The EPA provides the legal framework designed to prevent and reduce the discharge of harmful contaminants into the environment (air, water, land) for the purpose of “protecting and conservation of the natural environment”. The EPA provides the Ministry of the Environment, Conservation and Parks (Ministry) with EPA oversight responsibilities, including administrative, investigative and general accountability powers.
Who does the EPA apply to?
For the purpose of this resource, the EPA applies to any “person” who “discharge[s]” any “contaminant” above specified limits outlined in the Act and/or its according regulations. A hospital is captured within the definition of “person”. “Waste” includes biomedical waste. Additional and specific applicability definitions may apply dependent upon a specific regulation under the EPA, some of which have been captured by this Guide.
What are the key requirements for hospitals under the EPA?
- Hospitals must not discharge, or permit discharge, of any contaminant in an amount, concentration, or level exceeding those prescribed by regulations under the Act. (s 6; Reg 347)
- Hospitals must notify the Ministry if contaminants are discharged in an amount, concentration, or level in excess of those prescribed by regulations under the Act. (s 13; Reg 347)
- Hospitals must seek and obtain Environmental Compliance Approvals, and/or register with the Environmental Activity and Sector Registry (EASR), and/or seek renewable energy approvals, as may be applicable. (ss 9, 20.2, 20.21, 47.3; O Reg 255/11; O Reg 245/11; O Reg 359/09)
- Hospitals classified as a Group A, B, or F in Reg 964 (Classification of Hospitals) under the Public Hospitals Act must conduct waste audits and prepare both written audit reports as well as waste reduction work plans respecting the waste generated by the operation of the hospital in compliance with regulatory requirements. (O Reg 102/94, ss 46-50)
A series of deadlines exist for a variety of matters under the EPA, including potential administrative proceedings. Careful consideration and/or legal advice should be sought with respect to these timelines. More specifically:
- Hospitals must update their waste audits, and prepare an updated written audit report, in every year following an initial waste audit. (O Reg 102/94, s 47)
- Hospitals must prepare updated written waste reduction work plans in every year following the preparation of an initial waste reduction work plan. (O Reg 102/94, s 48)
Every person who contravenes the EPA, and its according regulations, is guilty of an offence. (s 186) More specifically, directors and officers have a duty to “take all reasonable care” to prevent the corporation from:
Discharging or causing or permitting the discharge of a contaminant in contravention of the EPA, its according regulations, an environmental compliance approval, certificate of property use, renewable energy approval, or licence or permit under the EPA. (s 194)
Failing to notify the Ministry of a discharge of a contaminant in non-compliance with the EPA, its according regulations, an environmental compliance approval, certificate of property use, renewable energy approval, or licence or permit under the EPA. (s 194)
Failing to install, maintain, operate, replace or alter any equipment or other thing, in contravention of the EPA, its according regulations, an environmental compliance approval, certificate of property use, renewable energy approval, or licence or permit under the EPA. (s 194)
Directors who fail to comply with the above section 194 duties are guilty of an offence and may be liable for a series of penalties as outlined in section 187. (s 194(2))
Additional Resources
For more information about the EPA, please refer to the following resources:
The FPPA establishes a framework for public protection with respect to fire safety. The Ontario Fire Code is a regulation under the FPPA and outlines the minimum requirements of fire safety in buildings.
Who does the FPPA apply to?
The Act applies across Ontario and governs fire safety within and around existing buildings and facilities. Unless otherwise noted, it is the building owner who is responsible for complying with the FPPA and the Ontario Fire Code.
What are the key requirements for hospitals under the FPPA?
