accurately record the violent incident and take
appropriate action.
2. Workplace Risk Assessment Questionnaire – These assessments

will allow an individual to accurately point out current and possible risks
in the workplace. By, making these employees aware of the risks in the
workplace they can work to alleviate and reduce workplace violence.
3. Trillium Interim Staffing Inc. Inspection Form – This is an

evaluation form that is extremely important in keeping policies,
standards, and procedures up to date, accurate and legitimate

These Forms Will Be Made Available At the Corporate and All Branch Offices –
Also Included in the Trillium Interim Staffing Inc. Violence in the Workplace
Standards Booklet.
For any other Workplace Violence Inquiries please contact:
Tel: 1 800 335 9668 ext. 225

safety@trilliumhr.com
Worker Awareness Policy

Important Facts:
> A young worker is considered to be anyone under the age of 25

> New workers should also be considered in this category
> Most young/new workers come to us with little or no prior work
experience, they have yet to discover their limitations and capabilities
and usually act and sound like a seasoned veteran.
> The workplace can be a dangerous place to rely on trial and error to
find answers
> Remember, young/new workers are ready to work, but are they ready
to do the job?
Trillium Interim Staffing Inc.’s Policy:
Besides our role as employer, Trillium Interim Staffing Inc. will actively take on
the role of guide and mentor for our young/new workers and work hard to
increase their awareness in the workplace.
As an organization, we must ensure that new/young workers have the training

and monitoring that is required to maintain their health and safety while
developing their skills and expertise in the marketplace.

Below are safety Reminders:
> Damaged skids, bins, pallets or plywood dividers will not be used. They
will be removed from the worksite and disposed of in a proper manner.
> Loads and/or forks are to be driven through the work area(s) between
two (2) to six (6) inches above the floor.
> Forks will be centred and adjusted to suit the width of the load.
> Material(s) must be stacked in a proper manner to prevent collapse.
> Forklift trucks will not to be used to lift or assist any person climbing on
racks of stacked materials.
> The lifting capacity of forklift trucks will not be exceeded under any
circumstances. Always respect the manufacturers guidelines for
load/capacity limits.
> Load capacity plates must be in place on all lift trucks.
> Safety restraint chains must be used when carrying long loads.
> Engines must be shut off when refuelling. If propane operated, only
authorized personnel will change tanks.
> To protect against falling material(s), the forklift truck operator must
remain under a protective rollover cage at all times.
> All fork lift truck operators are required to us provided seat belts at all
times.
> Inspect truck floors prior to driving onto them with a clamp/fork lift. >
Bridge plates and dock leveller plates must be secured prior to driving
onto truck floors.
> Care must be taken when approaching blind corners. Horns must be
sounded at all times.
> Forklift truck operators must be aware of all persons at all times.
Special care and attention must be taken when operating fork-lift(s) in
reverse, turning corners and/or doorways. Operators are to make eye
contact before proceeding.
> Back up alarms (reverse direction signals) on clamp/forklift trucks must
be in proper working order at all times.
> Loads must always be carried against the back of the forks and both
forks must be used.
> Operators must conduct safety inspections and document
findings using a checklist prior to use.

Material Handling Policy

It is the policy of Trillium Interim Staffing Inc. to identify and eliminate potential
safety hazards associated with the handling and transportation of material(s).
Responsibilities:
> Workers are to follow the rules and practices established for material
handling by the company.
> Workers are to report material handling problems or concerns to their
respective immediate supervisor and to a Trillium Interim Staffing Inc.
representative immediately.
> Internal employees must ensure that material handling practices are
properly implemented.
Manual Lifting Procedures:
> Always identify the weight of the load and ensure it is free to move.
> The direction of movement must be free of obstacles and other
potential hazards.
> Loads must be kept as close as possible to the body.
> The feet must be kept approximately shoulder width apart. Always
bend the knees when lifting.
> Always have a good secure grip using both hands when lifting.
> Always lift in a smooth gradual manner with no jerking movements.
> Always avoid twisting or side bending when lifting.
> Lower loads smoothly while bending the knees and keeping the back
straight.
General Fork Lift Handling Procedures:
> All material(s) will be lifted and stacked in a proper and safe manner.
> Skids will be loaded and stacked horizontally to a level no higher than 3
ft from the ground.
> Only authorized persons will operate forklift truck(s).
> No passengers will be carried on forklift trucks unless a seat is provided
in the cab for that purpose.

