A Study of the Effectiveness of Workplace Health and Safety Programmes in a University Setting in Canada.

Introduction: Nearly a quarter-million people work in universities in Canada, making it one of the fastest-growing sectors. Although each university provides occupational health and safety services and training programmes to their employees, there have been no studies conducted on the impact of such programmes on employees' knowledge, attitude and behaviour. The aim of this study was to evaluate the effectiveness of dissemination of information of workplace health and safety programmes to workers at a Canadian university.
Methods: The study compared two cross-sectional online surveys of employees of a Canadian university regarding workplace health and safety with a previously conducted cross-sectional study and thematic analysis of key informant interviews to address the issues raised in the surveys.
Results: Participation in health and safety presentations could enhance understanding and practices of safety. Age, employment status and duration of employment were associated with the levels of knowledge, attitudes and behaviour of employees and graduate students. The key informant interviews highlighted some new initiatives such as the establishment of workplace health and safety committees in all university buildings; the development of a safety app and health and safety management system; routine annual inspections of all university building offices and laboratories; new orientation for undergraduate students where general safety rules are described. Discussion: University should have regular presentations on the available health and safety programmes and should increase the number of safety training programmes and keep track of the employees that have not received any training, particularly for those working in hazardous environments. Copyright:

INTRODUCTION

The labour force in the university sector in Canada is large and has considerable occupational diversity. According to Statistics Canada, out of 17 million-member workforce, 1.3 million (8%) are in educational services, and almost 20% of these individuals (~250,000) work in various universities.[1] The 2016 census shows that educational services in Canada had the fourth-highest rate of growth and more than half of this increase was in universities.[2] The working environment in universities is highly diverse, as there are a wide range of disciplines involving teaching, research, administration and maintenance. Due to this multifaceted working environment in the universities, employees encounter various types of occupational health risks. Despite the complexity of occupational risks, little has been written about occupational health and safety programmes of the university employment sector.[3]

In Canada, workers are covered by provincial or federal labour codes, depending on the sectors in which they work. While workers in mining, transportation, and the federal government are covered by the Canada Labor Codes, other workers such as employees of universities are covered by provincial health and safety legislation.[4]

Venables and Allender (2007) described the occupational health services in 93 universities in the UK by drawing on data from surveys carried out in 2002, 2003 and 2004. Most survey responses were received from universities and in-house services. The surveys requested self-completed information on occupational health services from each university. The results indicated that 50% of the universities had an in-house health service, 32% relied on a contractor, 9% used the campus student health service, and a further 9% had an ad hoc arrangement or no arrangement. On average, the service was poor, as usually only one half-day doctor with one full-time nurse and a part-time clerk were available to provide service. The wide variation among universities in staffing levels suggested that some universities might have less-adequate services than others.[3] A study examining the safety concerns of faculty members of a university campus in USA (Alabama) showed that women faculty members took more personal safety precautions than men and felt more strongly about the need for the improvement of safety features on campus. A 160-item questionnaire was distributed to the faculty members asking about socio-demographic information, daily campus activities, personal safety protection taken while on campus, awareness and attitudes about safety on campus, and reported cases of victimization on campus. A few months later, the authors examined the safety awareness of male and female staff members in the same university using the same questionnaire. The results indicated that although female staff members reported more regarding acts of violence against them than male staff members, there was not much difference in their attitudes towards improving safety features on campus. Faculty and staff members identified that they like to use avoidance strategies such as walking with a friend or using objects as a weapon rather than contacting campus security.[5]

All Canadian universities have Environmental Health and Safety (EHS) or similar departments through which Occupational Health and Safety (OHS) services are provided. All the universities follow a similar practice such as a) having health and safety committees on the campus, b) promoting health and safety and providing risk management services, c) conducting regular workplace inspections and reviewing incident investigative reports, e) creating annual reports about incidents, lessons learned, and providing recommendations to senior administrators, and e) organizing health and safety information session for the employees. The EHS unit mainly offers training on fire safety, first aid, laboratory safety, biosafety, X-ray safety, radiation and laser safety, WHMIS (Workplace Hazardous Materials Information System), contractor safety, respiratory protection, ergonomics, hazardous waste management and disposal and also provides health and safety committee representative training.[6]

Despite the existence of occupational health and safety programmes in various Canadian universities, recorded evaluation of such programmes is sparse. Considering the large workforces in universities and their unabated positive growth, it is crucial to evaluate the existing occupational health and safety programmes in Canadian university settings. The aims of this study were: a) to evaluate the effectiveness of health and safety programmes through well-designed surveys of faculty members, staff and graduate students of a Canadian university (Memorial University of Newfoundland or MUN); and b) to conduct a key informant interview of the officials of MUN responsible for the operation of the health and safety unit to address the issues raised in the surveys.