- Hospitals must develop and submit a fire safety plan (Plan) to the Chief Fire Official for approval. This is a one-time submission that must include the emergency procedure followed in case of fire, outline supervisory staff responsibilities, provide for their training which must be recorded, include diagrams of fire systems and exits, and set procedures for fire drills held monthly and annually under approved scenarios. Additionally, the plan must provide for the control of fire hazards in building and the maintenance of building facilities. The plan must be updated before construction or demolition and kept on-site for annual reviews. (O Reg 213/07, Div B, P. 3, s 2.8.2.1)
- The persons responsible for implementing the Plan must complete a qualification course acceptable to the Fire Marshal. (O Reg 213/07, Div C, s 1.2.3.1(1))
- At least one copy of the fire emergency procedures shall be prominently posted on each storey of the building. (O Reg 213/07, Div B, P.1, s 2.8.2.5)
- Hospitals must ensure fire drills are held for supervisory staff at least once a month and at least once a year for supervisory staff for an approved scenario representing the lowest staffing level complement in the occupancy. Fire drill records shall be created and kept for at least 12 months. (O Reg 213/07, Div B, P.1, ss 2.8.3.2, 2.8.3.4)
- Hospitals must inspect and maintain fire separations, closures (doors), and emergency lighting, ensuring they remain functional, operable, and not obstructed. Lint traps in laundry facilities and combustible deposits in ducts, hoods, and filters must be cleaned regularly. Non-functioning fire protection devices or systems must be repaired or replaced promptly to ensure fire safety. (O Reg 213/07, Div B, P.1, ss 2.2.1.1-1.2.3.1, 2.2.3.4, 2.2.4.1.5, 2.6.1.3)
- Hospitals must have exit signs clearly visible and maintained in a clean and legible condition. (O Reg 213/07, Div B, P.2, s 2.7.3.1)
Hospitals must ensure fire dampers, fire stop flaps, chimneys, flues, disconnect switches, and emergency lighting systems are inspected annually or as required, with all deficiencies addressed promptly. (O Reg 213/07, Div B, P. 3, ss 2.2.3.5, 2.6.1.4(1), 2.6.1.8(1), 2.7.3.3)
Every person is guilty of an offence if they hinder, interfere, prevent, or refuse to obey the Fire Marshal, assistant, or Chief’s duties, contravene the Act or the regulations, or neglect directives of the Fire Marshal. (s 28(1)) A director who either knowingly commits an above offence or knows the corporation is violating or has violated the Fire Code is guilty of an offence and, on conviction, may be fined up to $50,000 for a first offence and $100,000 for any subsequent office, or face imprisonment for up to one year, or both. (ss 28(5)-(6))
For more information about the FPPA, please refer to the following resources:
The HPA establishes a regime requiring suppliers of hazardous products to “communicate the hazards associated with their products via product labels and Safety Data Sheets (SDSs) as a condition of sale and importation for workplace use” (see Frequently Asked Questions link below).
Who does the HPA apply to?
The HPA applies to “suppliers” of hazardous products, which is defined in the HPA as those that “in the course of business, sells or imports a hazardous product”. Hospitals should further consider the definitions of “sell” and/or “import” under the HPA to determine potential applicability based on unique business operations.
What are the key requirements for hospitals under the HPA?
- If a hospital meets the definition of “supplier” under the HPA, it must ensure compliance with the requirements of the HPA and its according regulations. (ss 13-14.3; SOR/2015-17)
- Hospitals should ensure their suppliers of hazardous products provide the required safety data sheets on sale, and that the hazardous product package has a label meeting regulatory requirements. (s 13; SOR/2015-17)
If a hospital meets the definition of “supplier” under the HPA, a series of documents are required to be prepared and maintained. (s 14.3) If applicable, a hospital must keep the required documents for six years after the end of year to which they relate. (s 14.3)
Every person who contravenes this Act, its regulations, or an order made under it is guilty of an offence. The penalty on indictment is a fine of up to $5,000,000, imprisonment for up to two years, or both. On summary conviction, the penalty for a first offence is a fine of up to $250,000, imprisonment for up to six months, or both, increasing to a fine of up to $500,000, imprisonment for up to 18 months, or both for subsequent offences. (s 28(1)) However, a person is not guilty if they prove they exercised due diligence to prevent the offence. (s 28(1.1))
If the contravention is committed knowingly or recklessly, the penalty on indictment is a fine determined by the court, imprisonment for up to five years, or both. On summary conviction, the penalty for a first offence is a fine of up to $500,000, imprisonment for up to 18 months, or both, increasing to a fine of up to $1,000,000, imprisonment for up to two years, or both for subsequent offences. (s 28(1.2))
Officers, directors, or agents of non-individual entities who “directed, authorized, assented to, acquiesced in or participated in the commission” of an HPA offence are also guilty and subject to the same penalties. (s 28(2))
For more information about the HPA, please refer to the following resources:
The HPTA establishes a “national safety and security program to protect the health and safety of the public against risks posed by human pathogens”. In doing so, the HPTA identifies what constitutes a human pathogen for the purpose of the HPTA and together with its regulations, the HPTA creates licensing requirements and outlines the oversight authority of the federal Minister of Health (Minister).