Repetitive Strain Injury Policy

The purpose of a Repetitive Strain Injury (RSI) Policy is to ensure that workers
understand our commitment to a safe and healthy work environment and that
Trillium Interim Staffing Inc. will ensure that every branch has information on
how to prevent RSI’s.
Repetitive Strain Injuries occur from repeated physical movements doing

damage to tendon, nerves, muscles and other soft body tissues. Occupations
that involve a lot of repetitive tasks can cause damage to the body.
Internal employees will have read the RSI Policy and signed the
acknowledgement.
What is Repetitive Strain Injury?
Repetitive Strain Injuries are injuries involving tendons of the fingers, hands,
and arms that become inflamed from repeated stresses and strains. RSI arises
when a tunnel of bones and ligaments in the wrist narrows, allowing pinching of
the nerves that reach the fingers and the ball of the thumb.
The rise of computer use and flat, light-touch keyboards that permit high speed
typing have resulted in an epidemic of injuries of the hands, arms, and
shoulders. Repeated keystrokes and long periods of clutching and dragging with
mice slowly accumulate damage to the body.
This can happen even more quickly as a result of typing technique and body
positions that place unnecessary stress to the tendons and nerves in the hand,
wrist, arms, and even the shoulders and neck. Lack of adequate rest and breaks
and using excessive force almost guarantee trouble.
What are the Symptoms?
• Tightness, discomfort, stiffness, soreness or burning in the

hands, wrists, fingers, forearms, or elbows
• Tingling, coldness, or numbness in the hands
• Clumsiness or loss of strength and coordination in the hands
• Pain in the upper back, shoulders, or neck associated with using the
computer

Prevention Techniques
 Sit all the way back into your chair, this will allow for proper back
support
 Back and Neck should be facing straight not sideways
 Knees should be slightly lower than hips in chair
 Try not to keep legs crossed or shift weight to one side
 Upper arm and forearm should form a right angle when you’re
hands are placed on the keyboard
 Hands should be lined up with forearm
 Hands and wrists should be placed horizontally (if hands are angled
up try attaching an ergonomic armrest in front of the keyboard)
 Fingers should be relaxed and wrists in an unbent position
 Feet should lie flat on the floor
 Back should be supported by backrest support centered at the bottom
of the ribcage
 Monitor should be placed slightly below eye level in front of you
 Document holder should be placed should be positioned at the same
viewing distance and height as the computer screen. Do not position
document holders at angles that may cause neck strain.
 Use a soft touch on the keyboard; do not pound keys
 Use entire hand to lift objects and reduce strain on wrist
 Look away from screen frequently to change eye focus
 Take mini breaks in a non-seated position. Go for a short walk or stand
and stretch
Repetitive Strain Injury (RSI) is definitely preventable
The answer to reducing damage is to identify the warning signs early, and
be active in changing you work habits to limit harm.
 Encourage continuous safety education for supervisors and workers.

 Appoint competent staff to manage work activities.
 Train workers in the proper use of equipment, materials and
Personal Protective Equipment (PPE).
 Create and/or establish a Joint Health & Safety Committee
(JHSC) and/or safety representative as required.
 Encourage regular Health & Safety Meetings.
 Provide safety awareness to workers.
 Establish and maintain Early & Safe Return To Work (ESRTW)
procedures.
 Have a copy of the current, applicable Health and Safety Act, and
associated Regulations available at all times.

Branch Managers and Staffing Specialist duties include, but are not
limited to the following:
> Ensure that a safe workplace environment is constantly maintained to