In 2013, MUN contracted a third-party consultant to conduct an impartial assessment of the safety culture at the university. The consulting group was asked to do a complete assessment of the current state of health and safety programmes offered by MUN through the Office of the Chief Risk Officer and to identify gaps in the programme. The consulting group surveyed about 10% of the permanent employees of MUN in 2013 and produced a report in 2014. The Office of the Chief Risk Officer called the report a ‘Gap Analysis (GA) survey’. In 2015, to address the identified gaps and to increase awareness about the health and safety programmes, the Office of the Chief Risk Officer organized several health and safety presentations for MUN employees. We sought to examine if these presentations had any effect on the knowledge, attitudes and behaviour of the employees and graduate students at MUN and if their level of knowledge, attitudes and behaviour are sustainable over time. As a result, in consultation with the EHS Unit in 2016, we administered two identical online surveys to employees and graduate students at MUN. The purpose of the first survey was to answer the following research questions:

Has there been any significant improvement in the perception of the workplace health and safety of MUN employees since 2013 when the survey on gap analysis in safety culture was conducted?

Do knowledge, attitudes, and practices regarding the health and safety of MUN employees differ with respect to demographic variables?

Is there any significant difference in the perception of safety practices between those who attended the health and safety presentations and those who did not attend these presentations?

The purpose of the second survey (using the same questionnaires of the first survey) was to assess the retention of health and safety knowledge over the period of 6 months. The intent of conducting the surveys was to gain insight into important factors that could make MUN's health and safety programmes more effective. The study also intended to explore the responses of the officials to the issues raised in the surveys.

METHODS

We used a mixed-methods approach by collecting, analysing and integrating quantitative (surveys) and qualitative (interviews) data to gain in-depth understanding and corroboration while offsetting the weaknesses inherent in using each approach by itself.[789] Approval from the ethics committee was obtained. The date of the approval 23rd August 2016.

Survey participants

The survey participants in the two surveys that we conducted, included graduate students/researchers, faculty members and staff, as they work for the MUN as employees. As the surveys were anonymous, the second survey was sent to the same entire population and not to only the respondents of the first survey. This allowed us to compare the results with those of the independent surveys to determine if there are any changes in the knowledge level of the employees on health and safety-related information.

Survey design

Two identical online surveys of MUN employees were conducted between 1) October 19, 2016 and November 30, 2016, and 2) April 10, 2017 and June 10, 2017. The purpose of the first survey was to gauge the level of uptake of the information on health and safety, disseminated by the EHS Unit to the MUN Community through their safety workshops in 2015–2016 as well as through their broader reach-out mechanisms. Further, we wanted to study the effect of the knowledge about health and safety on the attitudes and behaviour of the employees and graduate students at MUN. The second survey was conducted six months after the first survey. It targeted the same population and followed the same methodology as the first survey and aimed to understand the retention of knowledge over time and whether the knowledge, attitudes and behaviour of the employees changed over time.

Our survey was developed based on input from the EHS unit. Some questions were based on questions from the GA survey with the intent of comparing the results. We also adopted some questions from the survey questionnaire of the study ‘Montana Tech Campus Safety, Security and Safety Awareness Survey’ conducted by Kristine Witt in 2011 at Montana Tech University, USA.[10] We conducted a pilot survey of some faculty members, staff and graduate students to ensure the readability, clarity, and organization of the survey questionnaire. We sent e-mails to all faculty and departments of MUN's main campus in St. John's and affiliated Grenfell campus in Corner Brooke, detailing the nature of the survey and provided a web-link (Survey Monkey®) to access the survey. The questionnaire with the references is presented in a supplementary file (S1). At the beginning of the survey, online consent was obtained. The survey instrument was prepared to capture the awareness, attitudes and behaviour of employees and graduate students toward health and safety programmes offered by MUN. The questions were divided into three groups: 1. Knowledge (refers to the awareness and perception of the participants related to health and safety); 2. Attitudes (collects information on the viewpoints and beliefs of the participants about occupational health and safety); and 3. Behaviour (collects information on participants’ day-to-day safety practices/protocols at the workplace).[11] Questions 7-18, 21, 22, 25, 29, 31 and 40 were designed to test the knowledge of the participants regarding occupational health and safety; questions 19–20, 26–27 were combined to assess their attitudes; and questions 28, 30, 32, 34, 36 and 41 were grouped under behavioural questions (please refer to the questionnaire in supplementary file S1). The last few questions were on the perceptions of the participants about safety in specific areas on the campuses.