Who does the HPTA apply to?
The HPTA applies to a “person”, which may include a hospital if it conducts a “controlled activity” under the HPTA. Controlled activities require licensing and include: possession, handling, use, production, storing, releasing, transferring, disposing of, importing or exporting, or permitting access to a human pathogen.
What are the key requirements for hospitals under the HPTA?
- A hospital cannot possess, handle, use, produce, store, release, transfer, dispose of, import or export, or permit access to a human pathogen without an HPTA licence in compliance with regulatory requirements. (s 7; SOR/2015-44, ss 2-7)
- Hospital licensees must establish and maintain a list of all persons authorized to access licensed facilities, including those holding security clearances, and provide the list to the Minister on request. (s 31)
- Hospital licensees must designate an individual as a biological safety officer that meets the regulatory qualifications in compliance with the HPTA. (s 36; SOR/2015-44, ss 8-9)
- Hospitals must comply with ministerial orders in compliance with the HPTA and according regulations. (ss 38, 67) Hospitals must also comply with investigator orders in compliance with the HPTA and according regulations, unless doing so would expose them to danger as defined under the Canada Labour Code. (ss 41, 43)
- Hospitals should ensure compliance respecting security clearance requirements. (SOR/2015-44, ss 11-24)
- Hospitals must keep a record of the full name of every person who enters a facility under accompaniment and supervision of an individual with security clearance, the date on which they entered, and the name of the person who accompanied and supervised them. (SOR/2015-44, s 25)
- Hospital licensees must, without delay, inform the Minister when a human pathogen or toxin has been inadvertently released in compliance with the requirements of the HPTA. (s 12)
- Hospital licensees must, without delay, inform the Minister in writing of their decision to prohibit the holder of security clearance from access to licenced facilities, including their reasons for the decision. (s 32; SOR/2015-44, s 7)
- Hospital licensees must notify the Minister in writing, within a reasonable time after making any change to their name. (SOR/2015-44, s 6(2)
- Hospitals must keep records required by the HPTA and according regulations for five years after the day on which they are provided and must provide such records to the Minister on request. (SOR/2015-44, s 29)
- Hospitals must notify the Minister of a variety of situation specific changes and/or topics in compliance with regulatory requirements. (SOR/2015-44, ss 6, 7, 19, 26)
Directors who direct, authorize, assent to, acquiesce or participate in the commission of an HPTA offence are liable on conviction to the corresponding punishment. (s 63) The HPTA contains a series of penalty provisions ranging from fines to imprisonment dependent on the risk group of the human pathogen involved, the nature of the conviction (summary or indictment), whether the offence is a first or subsequent contravention of the HPTA and its according regulations, and the risk classification of respective human pathogens and toxins. (s 53-58)
Generally, for Risk Group 2 pathogens, the penalty for a first offence is a fine of up to $50,000, and for subsequent offences, a fine of up to $250,000, imprisonment for up to three months, or both. In all other cases, the penalty for a first offence is a fine of up to $250,000, imprisonment for up to three months, or both, and for subsequent offences, a fine of up to $500,000, imprisonment for up to six months, or both. (s 53) There are many exceptions to this general penalty with the maximum fine being $1,000,000 or imprisonment up to 10 years. (ss 57-58)
For more information about the HPTA, please refer to the following resources:
Overview
The OLA codifies law respecting occupier liability. Broadly speaking, this codification governs the responsibilities of occupiers of property toward individuals who enter onto their premises.
Who does the OLA apply to?
The OLA applies to “occupiers” of premises, which includes hospitals within the meaning of the Public Hospitals Act.
What are the key requirements for hospitals under the OLA?