foster attitudes of accident prevention consistent with the company’s
objectives.
> Visibly demonstrate safety attitudes that nurture a safe working climate.
> Enforce Trillium Interim Staffing Inc.’s Health & Safety Program at all
times.
> Ensure competency of relevant Health & Safety, Workers Compensation
and applicable regulations legislation through continuing education.
> Visibly demonstrate positive attitudes on health and safety issues. >
Ensure that PPE is provided and used by workers when required. >
Report and investigate all workplace accidents. Help implement
preventative actions as recommended by the safety representative
and/or the Joint Health and Safety Committee.
Workers duties include, but are not limited to the following:
> Assist management to find temporary and suitable modified duties when
injured in accordance with the company’s modified work program.
> Participate in, and initiate regular safety meetings.
> Encourage workers to report unsafe work practices at all times.
> Work in a safe and productive manner consistent with the applicable
Health and Safety Act and Regulations.
> Know, understand and comply with the company’s health and safety
policies.
> Report all work-related accidents immediately to the supervisor and the
Trillium Interim Staffing Inc. branch office. (An accident is defined as
any specific event that causes immediate injury or gradual onset of
injury relating to work activities. It also includes property damage and
near misses).
> Always use proper PPE where and when required. This includes protective
devices or clothing required in accordance with the Applicable Health
and Safety Act and Regulations.
> Report to supervisor(s) and/or safety representative(s) any defect in
equipment or protective device that may create a potential hazard.
> Comply with the applicable Health & Safety Act and Regulations and
take every reasonable precaution to protect the safety of everyone.
> Report to supervisor and Trillium Interim Staffing Inc. branch office, any
infractions, under the applicable Health & Safety Act or
Regulations. > Participate in Health and Safety Awareness Training.
> At no time remove or make ineffective any protective device(s) required
under the applicable Health and Safety Act or Regulations.

> If any equipment or machinery needs to be repaired which requires the
removal of any protective device, an adequate temporary protective
device shall be used, and when the need for removing or making
ineffective the protective device has ceased, the original protective
device shall be re-installed immediately.
> Workers will not use or operate any equipment, machinery, or device in
a manner that may endanger themselves or any other worker. This
includes such things as engaging in any pranks, contests, and feats of
strength, un-necessary running or rough and boisterous conduct.
Heat Stress in the Workplace

Being uncomfortable is not the major problem with working in high
temperatures and humidifies. Workers who are suddenly exposed to working
in a hot environment face additional and generally avoidable hazards to their
safety and health.
Heat stress can be induced by high temperatures, heavy work loads, the type of
clothing being worn, etc.
Heat stress includes a series of conditions where the body is under stress from
overheating. It can include:
• heat rash
• heat cramps
• heat exhaustion,
• heat stroke.
Each produces bodily symptoms that can range from profuse sweating to
dizziness to a possible collapse. Heat Stress can be induced by high
temperatures, heavy work loads to the type of clothing/equipment being worn.
Heat Conditions:
Condition Signs/Symptoms First Aid
Heat Cramps Painful muscle Increase Water intake

spasms Rest in shade/cool
Heavy sweating environment
Heat Syncope Brief fainting Increase Water intake

Blurred vision Rest in shade/cool
environment

Dehydration Fatigue Increase Water intake

Reduced movement Rest in shade/cool
environment
Heat Exhaustion Pale and clammy Lie down in cool

skin environment
Possible fainting Water intake
Weakness, fatigue Loosen clothing
Nausea Call ambulance if symptoms
Dizziness continue once in cool
Heavy sweating environment.
Blurred vision
Body temp slightly
elevated
Heat Stroke Cessation of Medical Emergency!

sweating Call Ambulance
Skin hot and Move Victim to shade,
dry Red face immerse in water
High body
temperature
Unconsciousness
Collapse
Convulsions
Confusion or erratic
behavior
Life threatening
condition
Prevention of Heat Stress:
> The Heat Conditions Table helps to recognize the signs and
symptoms of heat stress.
> Pace the work, taking adequate rest periods in shade or cooler
environment.
> Use adequate fans for ventilation and cooling, especially when
wearing personal protective equipment (PPE) or working around
equipment that is hot.
> Wear light colored, loose (unless working around equipment with
moving parts) clothing.
> Keep shaded from direct heat where possible, for example, wear a
hat and apply sunscreen.
> Drink plenty of water. In hot environments the body requires
more
water than it takes to satisfy thirst. Drink BEFORE you are thirsty.
Sports drinks are not necessary, plain water works well.
> If possible provide cool rest areas in hot work environments.

> Have employees read Heat Stress Policy to help recognize the signs
and symptoms.
> Report any Heat Stress incident to supervisor and Trillium Interim
Staffing Inc. Heath & Safety representative or manager.
> Representative will contact Trillium Interim Staffing Inc. Health &
Safety Department to help in addressing the situation.
Musculoskeletal Disorders Prevention Policy
Trillium Interim Staffing Inc. is committed to providing a safe work environment

to all of our employees. In our ongoing efforts to build and maintain a
comprehensive Health & Safety Program we are continually analyzing the
workplace. We analyze accident reports and claims to identify areas of risk
exposure.
In today’s work environment one of the growing concerns is Musculoskeletal