In the knowledge group, there are 18 questions. For each question, we assigned a score of 1 for the answer “No” and a score of 2 for the answer “Yes”. We added the scores of these 18 questions, which ranged from 18 to 36. We divided this range of responses into halves, 18–27 representing lower score and 28–36 representing higher score, following the procedure described in.[1213] we used a similar procedure with four questions representing attitudes and six questions representing behaviour groups. The purpose of creating these categories was to test for the association between the levels of the knowledge, attitude, and behaviour of the participants among themselves and with the demographic variables, using frequency analysis technique.

In order to compare with the GA survey, we selected only the Yes/No-type questions (similar to the GA survey) and divided them into three broad themes: i) Environmental Health and Safety Office-related questions, ii) Faculty/Building-related questions, and iii) Department/Division-related questions.

Key informant interviews (KII)

After completing the cross-sectional surveys, we conducted KII with eight officials who have been responsible for the development and implementation of health and safety programmes at MUN. Among them, five officials were from the Environmental Health and Safety (EHS) unit, two officials were from the Workplace Health and Safety Committee (WHSC) and one official was from Facilities Management (FM). The interviews were recorded in writing. A thematic content analysis approach was used for data analysis. Each transcript was reviewed and coded to identify key emerging themes. We then compared the coding of the transcripts. The first question of the interview is about the initiatives taken by the EHS unit to raise awareness about health and safety among MUN employees after 2013. For further analysis, we divided the rest of the questions into three groups. The first group is about knowledge and awareness of safety policies. Questions 2–6, 12 are included in this group. Questions 7–10 are in the group on laboratory safety and workplace hazards. Questions 11, and 13–15 are in the group of MUN facilities and services (please refer to the questionnaire in supplementary file S2). The primary motivation of the KII was to collect further information related to the survey questionnaire and to find answers to some of the comments made by the participants in the surveys. Therefore, some questions asked in the KII were based on the outcomes of the survey results.

Data analysis

Apart from descriptive statistics, Chi-square tests were conducted for correlation and P - value less than 0.05 was considered significant. For data analysis, SPSS (version 24) was used. For a detailed statistical analysis, please refer to the supplementary file (S3).

RESULTS

In the first and second surveys, 148 and 103 valid independent respondents were identified, respectively. Table 1 shows demographic information of survey 1 and survey 2 participants. There was an increase in the level of the participants’ knowledge/awareness about MUN's health and safety policies, when compared to GA survey (please see detailed findings in Supplementary file (S4)). There was an increase in the level of awareness among the employees about the presence of the EHS unit at MUN and improved communication with the Health and Safety Committee compared to GA results. On the other hand, there were lower levels of knowledge about MUN's working alone procedures, and about AED (automated external defibrillator) locations. In all three surveys, the participants demonstrated little familiarity with the OHS Act.

Table 1

Demographic characteristics of the university worker participants

Demographic information	Survey 1 N=148	Survey 2 N=103
Employment status
Faculty	19	24
Staff/administrator	48	35
Graduate student/researcher	33	41
Gender
Male	51	52
Female	49	48
Department?
Medicine	21	22
Pharmacy	1	2
Nursing	1	1
Science	8	8
Engineering	38	42
Business	5	7
Education	1	1
Arts	2	2
Administrative and other offices	23	15
Years of Age
Less than 30	22	20
30-39	26	29
40-49	23	31
50-59	20	12
60 or more	9	8
Duration of employment
Less than 4 years	43	53
4-9 years	24	19
10-14 years	9	13
15-19 years	11	5
20-24 years	5	2
25 years or more	8	8
Attended the safety presentation at MUN
No	42	44
Yes	47	41
I don’t remember	11	15

We have observed some association between demographic variables and knowledge, attitudes and behaviour (safety practices) of employees regarding health and safety programmes. Table 2 presents the association between the knowledge level score and demographics of the employees. In the first survey, there are associations between ‘the level of health and safety knowledge of the participants’ and their (a) ‘attendance at the safety presentations’ (P < 0.05), b) ‘employment status’ i.e., faculty/staff/graduate student (P < 0.05) and c) ‘age’ (P < 0.05). For a detailed statistical analysis, please refer to supplementary file (S3) [Tables # S3.3.1, S3.3.2, S3.3.3]. In the second survey, there are associations between: ‘the level of health and safety knowledge’ and (a) ‘employment status’ (P < 0.05), b) ‘age’ (P < 0.05), and c) ‘duration of employment’ (P < 0.05). For a detailed statistical analysis, please refer to supplementary file (S3) [Tables # S3.3.4, S3.3.5, S3.3.6].

