Revised 2013

Board of Canadian Registered Safety Professionals

Sample Application & Eligibility Requirements



This application has been completed as sample for you to reference. Please use the Application document to
complete your application for submission to the BCRSP.

PLEASE READ THE ENTIRE APPLICATION FORM
BEFORE YOU BEGIN COMPLETING EACH SECTION


PLEASE COMPLETE AND SUBMIT ORIGINAL AND ONE COPY OF APPLICATION FORM
AND ONE COPY ONLY OF SUPPORTING DOCUMENTATION ALONG WITH THE NON-REFUNDABLE
APPLICATION FEE TO:

Board of Canadian Registered Safety Professionals
6519B Mississauga Rd
Mississauga, ON L5N 1A6


FEES: R#100304195

Non-Refundable Application fee (includes first writing of examination) is $525.00 + HST/GST

Residents of AB, BC, SK, MB, QC, YT, NT, NU Add 5% GST ($525.00 +$26.25 =$551.25)
Residents of ON, NB, NL Add 13% HST ($525.00 +$68.25 =$593.25)
Residents of PEI Add 14% HST ($525.00 +$73.50 =$598.50)
Residents of NS Add 15% HST ($525.00 +$78.75 =$603.75)
Residents outside of Canada - $525.00
Examination Writing Extension Fee is $100 +HST/GST
Supplementary Examination Fee (maximum of three additional) is $125.00 +HST/GST
Annual renewal fee is $150.00. An additional $25.00 fee increase has been approved for 2012, 2013, 2014 and
2015 +HST/GST

Application Fee Credit Card Payment:

Name of Applicant: Robert K. Jones Province of Residence: SK

Payment By: [ ] American Express [ ] MasterCard [ ] Visa

Card # Cardholders Name:

Expiry Date:

I authorize a $525.00 +HST/GST charge to the credit card noted above.

Signature:

Payment By: Cheque enclosed made payable to the BCRSP
Payment Online: [ ] If you submitted your payment via the BCRSP website, please enclose a copy of the
receipt delivered to you via email.


Applications submitted electronically or via facsimile or handwritten submissions will not be accepted.
Please do not cerlox bind your submission.


BCRSP Application Page 2 of 11


Revised 2013

BCRSP Application Requirements

Before submitting your application, please ensure that all sections of the application (Parts A, B, C and Factors 1,
2, and 3) are completed in full and the Declaration is signed and dated. Supporting documentation must be
clearly identified by Factor and attached in the same order as listed on the application.

Applications that are not fully completed with documentation attached and in the proper order will be
returned to the candidate for resubmission. A $50.00 (+ HST/GST) resubmission fee must accompany the
resubmitted application.

Chronological resumes should be submitted with your application however, they are not considered official
documents but may be used by the Qualifications Review Committee to clarify formal education and employment
information and dates.

International Candidates

International candidates whose first language is neither English nor French must:

Submit documentation verifying a minimum score of 94-101 on a Test of English as a Foreign Language
(TOEFL) IBT; a band score of 7 on the International English Language Testing Sytem or a score of 785-
900 on a Test de franais international (TFI). (Equivalent proof of language proficiency (e.g. a university
assessment) will also be accepted)
Foreign credentials must be translated to English or French and be verified by an official translator
Foreign credentials must be submitted to a Canadian Credentialing Agency (see below) prior to
application submission.

Foreign Credential Assessment and Evaluation

Alliance of Credential Evaluation Services of Canada (Pan-Canadian) www.canalliance.org/indexe.stm
Canadian Association of prior Learning Assessment (Pan-Canadian) www.capla.ca/news.php
Canadian Information Centre for International Credentials (Pan-Canadian) www.cicic.ca
University of Toronto Comparative Education Service (Pan-Canadian) www.adm.utoronto.ca/ces
International Qualifications Assessment Services (AB, SK, NT)
www.employment.alberta.ca/cps/rde/xchg/hre/hs.xsl/4512.html
British Columbia Institute of Technology - International Credential Evaluation Services (BC)
www.bcit.ca/ices
Academic Credentials Assessment Service (MB)
www2.immigratemanitoba.com/browse/work_in_manitoba/work-recognition-acas.html
World Education Services (ON with pan-Canadian applicability) www.wes.org/ca/employers/index.asp
Centre dexpertise sur les formations acquises hors du Qubec (QC) www.immigration-
quebec.gouv.qc.ca/en/education/comparative-evaluation/index.html