Disorders. Across Canada these injuries are the most common injury in the
workplace and cost workplaces hundreds of millions of dollars due to
absenteeism, attrition and lost productivity.
MSD (Musculoskeletal Disorders) is an umbrella term for of a number of injuries,

disorders of the muscles, tendons, nerves etc. and two other terms that mean
the same include: Repetitive Strain Injury, Sprain strain.
Some common MSD diagnoses include; tenosynovitis, tennis elbow, carpal

tunnel, rotator cuff syndrome and tendonitis.
Trillium Interim Staffing Inc.’s MSD Policy will be comprehensive and cover
various crucial areas to work towards enabling a program that works toward an
ongoing commitment from all parties towards Prevention. These areas include
Understanding MSD Hazards, Recognize the hazards and identify solutions to
control the hazard, commitment from management, an established
communication process including early reporting, worker participation and
evaluation of solutions.

Understanding MSD Hazards
The primary MSD risk hazards are force, fixed or awkward postures and
repetitions.
Force: All work tasks require workers to use their muscles yet when a task
requires them to exert a force too high for that particular muscle it can damage
the muscle, tendon, joints or other tissue most commonly over an extended
period of time or while the body is an awkward position of posture.
Fixed or Awkward Posture: Posture is another name for the position of various
parts of the body during activity. Again we must look at the following: how long
workers need to hold a specific posture (fixed posture), how many times an
awkward posture is used in a given period of time and the amount of force
being exerted when an awkward posture is used.
Repetition: The risk of developing an MSD increases when the same parts of the
body are used repeatedly over a long period of time, one sign of a potential
MSD injury while a worker is engaging in highly repetitive motions is pain,
tightness and discomfort. When analyzing repetitive tasks you must analyze
how long workers will be performing the task, the posture required, and the
amount of force required
Other MSD Hazards and factors include; hand/arm/body vibration, work

methods, and contact stress
MSD Hazard Recognition
Trillium Interim Staffing Inc. understands Hazard Recognition is the

responsibility of all parties in the workplace the worker, the client and Trillium
Interim Staffing Inc.
Trillium Interim Staffing Inc. will endeavor to recognize MSD Hazards through
the initial worksite survey; as the Trillium Interim Staffing Inc. Policy advises a
worksite survey must be completed of the client site before placing any workers.
During this worksite survey the Trillium Interim Staffing Inc. Representative
with communication and involvement with the client will identify any areas of
concern with regards to MSD. As procedure if a Trillium Interim Staffing Inc.
Representative identifies a work environment which requires repetitive motion
over an extended period of time they will identify this on the worksite survey.

The Trillium Interim Staffing Inc. Health & Safety Department will then work
with the branch and client to implement solutions to control the risk associated
with the identified MSD hazard before placement. The detailed assessment will
require the Trillium Interim Staffing Inc. Branch Manager, Safety Representative
and Health & Safety Department to collect data from the site tour and to
communicate with the client.
The Data may include; the dimensions of the work area; force required for
pushing/pulling/reaching; work postures required; the frequency of physical
motions, potential contact stress, vibration, shift schedules, rotation schedules,
PPE, and environmental factors.
Trillium Interim Staffing Inc. understanding that it may be difficult to assess

every situation before placement, will assess the most common areas serviced by
conducting a worksite survey and obtaining detailed ergonomic, job demand
analysis for positions in assembly, manufacturing, and warehouse environments.
Once we have analyzed the worksite surveys and physical job demands of these
industries, Trillium Interim Staffing Inc. will develop a general hazard
Identification orientation for all of its temporary industrial workers. The
orientation will advise workers of the identified hazard, the problem that can
occur and the corrective measure to prevent the problem. The orientation will
also include a thorough discussion with the worker, identifying the job tasks and
demands of the position.
Trillium Interim Staffing Inc. will, on a quarterly basis, conduct a workplace

inspection of sites from each of the most common industries they are servicing
as part of its ongoing MSD Hazard Recognition.
MSD Prevention: Employer’s Responsibilities
Trillium Interim Staffing Inc.’s Health & Safety Department will monitor all
workplace incidents and injuries to track the type of injuries occurring at certain
job sites or industries, to identify certain job placements that may be an area of
high incident ratio. These worksites will be identified and an investigation
involving communication with the branch will commence. The branch will
immediately be advised to conduct a workplace inspection to assess the
situation and reach possible solutions.