Table 2

Cross-tabulation between demographics and Knowledge level score

Whether attended the safety presentation at MUN α	Survey 1		Survey 2
	Low score*	High score*	Low score*	High score*
No	23	23	15	20
Yes	9	50	8	28
Employment status α β
Faculty	6	16	6	15
Staff/administrator	6	52	4	26
Researcher/graduate student	24	13	17	17
Gender
Male	20	35	14	32
Female	17	44	13	26
Age α β
Below 40 years	24	30	18	22
40 years or more	13	50	8	35
Duration of employment β
Less than 4 years	5	13	7	11
4 years or more	8	53	3	28

* Low score: 18-27; High score: 28-36; α significant for survey 1, β significant for survey 2

Table S3.3.1

Chi-Square Tests for table 3

	Value	df	Asymptotic Significance (2-sided)*	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	14.728a	1	0.000
Continuity Correctionb	13.133	1	0.000
Likelihood Ratio	14.951	1	0.000
Fisher’s Exact Test				0.000	0.000
Linear-by-Linear Association	14.587	1	0.000
No. of Valid Cases	105

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 14.02, * p-value < 0.05 considered significant

Table S3.3.2

Chi-Square Tests for table 3

	Value	df	Asymptotic Significance (2-sided)*
Pearson Chi-Square	30.585a	2	0.000
Likelihood Ratio	31.058	2	0.000
Linear-by-Linear Association	14.304	1	0.000
N of Valid Cases	115

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 6.89

Table S3.3.3

Chi-Square Tests for Table 3

	Value	Df	Asymptotic Significance (2-sided)*	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	7.623a	1	0.006
Continuity Correctionb	6.562	1	0.010
Likelihood Ratio	7.681	1	0.006
Fisher’s Exact Test				0.009	0.005
Linear-by-Linear Association	7.558	1	0.006
N of Valid Cases	117

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 17.08

Table S3.3.4

Chi-Square Tests for Table 3

	Value	df	Asymptotic Significance (2-sided)*
Pearson Chi-Square	10.017a	2	0.007
Likelihood Ratio	10.442	2	0.005
Linear-by-Linear Association	4.060	1	0.044
N of Valid Cases	85

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 6.67

Table S3.3.5

Chi Square Tests for Table 3

	Value	df	Asymptotic Significance (2-sided)*	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	6.711a	1	0.010
Continuity Correctionb	5.541	1	0.019
Likelihood Ratio	6.830	1	0.009
Fisher’s Exact Test				0.017	0.009
Linear-by-Linear Association	6.631	1	0.010
N of Valid Cases	83

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 12.53

Table S3.3.6

Chi-Square Tests for table 3

	Value	Df	Asymptotic Significance (2-sided)	Exact Sig. (2-sided)*	Exact Sig. (1-sided)
Pearson Chi-Square	5.982a	1	0.014
Continuity Correctionb	4.319	1	0.038
Likelihood Ratio	5.820	1	0.016
Fisher’s Exact Test				0.025	0.020
Linear-by-Linear Association	5.860	1	0.015
N of Valid Cases	49

a. 1cells (25.0%) have expected count less than 5. The minimum expected count is 3.67

Table 3 presents the attitude level score and demographics of the participants. In the first survey, there are associations between ‘the level of attitude towards safety’ and: a) ‘employment status’ a) (P < 0.05), and b) ‘age’ (P < 0.05). In the second survey, no association was found between any of the demographic information and attitude towards safety. Please refer to Supplementary file S3 for a detailed statistical analysis [Tables # S3.4.1, S3.4.2].