Reference : The Employers Roadmap, Hiring and Retaining Internationally Trained Workers
Citizenship and Immigration Canada
Foreign Credentials Referral Office
C&I-1019-05-09E
www.credentials.gc.ca
BCRSP Application Page 3 of 11


Revised 2013

APPLICATION FOR CERTIFICATION

This application has been completed as sample for you to reference. Please use the BCRSP_application document in
order to complete your application.

Part A: Personal Information
Salutation Mr (Please select via drop down list)
Last Name J ones
First Name Robert K.
Employer
(Current employer information
must be completed)
ABC Manufacturing Co.
Your Position/Title HSE Coordinator
Business Address 500 Main St
City Saskatoon
Province SK
Postal Code S7K 5B2
Business Telephone (306) 555-1234
Email rjones@abcmanu.com
Home Address 14 Queen St S
City Saskatoon
Province SK
Postal Code S5N 7K3
Home Telephone (306) 555-5678
Preferred Mailing Address Business Home
It is the applicants responsibility to keep the Board informed of any changes to the above information.

BCRSP Application Page 4 of 11


Revised 2013


Part B: Reference Questionnaire (RQ)
Please provide the name, title, employer, telephone number and email address of your reference. When selecting
your reference, be sure this individual has knowledge of the OHS work you have done and the degree of
responsibility you have in the administering of your employers OHS program. You may not use anyone as a
reference over whom you have supervisory responsibilities. It is not necessary that your reference be a Canadian
Registered Safety Professional (CRSP).

The completed reference is NOT to be returned to the applicant, but sent directly to the Board. A Reference
Questionnaire included with an application will not be considered and a new reference will be requested.
Contact Information for the Individual Completing the Reference
Name J ames R. Mason
Title OHS Coordinator
Employer Government of Saskatchewan
Telephone (with area code) (306) 555-1278
Email jamesmason@email.ca

Part C: Practice Questionnaire (PQ)
Please provide the name, title, employer, telephone number and email address of your immediate supervisor. If
you are a private consultant, the Practice Questionnaire may be completed by a current client.

The completed Practice Questionnaire is NOT to be returned to the applicant, but sent directly to the Board. A
Practice Questionnaire included with an application will not be considered and a new practice
questionnaire will be requested.
Immediate Supervisor/Client Completing the Questionnaire
Employer Client
Name Roger J . Best
Title VP Human Resources
Employer (only if client) ABC Manufacturing Co.
Telephone (306) 555-1234
Email rjbest@abcmanu.com

The same individual may not complete both the Reference Questionnaire and the Practice Questionnaire
on behalf of the candidate.

BCRSP Application Page 5 of 11


Revised 2013


Factor 1 : Formal Education

Minimum points required = 50; maximum points available = 100
Minimum requirement: a one year college/university certificate/diploma in OHS OR a two year college/university
non OHS certificate/diploma.

Institutions that have made submission to the Board and received approval for their OHS programs are posted to
the Boards website. If your program is not listed, it may still be eligible for points.

Applicants who completed formal education above the minimum requirement (e.g. undergraduate degree or
college diploma in any discipline) meet the formal education requirements for certification.

All completed post-secondary education programs may be claimed to a maximum of 100 points as follows:

The highest level of completed formal education will be awarded the maximum number of points as per
the matrix below
Each additional level of completed formal education will be awarded 50% of its point total
Specialty certificates/diplomas/degrees within the scope of OHS practice should be claimed as non OHS
programs (i.e. kinesiology, ergonomics, environment, etc). OHS programs must be generalist in content
reflecting the CRSP generalist designation as outlined in the Examination Blueprint.