Branch Managers will ensure that all internal employees have been orientated
and educated regarding the following with regards to MSD’s:
• they understand and recognize the hazards and early signs and
symptoms
• they receive and understand the general clerical hazard identification
policy
• they receive and understand the material handling policy
• all employees are instructed how to adjust their workstations as detailed
in the ergonomic assessment policy
Branch Managers and staffing specialists will ensure that external employees
receive the orientation and education regarding:
• understanding and recognizing the hazards and early signs and

symptoms
• receive and understand the general industrial hazard identification
policy
receive and understand the material handling policy
• receive a job specific description detailing the physical demands of their
specific assignment prior to placement
MSD Prevention: Worker’s responsibilities
Trillium Interim Staffing Inc. believes that workers are essential in the ongoing
process of preventing musculoskeletal injuries in the workplace and identifying
potential job duties where there is a high risk exposure. The following are the
Worker’s responsibilities with regards to MSD Prevention:
• All Trillium Interim Staffing Inc. workers both internal and external are
required to complete the MSD Prevention orientation so that they may
have understanding of the signs and symptoms associated with MSD
injuries.
• All Trillium Interim Staffing Inc. workers both internal and external must
immediately report any MSD Hazards, pain or discomfort to their
supervisor and branch representative.
• Trillium Interim Staffing Inc. workers both internal and external have
a responsibility to work with Trillium Interim Staffing Inc. Management
having open dialogue to address MSD Hazards and work towards
effective control measures.

Pandemic Flu Policy

Trillium Interim Staffing Inc.’s Pandemic Flu policy defines what a Pandemic Flu
is and describes preventative measures that should be practiced before, during
and after a pandemic.
What it is:
The Pandemic Flu occurs when a new virus emerges for which there is little
or no immunity in the human population. It begins to cause serious illness
and then rapidly spreads between person-to-person worldwide.
A pandemic is likely to be a prolonged and widespread outbreak that could

require temporary changes in many areas of society, work, transportation and
other public services.
The threat of a Pandemic Flu is a very distinct possibility and because of this
potential threat, Trillium Interim Staffing Inc. is committed to its employees
and has a plan of action covering such an occurrence.
Preventative measures:
If you are having any of the following symptoms you are encouraged to stay
home:
• You have a fever of any kind — you could be contagious

• You have a persistent cough accompanied by green mucus
buildup and a runny nose
• You have a severe sore throat
• You are throwing up
• Your eyes are bright red and have a discharge
Practice good health habits and take these common-sense steps to stop the
spread of germs.
• Wash hands frequently with soap and water

• Cover coughs and sneezes with tissues
• Stay away from others as much as possible if you are sick

• Stay informed about pandemic flu and be prepared
• Listen to radio and television and read media stories about pandemic
Trillium Interim Staffing Inc. has developed a Pandemic Emergency

Preparedness Plan in the event that there is a public health emergency, such
as the Pandemic Flu.
Emergency Response Plan Policy

Each Trillium Interim Staffing Inc. Office shall have in place, an Emergency
Response Plan that includes; an evacuation plan, shelter in place plan,
emergency food, water and equipment kits, emergency contact information
and employee identification records.
Evacuation Plan:
A plan developed by the Building or Property Management Office for the safe
evacuation of all building tenants and visitors. Evacuation routes and
emergency exits should be clearly displayed on all floors. Branch Managers
and/or Department Heads should obtain a copy of the building Evacuation
Plan and include it in your twice-annual Emergency Response Plan drills.
Shelter In Place:
When emergency officials deem it unsafe to leave your place of

employment, it is necessary to ‘Shelter In Place’. This means you must stay
in doors and in the case of an airborne contaminate, it may be necessary
to discontinue use of external ventilation. In this instance building
management will be required to shut down all external air exchange
systems.
Emergency Kits:
Emergency kits consist of food, water, first aid and equipment supplies as
outlined in the attached lists.
 Every internal Trillium Interim Staffing Inc. employee will be trained to

respond accordingly in the event of an emergency.