Table 3

Cross-tabulation between demographics and attitude level and behaviour level scores

	Survey 1		Survey 2
Attitude level score
Whether attended the safety presentation at MUN	Low	High	Low	High
No	35	42	30	13
Yes	23	19	24	14
Employment status α
Faculty	16	9	14	10
Staff/administrator	49	16	26	9
Researcher/graduate student	22	21	24	13
Gender
Male	44	20	32	19
Female	42	27	32	13
Age α
Below 40 years	35	28	32	13
40 years or more	52	18	31	18
Duration of employment
Less than 4 years	15	4	13	8
4 years or more	49	21	26	10
α significant for survey 1
Behaviour level score
Whether attended the safety presentation at MUN α β
No	44	9	32	3
Yes	39	23	21	15
Employment status α
Faculty	19	5	17	4
Staff/administrator	38	27	22	9
Researcher/graduate student	36	5	26	7
Gender
Male	47	14	33	14
Female	47	22	32	6
Age
Below 40 years	46	14	30	9

αsignificant for survey 1, βsignificant for survey 2

Table S3.4.1

Chi-Square Tests for table 4

	Value	df	Asymptotic Significance (2-sided)*
Pearson Chi-Square	6.455a	2	0.040
Likelihood Ratio	6.440	2	0.040
Linear-by-Linear Association	2.187	1	0.139
N of Valid Cases	132

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 8.71

Table S3.4.2

Chi-Square Tests for Table 4

	Value	df	Asymptotic Significance (2-sided)*	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	5.142a	1	0.023
Continuity Correctionb	4.347	1	0.037
Likelihood Ratio	5.166	1	0.023
Fisher’s Exact Test				0.029	0.018
Linear-by-Linear Association	5.103	1	0.024
N of Valid Cases	133

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 21.79

Table 4 also presents the association between ‘the behaviour (safety practice) level score’ and ‘demographic variables’ of the participants. In the first survey, there are associations between ‘behaviour level score’ and: a) ‘attendance at the safety presentation’ (P < 0.05), and b) ‘employment status’ (P < 0.05). In the second survey, there is an association between ‘attendance of the safety presentation’ and ‘behaviour level score’ related to health and safety (P < 0.05). Please refer to Supplementary file S3 for a detailed statistical analysis [Tables # S3.5.1, S3.5.2, S3.5.3].

Table 4

Laboratory safety related responses from different groups (in percentage)

Faculty/staff/administrator	Survey 1			Survey 2
	Agree	Neutral	Disagree	Agree	Neutral	Disagree
I feel safe in campus labs	70	28	2	82	18	0
PPE is available in the labs	62	33	5	78	21	1
Lab safety is properly explained	66	26	8	65	35	0
I received training on appropriate use of eyewash station	57	27	16	63	29	8
I know the location of the nearest safety shower	63	24	13	76	16	8
Overall the lab is safe	59	37	4	63	37	0
Graduate student/researcher
I feel safe in campus labs	51	43	6	37	53	10
PPE is available in the labs	63	34	3	46	47	7
Lab safety is properly explained	58	34	8	38	52	10
I received training on appropriate use of eyewash station	53	30	17	45	39	16
I know the location of the nearest safety shower	58	31	11	50	38	12
Overall the lab is safe	50	40	10	44	39	17

Table S3.5.1

Chi-Square Tests for table 4

	Value	df	Asymptotic Significance (2-sided)*	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	5.757a	1	0.016
Continuity Correctionb	4.799	1	0.028
Likelihood Ratio	5.933	1	0.015
Fisher’s Exact Test				0.022	0.013
Linear-by-Linear Association	5.707	1	0.017
N of Valid Cases	115

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 14.75

Table S3.5.2

Chi-Square Tests for table 4

	Value	df	Asymptotic Significance (2-sided)*
Pearson Chi-Square	12.299a	2	0.002
Likelihood Ratio	12.920	2	0.002
Linear-by-Linear Association	1.858	1	0.173
N of Valid Cases	128

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 6.94

Table S3.5.3

Chi-Square Tests for Table 4

	Value	df	Asymptotic Significance (2-sided)*	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	10.271a	1	0.001
Continuity Correctionb	8.597	1	0.003
Likelihood Ratio	11.019	1	0.001
Fisher’s Exact Test				0.002	0.001
Linear-by-Linear Association	10.126	1	0.001
N of Valid Cases	71

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 8.87

In our two surveys, we observed that those who attended safety presentations had a better level of safety practices than those who did not attend the safety presentations. Overall, there is no significant difference in the knowledge, attitudes, and behaviour of the employees and graduate students between the two surveys. In Tables 2 and 3, the Chi square test results indicate that the levels of knowledge, attitudes and behaviour of the employees and graduate students have not changed much over the period of six months.