Formal Education Value
OHS
**One year OHS college or university certificate or diploma 50
Two year OHS college or university certificate or diploma or one year post diploma 70
Three year OHS college or university certificate, diploma or degree 80
Four year OHS college or university diploma or degree 100
Post graduate OHS degree 100
NON-OHS
**Two year non-OHS college or university certificate or diploma 50
Three year non-OHS college or university certificate, diploma, degree or one year non-OHS post diploma 60
Four year non-OHS college or university diploma or degree 70
Post graduate non-OHS college or university degree 80

Example #1
Candidate has a 4-year, undergraduate, non-OHS university degree and a 1-year, OHS university certificate.

4-year, undergraduate, non-OHS degree 70 points
1-year, OHS certificate (50% of 50 points) 25 points
Total Factor 1 95 points


BCRSP Application Page 6 of 11


Revised 2013

Factor 1 : Formal Education

Minimum points required = 50; maximum points available = 100
Example #2
Candidate has a 3-year, OHS college diploma and a 2-year, college non-OHS certificate.

3-year, OHS college diploma 80 points
2-year, non-OHS certificate (50% of 50 points) 25 points
Total Factor 1 100 points (maximum allowable)

To receive Factor 1 credit, candidates must request granting institution to provide a final sealed transcript.
Transcripts that have been photocopied or scanned will NOT be accepted.

Candidates who have not graduated from college/university but who have successfully completed some
OHS credit courses may claim these courses under Factor 2, Category B.
Program length is based on full-time attendance. If you are enrolled as a part-time student and it takes
two to three years to complete what is a one year program for a full-time student, you must claim it as a
one-year program.
Level Completed College/University Program Name Year
Graduated/
Completed
QRC Use Only
One year OHS college
or university certificate or
diploma
Two year non-OHS
college or university
certificate or diploma








35 (50% of 70)








70 (full points)







Maximum 100
Points Awarded
Two year OHS college or
university certificate or
diploma or one year post
diploma
Three year non-OHS
college or university
certificate, diploma, degree
or one year non-OHS post
diploma
Northern Alberta
Institute of
Technology
Occupational Health &
Safety Diploma
2006
Three year OHS college
or university certificate,
diploma or degree
Four year non-OHS
college or university diploma
or degree
University of British
Columbia
Arts 2002
Four year OHS college
or university diploma or
degree
Post graduate OHS
degree
Post graduate non-OHS
college or university degree



BCRSP Application Page 7 of 11


Revised 2013


Factor 2 : Professional Development

Minimum points required = 15; maximum points available = 100
List all OHS-related training courses/seminars/conferences you have completed beginning with the most
recent. To obtain credit, you must attach a copy of the course/seminar/conference outline and a copy of any
certificate received or furnish equivalent proof of completion such as a letter from the organization presenting the
course/seminar/conference. The documentation must specify the duration of the course and demonstrate
proof of completion.

Professional development credits will not be granted without documentation. Documentation must be
attached for each course/seminar/conference in the same order as listed on the application. If you do not have
supporting documentation, do not list the professional development activity on your application.

In-house training will be considered, however, candidates must provide verification from their employer of course
dates, content and successful completion. Orientation training to meet job requirements may not be claimed
in Factor 2.