> Every Trillium Interim Staffing Inc. Office shall maintain and replenish
as required; a minimum of three (3) days supply of food, water and
emergency equipment as outlined in the attached Emergency Food,
Water and Equipment Kit lists.
Every Trillium Interim Staffing Inc. Office should keep individual sealed
records of identification and medical information for each internal Trillium
Interim Staffing Inc. employee in a fireproof lock-box, which will be accessible
only by the branch manager or department head, or when required, a senior
staff member, who will be designated by the branch manager or most senior
staff member within each office
Every Trillium Interim Staffing Inc. Office shall inspect the Emergency Food,
Water and Equipment Kits contents quarterly (once every three months) and
mark the inspection card with the date of the most recent inspection and the
signature of the person making the inspection.
To ensure the effectiveness of the Emergency Response Plan, every Trillium

Interim Staffing Inc. Office shall conduct a full drill bi-annually (twice each
year). All Trillium Interim Staffing Inc. offices will be provided with an
Emergency Response Plan Drill Evaluation Form. The form will be completed
after each drill and forwarded to the Health and Safety Manager to ensure
compliance.
Purpose:
> The purpose of this policy is to define, educate and communicate to all
workplace parties their responsibilities with regards to health and
safety in the workplace.
> By defining workplace responsibilities, this policy will help to provide a
framework, which allows for the co-ordination and communication of
safe workplace activities.
Training:
> Trillium Interim Staffing Inc. will ensure that all new internal employees
will be trained on the requirements applicable to them.
> Trillium Interim Staffing Inc. will ensure that all existing employees are
trained on the requirements applicable to them and receive a copy of
the policy.
> Trillium Interim Staffing Inc. will work hard to increase employee
awareness and knowledge to help keep employees aligned with
policies and standards.

Persons Affected:
> Trillium Interim Staffing Inc. Management (all levels)

> Trillium Interim Staffing Inc. Branch Managers and Staffing Specialists
> Internal and External Workers.
Management duties include, but are not limited to the following:
> Take every reasonable precaution to provide a safe working

environment for all employees.
> Workers for each branch office shall select a safety representative.
> Establish an ongoing standard of excellence on best workplace
practices.
> Continually recognize and eliminate foreseeable hazards which may
result in illness, injury, fire or damage to equipment, property or
persons.
> Communicate and distribute policies and procedures on Health & Safety.
> Communicate to clients and field staff their joint responsibilities to work
in a safe manner consistent with the applicable Health & Safety Acts
and regulations
> All employees will be held accountable for Health & Safety infractions.
> Workplace accidents will be investigated in a reasonable time frame.
Any necessary steps to prevent a reoccurrence will be taken.
> Monitor and regularly audit (annually) the Health & Safety Policies and
Procedures.
> Enforce safety through appropriate disciplinary action.

Certificado de finalización
Identificador del sobre: D17753BD9F974F5683F94B2392E3DE71 Estado: Completado
Asunto: Complete with DocuSign: 2. TIS Paper- Policy and Consent V2024.1.pdf
Sobre de origen:
Páginas del documento: 55 Firmas: 7 Autor del sobre:
Páginas del certificado: 4 Iniciales: 4 Trillium HR
Firma guiada: Activado 99 Sheppard Ave W
Sello del identificador del sobre: Activado Toronto, ON M2N 1M4
Zona horaria: (UTC-08:00) Hora del Pacífico (Estados Unidos y Canadá) camadmin@trilliumhr.com
Dirección IP: 38.40.111.108
Seguimiento de registro
Estado: Original Titular: Trillium HR Ubicación: DocuSign
03/05/2024 16:11:23 camadmin@trilliumhr.com
Eventos de firmante Firma Fecha y hora

Jorge Villarroel Pelizari Enviado: 03/05/2024 16:11:26
villarroelpelizarij@gmail.com Visto: 03/05/2024 16:11:39
Nivel de seguridad: Firmado: 03/05/2024 16:16:01
DocuSign.email
ID: 1 Adopción de firma: Dibujada en dispositivo
03/05/2024 16:11:27 Utilizando dirección IP: 38.40.111.108
Firmado con un dispositivo móvil
Divulgación de firma y Registro electrónicos:
Aceptado: 03/05/2024 16:11:39
ID: c5fa170f-00cf-46b4-83fc-0bae783b9ab5
Eventos de firmante en persona Firma Fecha y hora
Eventos de entrega al editor Estado Fecha y hora
Eventos de entrega al agente Estado Fecha y hora
Eventos de entrega al intermediario Estado Fecha y hora
Eventos de entrega certificada Estado Fecha y hora
Eventos de copia de carbón Estado Fecha y hora
Eventos del testigo Firma Fecha y hora
Eventos de notario Firma Fecha y hora
Resumen de eventos del sobre Estado Marcas de tiempo