The only change we observed is a decrease in the knowledge of graduate students and researchers regarding laboratory safety in the second survey [Table 4]. In both surveys, the participants reported that some places on the campus are safe [Table 4]. In the first survey, 70% of the faculty/staff reported that they felt safe in the campus labs, and 51% of graduate students/researchers reported that they felt safe in the campus labs. Compared to the first survey, the difference in knowledge regarding lab safety between faculty/staff/administrators and graduate students/researchers decreased in the second survey (Please refer to Table 5 for the results). It can, therefore, be stated that the graduate students/researchers need more awareness sessions and training on laboratory safety.

Table 5

Group wise health and safety ratings of different on-campus areas (except laboratories) (in percentage)

Faculty/staff/administrator	Survey 1			Survey 2
	Safe	Neutral	Unsafe	Safe	Neutral	Unsafe
Parking Lots	55	32	13	62	33	5
Elevators	63	31	6	60	34	6
Library	78	16	6	89	11	0
Classrooms	77	20	3	85	13	2
Restrooms	69	23	7	68	30	2
Gym	78	22	0	86	14	0
Student Union Building	75	22	3	85	15	0
Dormitories	64	30	6	73	27	0
Graduate student/researcher
Parking Lots	52	42	6	55	40	5
Elevators	56	25	19	40	43	17
Library	87	7	6	81	19	0
Classrooms	85	15	0	69	26	5
Restrooms	63	37	0	49	43	8
Gym	82	18	0	64	33	3
Student Union Building	79	21	0	60	39	1
Dormitories	55	42	3	50	39	11

For KII, five officials from the Environmental Health and Safety (EHS) unit of MUN, two officials were from the Workplace Health and Safety Committee (WHSC) and one official was from Facilities Management (FM). During the interviews, the participants from the EHS unit highlighted several initiatives undertaken by their unit since the release of 2013 Gap Analysis (GA) results. Some important recent initiatives undertaken by EHS were: (a) Five to seven safety campus-wide presentations were organized, some of which were geared towards senior management and WHSC members; (b) MUN restructured 27 WHSCs on its campuses to provide adequate safety services and to meet the legislated requirements of CCOHS and the University OHS Act and Regulations. Each of the 27 WHSCs covered few buildings on campus; (c) In 2014, MUN implemented electronic safety reporting system (e-alert) (d) MUN Safe App was introduced in 2016; (e) Inspections of all university building offices and 350 laboratories are being conducted annually; (f) Orientation sessions for new undergraduate students each year are being organized, where general safety rules are described; (g) Established a chemical management system for labs; and (h) Created annual water sampling procedure for drinking water safety. The participants from WHSCs also mentioned some initiatives undertaken by the EHS unit such as (a) an increase in the participation of representatives from the EHS Unit to sit on the WHSC meetings and (b) more frequent laboratory inspections. The participant from FM mentioned some initiatives such as maintaining a good database to track the expiry date of the employee training; and more engagement in the weekly Toolbox Talks to discuss potential hazard assessment.

Most of the KII participants mentioned that the graduate students’ supervisors are responsible for providing information to the students on laboratory safety rules and whom to call first in the event of an incident/accident. They placed the responsibility for providing laboratory safety equipment on the Department Heads. The participants emphasized budget and manpower as the main bottlenecks for addressing workplace hazards in a timely manner. There were some suggestions from the KII participants to improve health and safety at MUN such as (i) making attendance of safety presentations mandatory and included as part of the new employee and student orientation packages, (ii) demonstrating the AED in every building, (iii) encouraging all university members to install the MUN Safe App on their phones, and (iv) constantly improving app on a regular basis.

DISCUSSION

The survey results indicate that there are significant associations between: a) ‘attendance at the safety presentation’ and ‘participant's health and safety knowledge’, b) ‘level of attitude’ and ‘behaviour levels’, c) ‘employment status’ and ‘participant's knowledge level on health and safety’, d) ‘participant's age’ and 'safety knowledge level’, and e) ‘length of service’ and ‘participants’ level of knowledge on health and safety. In our two surveys, we observed that those who attended safety presentations had much better understanding and practices of health and safety than those who did not attend. It is clear from the results that there should be more emphasis on dissemination of the activities of the EHS unit to a larger number of MUN employees and students on a regular basis. The results of the cross-sectional surveys (our two surveys and the GA survey) show consistency in the three survey results. As presented in Table 2, the respondents increased their awareness about the presence of the EHS unit at MUN and improved their (respondents) communication with the Health and Safety Committee over time. On the other hand, we identified some issues that need to be addressed such as less familiarity with MUN's working alone procedures, AED locations, and OHS Act. The dissemination of information on the OHS Act needs improvement, as this is the basis of all health and safety-related regulations, responsibilities, and rights.