Activity Value
A1. OHS courses/seminars/conferences of a minimum one day
(6 hours) duration
1 point/day
A2. Non OHS course/seminars/conferences of a minimum of
one day (6 hours) duration
1 point/day (to a maximum of 5 points)
B. College/university OHS credit course (not part of formal
education Factor 1)
10 points/course


A1. OHS courses/seminars/conferences, minimum of one day (6 hours duration) completed in the last five
years.(60 months from date application received by BCRSP).
Course Provider Title of Course /
Seminar / Conference
Total
Hours
Start/Finish Dates QRC Use Only


1


2


2


2


3
Alberta Construction
Safety Association
Confined Space
Awareness
7 Mar 16/2010
Alberta Construction
Safety Association
Leadership for Safety
Excellence
14 May 16-17/2010
St J ohn Ambulance Standard First Aid 14 J une 8-9/2010
University of Alberta Managing Contractor
Safety Performance
14 Sept 15-16/2010
University of Alberta H&S Legislation 21 Feb 18-20/2009
BCRSP Application Page 8 of 11


Revised 2013

Factor 2 : Professional Development

Minimum points required = 15; maximum points available = 100
ABC Manufacturing Accident Investigation 4 Apr 7, 2009

0 (not min 6 hrs)

1


Total: 11






2


5

MAXIMUM 5
POINTS AWARDED

A1 +A2 Total: 17

Alberta Construction
Safety Association

Back Injury Prevention

7

Sept 4/2008
A2. Non OHS courses/seminars/conferences, minimum of one day (6 hours duration).,
to a maximum of 5 points completed in the last five years. (60 months from date
application received by BCRSP).
Course Provider Title of Course /
Seminar / Conference
Total
Hours
Start/Finish Dates
Excel Group Development Real Time Coaching 14 Dec 11-12/2008
Dale Carnegie Customer Service 35 Mar 6-10/2007

B. College or university credit courses having a duration of one semester or a
minimum of 35 hours. College/university transcript must be attached in order to
receive credit. Do not include courses completed for formal education
programs claimed in Factor 1.
QRC Use Only







10


10
College/University Course Total
Hours
Start/Finish Dates
University of Alberta Occupational Hygiene 39 Nov 19-28/2012
University of Alberta Hazard Recognition 39 Feb 6-13, 2012
IMPORTANT: The time limit for Category A1 and A2 professional development activities is five (5) years
or 60 months. (The 5 years (60 months) is calculated from the date the application is received by BCRSP.)

There is no time limit for Category B OHS credit courses.

Online Courses:
Points may be awarded based on technical contact time as identified by the course provider, not the actual
contact time for the applicant completing the activity. If the course provider cannot provide contact time for
the activity, no points will be awarded.
BCRSP Application Page 9 of 11


Revised 2013


Factor 3 : Professional Practice (Related Experience)

Minimum points required = 50; maximum points available = 100
While the Board recognizes the value of specialists within the broad parameters of OHS, the CRSP is a generalist
designation. Candidates are expected to demonstrate knowledge in the eleven domains identified in the
Examination Blueprint.

Full-time OHS related experience Value
Minimum 36 months (3 years) 50
37-60 months (3 years - 5 years) 65
61-84 months (5 years - 7 years) 80
85+months (7+years) 100

Credit will be given for each year of continuous OHS employment to a maximum of eighty-five months (seven
years). The minimum requirement for registration is thirty-six months (three years). The Qualifications
Review Committee evaluates each job position using the criteria below to determine whether it is accepted as
professional practice. Failure on any one means that the position is not accepted. 1. The position must be full
time. This could include job-sharing. 2. The professional OHS function must be greater than 50% of the listed
positions duties, (i.e. a minimum of 900 hours per year) The positions responsibility must be the prevention of
harm to people, property, and the environment, rather than the responsibility for responding to harmful events.
Duties could include systems analysis, preventive methods, risk management, and audit functions. Collateral
duties in OHS are not considered the primary function. 3. The position must be at a professional (engaged in an
OHS occupation for pay or livelihood) level. This is determined by evaluating the responsibilities, activities, and
reliance by peers, employers, or clients on the applicants ability to defend analytical approaches used in
professional practice and the recommendations made for controlling hazards through engineering and/or
administrative approaches. 4. The position must have a broad scope of duties. This is determined by evaluating
the variety of hazards about which a candidate must advise and the range of skills involved in recognizing,
evaluating, and controlling hazards. Examples of skills are analysis, synthesis, design, investigation, planning,
administration, and communication.