Sobre enviado Con hash/cifrado 03/05/2024 16:11:26
Certificado entregado Seguridad comprobada 03/05/2024 16:11:39
Firma completada Seguridad comprobada 03/05/2024 16:16:01
Completado Seguridad comprobada 03/05/2024 16:16:01
Eventos del pago Estado Marcas de tiempo

Divulgación de firma y Registro electrónicos
Divulgación de firma y Registro electrónicos creada el: 30/04/2024 6:13:44
Las partes acuerdan: Jorge Villarroel Pelizari
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Trillium HR (we, us or Company) may be required by law to provide to you
certain written notices or disclosures. Described below are the terms and conditions for providing
to you such notices and disclosures electronically through the DocuSign system. Please read the
information below carefully and thoroughly, and if you can access this information electronically
to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please
confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and
signatures’ before clicking ‘CONTINUE’ within the DocuSign system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per-page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will be sent to you electronically

Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Trillium HR:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: thradmin@trilliumhr.com
To advise Trillium HR of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at thradmin@trilliumhr.com and in
the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address through your
account preferences.
To request paper copies from Trillium HR
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to thradmin@trilliumhr.com and in the
body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Trillium HR
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your signing session, and on the subsequent page,
select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an email to thradmin@trilliumhr.com and in the body of such request you must state
your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: https://support.docusign.com/guides/signer-guide-
signing-system-requirements.
Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before
clicking ‘CONTINUE’ within the DocuSign system.
By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm
that:
 You can access and read this Electronic Record and Signature Disclosure; and
 You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
 Until or unless you notify Trillium HR as described above, you consent to receive
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to you by Trillium HR during the course of your relationship with Trillium HR.

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PERSONAL INFORMATION – CONSENT & DISCLOSURE

 To establish and maintain your applicant file

Third Party Service Providers & Other Third Parties

 Law enforcement agencies: TIS would disclose Personal information in case of

Jorge Villarroel Pelizari

Please initial beside each item to indicate consent.

2. My Address, telephone number & email address (Will be disclosed to internal

3. The Region/City where I prefer to work

4. My Work History, Skills & Test Results

6. My Current Salary & Future Salary expectations

9. The results of my Reference verifications

10. My completed Consent form to conduct a Criminal Reference Check if this is

12. My completed Consent form to conduct a search of my Credit History if this is

13. My completed Government of Canada Personnel Screening, Consent and

16. My Social Insurance Number _____

17. My responses to interview questions ______

18. First Aid Medical Documentation: ______

I have reviewed and fully understand the information provided above.

Criminal/Credit Check/Education Verification

This is to confirm that I am aware that a Criminal/Credit check/Education verification

PAYROLL & AGREEMENT TO DEDUCT PAYROLL FEE – SEC. 13(3) ESA,2000

Jorge Villarroel Pelizari

________ It is my responsibility to provide correct and current mailing address for

Trillium Interim Staffing Inc.

Human Resources Policies and Procedures

Assignment Employee Rules & Regulations and Policies

Availability Policy and Procedures

Health & Safety Rules and Protocol

Human Resources Policies and Procedures

Employee Discipline Policy

In general terms, the discipline steps are (i.e. for lateness):

Right to Refuse Unsafe Work Policy

Guidelines for All Employees:

Right to Refuse Unsafe Work Procedures

a) If agreement is reached the assignment employee returns to work.

Assignment Employee Acknowledgement

I have reviewed and fully understand the information provided above.

Assignment Employee Acknowledgement

Jorge Villarroel Pelizari 5/3/2024

Ontario Safe at Work Employee Handbook Acknowledgement Form

Jorge Villarroel Pelizari 5/3/2024

Agreement to Work Excess Hours

Jorge Villarroel Pelizari 5/3/2024

Jorge Villarroel Pelizari

Signature: __________________________ Signature: _____________________

Information for Employees About Hours of

For more information or to file a claim

Your Employment Standards Rights –

Assignment employees of a temporary help agency

Right to public holidays and public holiday pay

Right to notice of termination and severance pay

Right to notice of termination of assignment

1. the assignment employee is assigned to perform work for a client;

3. the assignment is terminated before the end of its term.

An agency cannot charge you certain fees

If a client business of an agency wants to give you a job reference or

Information must be provided about the agency

Information must be provided about assignments

Signature: ______ Signature: _