Committee Minute Form Template

Committee Minute Form Template

​Your committee must meet at least once every 90 days, or four or more times per year. You can use the sample Workplace Safety and Health Committee Minute Form or set up your own format containing all the information in this form. Fill in your meeting information as outlined below and print the form.

​​The minute form is intended for your use to record briefly and clearly the safety and health concerns at your workplace, and steps taken by the committee or others to resolve them. They are designed to provide everyone at your workplace with information on your committee's activities and progress to date.

If you are unable to resolve an issue yourselves, call the Workplace Safety and Health Branch for assistance at 204-957-SAFE (7233) or toll-free in Canada at 1-855-957-SAFE(7233).

Instructions for Completing Minute Forms

  • You must complete all information in the top boxes:

    • ​Full Name & Full Address of Workplace: must include Department & Branch, where applicable.
    • Which Committee: needs to be completed only if you have more than one committee at the same address.
    • Number of Employees at the Workplace: the number at the workplace, not the number on the committee.
  • ​​
  • In the first column, "Origin," indicate the date an issue is first raised at a safety and health committee meeting. Continue to note this date in future minutes until the committee agrees the issue is resolved.

  • In the second column, "Concern or Problem," list the details of items discussed. Draw a line across the page to separate each issue.

  • ​In the third column, "Recommendation or Action Taken," indicate what has been done or the steps being taken, or the committee's recommendation as to what should be done to resolve the issue.

  • In the last column, "Action By," fill in who will be responsible for carrying out each interim step or action, and the date it will be completed; or, if the issue is resolved, fill in the date it was resolved and mark it as COMPLETED.

  • In the bottom section, "Other Business," record any points not covered, such as upcoming elections or date of next meeting.

  • Both management and worker co-chairs (or their alternates who attend the meeting in their absence) must sign each page of the minutes when they are satisfied that the record is complete and accurate. Please indicate by an (X) in the brackets who chaired that particular meeting.

  • Distribution of copies must be done within one week following the committee meeting:

    • Distribute copies to committee members, alternates, and relevant managers.
    • Keep one copy at the workplace for a period of at least 10 years from the date of the meeting.
    • Post one copy on the safety and health committee bulletin board(s).

Setting Agendas​

It is recommended that the co-chairs get together to set the agenda for each meeting. This must be posted on the safety and health committee bulletin board prior to each meeting and distributed to committee members at least 3 clear days ahead of the meeting. Following is a generic agenda outline that could be used in creating your own agendas.
  1. Review minutes of last meeting. You will need to determine if all issues have been resolved or if actions have been taken as indicated and next steps agreed to and noted.

  2. Review issues resolved by individual committee members or supervisors.

  3. Review illness, injuries and incidents since last meeting. This could also include a brief review of the safe work procedures, rules and policies related to the illness, injuries or incidents, and recommendations for changes to same.

  4. Consider new concerns or problems. These may arise out of inspection tours, surveys, investigations by committee, or concerns brought to the committee's attention by employees or management.

  5. ​Review of educational material and availability of safety and health training programs for all workers and those specifically designed for committee members.

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