NOTE: University/college/co-op work terms may not be applied to professional practice.

YOU MUST ENCLOSE YOUR OFFICIAL JOB DESCRIPTION (ON COMPANY LETTERHEAD AND/OR
VERIFIED/SIGNED BY HR OR SUPERVISOR) FOR YOUR CURRENT AND ANY PREVIOUS POSITIONS
CLAIMED UNDER FACTOR 3.

PLEASE ALSO ENCLOSE A CURRENT RESUME WITH YOUR APPLICATION.

If you do not have a formal job description, you must provide a detailed outline of your OHS
responsibilities on company letterhead and have those responsibilities verified by a company official (e.g.
HR department, immediate supervisor).
BCRSP Application Page 10 of 11


Revised 2013


Employer J ob Title Dates Employed
(Month/Year to
Month/Year)
Do not overlap
months
QRC Use Only







100 (85+months)
Current Employer ABC Manufacturing
Co.
HSE Coordinator Mar/05-Current
1
st
previous
employer
Premier Oil & Gas
Ltd.
Safety Supervisor Sep/02-Feb/05
2
nd
previous
employer

3
rd
previous
employer

If time in current position is less than 36 months, you must provide a job description and confirmation from
previous employer(s) confirming the 50% OHS content of your previous position(s) and employment dates for the
36 months immediately prior to application submission.

Note: Gaps in employment due to parental leave, LTD, returning to school full-time, unemployment, etc, to a
maximum of 12 months will not negate the 36-month continuous employment requirement but must be identified
on the application. Employment gaps of more than 12 months will be assessed on a case-by-case basis.
Factor 3 Matrix
Applicants must complete the following matrix to support the job description in outlining the percentage of their
duties and responsibilities spent in the listed domain areas. Not including General administrative duties and
Other, candidate position duties must include responsibility for at least four (4) domains, one of which MUST be
Safety Techniques and Technology (STT). Percentage for minimum four (4) domains must total at least 50% of
position duties.
Domain Mandatory
Part of position duties?
Explanatory Notes
QRC Use
Only
Yes (%) No
Safety Techniques and Technology
(e.g. inspections, investigations,
analysis, facilities management,
safety operations, safety
performance) please refer to the
Examination Blueprint for details) Yes 40%

Environmental Practice No 10%
Ergonomics No 5%
Fire Prevention and Protection No 5%
HSE Auditing No % X
External contracted
function
Health and Wellness No % X HR Function
Occupational Hygiene No 15%
Risk Management No 5%
General administrative duties No 20%
Other (identify) No % X
Total 100%
Please note: CRSPEX Domain areas of Accident Theory, Law and Ethics, Occupational Health
Safety and Environment Systems are not required categories.
DECLARATION
BCRSP Application Page 11 of 11


Revised 2013

I certify that the information contained in this application and all documents attached thereto, are factual and
accurate to the best of my knowledge and hereby request assessment by the Qualifications Review Committee. If
approved to proceed with the certification process, I agree to present myself at a Regional Screening Centre of
my choice for interview. If approved to write the certification examination (CRSPEX). I understand that the
examination is a computer based test (CBT) based on the Examination Blueprint and administered at third party
test centres contracted by the Board. I agree to abide by the Boards Code of Ethics and understand that the
Governing Board shall be the sole authority as to who shall and who shall not be approved for certification.
Signature: Robert Jones

Date: J anuary 24, 2011

Application Assessment
The final determination of the acceptability of an applicant to proceed to a Regional Screening Centre interview is
made by the Qualifications Review Committee. Candidates should not assume that their assessment of points
awarded in Factors 1, 2 and 3 will be the same as that of the Qualifications Review Committee.

A minimum total of 150 points from all three Factors is required for a candidate to proceed in the certification
process. Candidates must obtain a minimum of 50 points in Factor 1 (Formal Education), 15 points in Factor 2
(Professional Development), and 50 points in Factor 3 (Professional Practice).