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Includes fields for employer and worker members, guests, meeting dates, next meeting date, employee count, and structured entries for the origin date of each concern, the concern or problem description, recommended actions, and the action owner with completion or resolution dates. Provides signing requirements for co-chairs, distribution steps within one week, guidance for setting agendas, and an example agenda outline.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sample-committee-minute-form-workplace-safety-and-health/243590/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sample-committee-minute-form-workplace-safety-and-health/243590.png","ImageObject",442,249,{"name":88,"@type":89},"วิน","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-14","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information must be completed in the top boxes of the committee minutes form?","Question",{"text":109,"@type":110},"The full name and full address of the workplace (including department/branch where applicable), which committee (if more than one), and the number of employees at the workplace must be completed.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How should an issue be tracked in future minutes?",{"text":114,"@type":110},"Enter the date the issue is first raised in the “Origin” column, and continue noting this same date in subsequent minutes until the committee agrees the issue is resolved.",{"name":116,"@type":107,"acceptedAnswer":117},"Who must sign the minutes, and when should copies be distributed?",{"text":118,"@type":110},"Both management and worker co-chairs must sign each page when they agree the record is complete and accurate. Copies must be distributed within one week following the committee meeting.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},243590,1790147538,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},2336475104736,"https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222","SAMPLE COMMITTEE MINUTE FORM PAGE   OF    \nSee instructions on back of form  \n\n| Complete Name and Address of Workplace\u003Cbr>Phone:\u003Cbr>Fax:\u003Cbr>Which Committee ( if more than one ):\u003Cbr>Meeting date:\u003Cbr>Date of next meeting:\u003Cbr>Number of employees at the workplace: | Employer Members (list all) | Occupation | Present | Absent |\n| --- | --- | --- | --- | --- |\n|  | Worker Members (list all) |  |  |  |\n|  | Guests (list any) |  |  |  |\n\n\n| Date of Origin | Concern or Problem\u003Cbr>(see reverse for completion instructions) | Recommendation or Action to be taken | Action By (who & when) |\n| --- | --- | --- | --- |\n|  |  |  |  |\n\nOther Business:  \nCo-Chairpersons’ Signatures  Please indicate by (X) in the brackets below who chaired this meeting.  \nBOTH management and worker co-chairs must sign each page of the minutes when they agree that the minutes are complete and accurate.  \nIf one, or both co-chairs do not agree with the minute record, please attach concerns on a separate page.  \nIn my opinion, the above is an accurate record of this meeting.  \n( ) Print name of Employer Co-Chair   ( ) Print Name of Worker Co-Chair    \nSignature  Signature    \nWithin 7 days, copy to: 􀁮 Committee members; 􀁯 Committee files; 􀁰 Post on S&H Bulletin Board  \nSAMPLE COMMITTEE MINUTE FORM PAGE   OF    \nGet a copy of this minute form by searching \"Committee Minute Form\" at [safemanitoba.com](safemanitoba.com. Fill)[. Fill](safemanitoba.com. Fill) in your meeting information as outlined below (Instructions for Completion of Minute Forms) and print the form.  \nYour committee must meet four or more times per year. You can use this sample Workplace Safety and Health Committee Minute Form or set up your own format containing all the information in this form.  \nThe 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.  \nIf 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) .  \nINSTRUCTIONS FOR COMPLETION OF MINUTE FORMS  \n􀁮 You must complete all information in top boxes:  \nFull Name & Full Address of Workplace-must include Department & Branch, where applicable.  \nWhich Committee-needs to be completed only if you have more than one committee at the same address.  \nNumber of Employees at the Workplace-the number at the workplace, not the number on the committee.  \n􀁯 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.  \n􀁰 In the second column \"Concern or Problem\" list the details of items discussed. Draw a line across the page to separate each issue.  \n􀁱 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.  \n􀁲 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.  \n􀁳 In the bottom section \"Other Business\" record any points not covered such as upcoming elections or date of next meeting.  \n􀁴 Both management and worker co-chairs 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.  \n􀁵 Distribution of copies must be done within one week following the committee meeting:  \na) Distribute copies to committee members, alternates, and relevant managers.  \nb) Keep one copy at the workplace for a period of at least 10 years from the date of the meeting.","cbCaist9PqxGHZJh","https://ap.wps.com/l/cbCaist9PqxGHZJh","pdf",160453,"English","# Minute Form Fields\n## Workplace Information and Attendance\n## Safety Concerns and Actions\n# Co-Chair Signatures and Distribution\n## Signing and Accuracy Requirements\n## Copy Distribution Timeline\n# Instructions for Completion\n## Column Guidance (Origin, Concern, Action, Action By)\n## Other Business\n# Setting Agendas\n## Generic Agenda Outline","[{\"question\":\"What information must be completed in the top boxes of the committee minutes form?\",\"answer\":\"The full name and full address of the workplace (including department/branch where applicable), which committee (if more than one), and the number of employees at the workplace must be completed.\"},{\"question\":\"How should an issue be tracked in future minutes?\",\"answer\":\"Enter the date the issue is first raised in the “Origin” column, and continue noting this same date in subsequent minutes until the committee agrees the issue is resolved.\"},{\"question\":\"Who must sign the minutes, and when should copies be distributed?\",\"answer\":\"Both management and worker co-chairs must sign each page when they agree the record is complete and accurate. Copies must be distributed within one week following the committee meeting.\"}]","Sample Committee Minute Form - Workplace Safety and Health | PDF",1789206022]