Health and safety programmes should be evaluated periodically to ensure that best practices are being followed on a regular basis. Programme Evaluation always helps the institute to update guidelines as necessary, and to address areas of need or concern in the institute. In some of the previous studies, periodical evaluations were conducted to investigate any change or improvement in population health. Two cross-sectional surveys were conducted in1990 and in 1998 in Copenhagen, Denmark to investigate whether the prevalence of skin-prick-test (SPT)-positive allergic rhinitis had increased in an adult general population in Copenhagen, Denmark. A screening questionnaire on respiratory symptoms was distributed in random samples of 15–41-year-old people in 1990 and in 1998. Among the responders, random samples were invited to a health examination including SPT.[14] Two International Studies on Asthma and Allergies in Childhood (ISAAC) - questionnaires based surveys were carried out in 1994 and in 2001 among school children in Singapore to evaluate the hypothesis that the prevalence of asthma would further increase and approach to western figures over time.[15] A questionnaire-based survey was conducted in 1973 among 12 years old children in South Wales, Britain. In 1988, the survey was repeated in the same area among 12 years old children to again to observe whether the prevalence of asthma had increased.[16] Frequency of prescribed drugs use was assessed by a sample of elderly people 65 years and over in Nottingham in 1985 and 1989. The aim was to observe the change in numbers in the use of prescribed drugs.[17] Though in our study, we do not observe any significant difference overall in the knowledge, attitude, and behaviour of the employees between the two surveys, we observe a significant decrease in the knowledge regarding laboratory safety in the second survey. Our study is therefore, successful to investigate the change in perceptions of the employees regarding workplace health and safety over time.

This study used a mixed-methods approach as such a method allows for a more robust analysis.[14151617] We conducted online surveys as online survey can easily obtain large sample, it can control answer order, it required completion of answers, and online survey can ensure that respondents answer only the questions that pertain specifically to them.[18] Through the quantitative online survey analysis of MUN employees and graduate students, we learned of their perceptions regarding MUN's workplace health and safety programmes. These perceptions are a one-sided view of the survey participants, and quantitative survey analysis does not provide a detailed explanation of several issues. Through the KIIs, we collected further information related to health and safety programmes at MUN and clarified some of the issues raised by the participants in the surveys. Such as, the KII participants clarified that the graduate students’ supervisors are responsible for providing information to the students on laboratory safety rules and whom to call first in the event of an incident/accident; the Department Heads are responsibility for providing laboratory safety equipment; and budget and manpower are the two main bottlenecks for addressing workplace hazards in a timely manner. The KII participants also mentioned some recent beneficial initiatives such as, the arrangement of five to seven safety presentations campus-wide, restructuring of the WHS and EHS committees, the implementation of an electronic safety reporting system and the MUN Safe App, new orientation for undergraduate students where general safety rules are described, and development of the Health and Safety Management System. There had been a gap in understanding about health and safety matters between the employees and MUN health and safety officials. The qualitative analysis of the KII has filled this gap.

Our study is the first of this kind in the context of Health and Safety Program evaluation in Canadian university. Our study focused on the level of uptake of the information on health and safety disseminated by the university EHS unit through their safety presentations and workshops. We have also studied the effect of employee's and graduate student's knowledge about health and safety programmes at MUN on levels of their attitudes and behaviours. In addition, we have conducted KII interviews of the officials who are engaged in developing workplace health and safety programmes at MUN. As a result, improvements in the health and safety programmes have been planned by university officials. This is the practical implication of this study as the KII participants suggested some future procedures to improve health and safety at MUN such as making attending safety presentations mandatory for all employees and students; demonstrating the AED in every building; and encouraging all university residents to install the MUN Safe App on their phones.

There were some limitations of our study. The sample sizes of the surveys were small as participation was voluntary, and there was no incentive for participating in the surveys. The survey participants were not equally distributed across the disciplines, as the numbers of respondents from some faculties were much higher (Engineering faculty) than the number of respondents from other faculties (Arts and Education faculties). The survey data were anonymous, so our assertion on sustenance of the perceptions of the health and safety of respondents over the six-month period of time is not stronger.

In future surveys, undergraduate students should be included, as they are also exposed to similar risks as graduate students, and they outnumber graduate students. There is a sizable workforce involved in post-secondary university institutions in Canada, and this sector is growing. Varying ranges of working environments in the universities expose employees to multiple occupational risks. Safety training in a university is often not mandatory, and the survey analysis clearly indicates that there is need to increase the level of uptake on the information on health and safety programmes of university by employees and graduate students. Therefore, the universities should increase the number of safety training programmes and keep track of the employees that have not received training, particularly for those working in hazardous environments. Assured provision of financial resources is the key to maintaining a safe work environment and practices.

Key Messages

Universities should make safety training mandatory for all employees and graduate students. Therefore, there is a need to increase the number of training sessions to accommodate all eligible persons. Also, the universities should keep track of the employees and students that have not received training, particularly for those working in hazardous working conditions. The universities have to set aside financial resources for such regular trainings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

	Safe	Neutral	Unsafe	N/A
Parking Lots
Elevators
Gym
Library
Student Union Building
Classrooms
Laboratories
Restrooms
Dormitories

	Agree	Neutral	Disagree	N/A
I feel safe in campus labs (Montana Tech Safety Awareness Survey, 2011)
PPE is available in the labs. (Montana Tech Safety Awareness Survey, 2011)
Lab safety is properly explained. (Montana Tech Safety Awareness Survey, 2011)
I received training on appropriate use of eye wash station
I Know the location of nearest safety shower

Table S4.1

Comparison of surveys

	GA Survey, 2013, n=293		Survey 1, 2016, n=148		Survey 2, 2017, n=103
	Yes	No	Yes	No	Yes	No
EHS Office related questions
Are you aware of the presence of the EHS Unit at MUN ?	62	38	90	10	91	9
Do you read newsletters, brochures, bulletins e-mailed by EHS Unit?	52	48	78	22	68	32
Were you informed about the Occupational Health and Safety Act?	69	31	68	32	68	32
Do you know where to report a safety concern, a safety hazard or accident?	84	16	85	15	86	14
Do you know the campus emergency telephone number?	N/A	N/A	73	27	73	27
Are you familiar with MUN’s Health and Safety Policies?	41	59	66	34	76	24
Are you aware of Memorial’s online reporting system for health and safety concerns?	66	34	61	39	75	25
Are you aware of MUN’s Safety Escort Service?	N/A	N/A	49	51	68	32
Faculty/Building related questions
Are you aware of Workplace Health and Safety Committee of the building you work in?	38	62	92	9	90	10
Does the WHSC in your building communicate with you?	37	63	75	25	73	27
Do you know your role in the event of an emergency?	54	46	72	28	89	11
Do you know the shortest exit rout from your work area (s)?	N/A	N/A	95	5	95	5
Do you know whom you call first if you get injured at work?	76	24	64	36	61	39
Are you aware of Automated External Defibrillator available in campus buildings?	N/A	N/A	87	13	81	19
Do you know where the AEDs are located in the buildings you work?	N/A	N/A	73	27	66	34
If AED training is made available through MUN, would you be interested in participating the training?	N/A	N/A	76	24	74	26
In your experience, do you think safety is a priority within your department/faculty/office?	72	28	81	19	86	14
Do you report unsafe acts/conditions if you see them?	94	6	86	14	90	10
Department/Division related questions
Do you understand your responsibilities for your and your colleagues’ health and safety?	63	37	85	15	88	12
Are toolbox talk/safety meeting relevant to your task?	24	76	59	41	47	53
Have you participated in a toolbox talk/safety meeting?	29	71	38	62	25	75
Is safety discussed in your workplace?	74	26	82	18	84	16
Were you provided information/training on the safe use of tools necessary for your job?	43	67	81	19	76	24
Have you requested specific safety training that is appropriate to your position?	23	77	53	47	45	55
Were you informed about the hazardous materials that are present in your workplace?	55	45	71	29	67	33
Are employees given feedback on accidents that occur in your workplace?	73	27	59	41	68	32
Do you work after hours at least sometimes?	75	25	85	15	81	19
Are you aware of MUN’s working alone procedures?	81	19	45	55	54	46