Hospitals must take reasonable care to ensure persons and tenants entering on the premises as well as their property are reasonably safe while on the premises. (ss 3, 8)
The Act does not contain any compliance deadlines.
The Act does not contain any director specific offence provisions.
For more information about the OLA, please refer to the following resource:
The PA establishes the legislative regime governing the use, storage, sale, transportation, and disposal of pesticides in Ontario. In doing so, the PA provides oversight authority and powers to the Minister of the Environment, Conservation and Parks (Ministry), creates a licensing regime for a variety of more commercialized pesticide uses, and restricts the use of pesticides in certain circumstances and settings.
Who does the PA apply to?
The PA largely applies to a “person” acting or operating within the scope of PA regulated activities. The PA also applies to a “licensee” under the Act (e.g., to sell, offer to sell or transfer any pesticide). For the purposes of this Guide, and unless also a licensee in which case more detailed compliance requirements may exist, a hospital fits within the definition of “person” under the PA.
What are the key requirements for hospitals under PA?
- Hospitals cannot discharge, cause, or permit the discharge of a pesticide or any substance containing a pesticide into the environment that causes, affects, impairs, or renders the adverse impacts explicitly outlined under the PA. (s 4)
- Hospitals cannot use, cause, or permit the use of a pesticide for cosmetic purposes unless the pesticide’s active ingredient is included in the Ministry’s published allowable list. (s 7.1; O Reg 63/09, s 18)
- Hospitals must comply with inquiries and/or orders of ministerially appointed Provincial Officers in compliance with the requirements of the PA. (ss 17, 19-27)
- Hospitals cannot use pesticides unless in compliance with regulatory requirements. (O Reg 63/09, ss 9-13)
The Act does not contain any compliance deadlines.
Every director or officer of a corporation is under a duty to take “all reasonable care to prevent the corporation from causing or permitting” activities that “may cause” a listed effect. (s 49) Every director or officer who fails to carry out this duty is guilty of an offence under the Act and liable to conviction and corresponding penalty. (s 49)
An individual convicted of an offence under the PA is liable, on first conviction, to a fine of up to $20,000 for each day or part of a day the offence continues. On subsequent convictions, the penalty increases to a fine of up to $50,000 per day, imprisonment for up to one year, or both. (s 43(1))
For more information about the PA, please refer to the following resources:
The PSISA establishes the accountability framework applicable to private security and investigative services in Ontario. In doing so, the PSISA creates standards applicable to businesses and individuals providing security services to ensure they operate in a manner compliant with the boundaries of the PSISA and its regulations. The PSISA provides for the appointment of the Registrar of Private Investigators and Security Guards (Registrar) to oversee the reporting, record keeping, and compliance with the Act and regulations.
Who does the PSISA apply to?
For the purposes of this Guide, the PSISA applies to “registered employers” under the Act. Hospitals within the meaning of the Public Hospitals Act who employ a private investigator or security guard are captured by certain requirements of the PSISA.
What are the Key Requirements for Hospitals under the PSISA?
- Hospitals meeting the definition of “registered employers” must provide the Registrar with a mailing address for service in Ontario. (s 5)
- Hospitals meeting the definition of “registered employers” must provide the Registrar with a list of all employees who are private investigators or security guards and the name, address and telephone number of a representative of the business entity. (O Reg 368/07, s 1)
- Hospitals meeting the definition of “registered employers” must renew registration, prior to expiration, in accordance with regulatory timelines and provide the Registrar with an updated list of all employees who are private investigators or security guards and the name, address and telephone number of a representative of the business entity, if different from the information previously given. (O Reg 368/07, s 3)
- Hospitals meeting the definition of “registered employers” must provide an updated mailing address for service in Ontario within five days of the change. (s 5)
- Hospitals meeting the definition of “registered employers” must renew their registration before it would expire in accordance with regulatory requirements. (O Reg 368/07, ss 2-3)
Directors who authorize, permit, or acquiesce in a failure to comply with the Act or regulations, knowingly provide false information, or fail to comply with any order under the Act, are guilty of an offence and liable to a fine of not more then $25,000, imprisonment for a term of not more than a year, or both. (ss 43-45)
For more information about the PSISA, please refer to the following resource:
The SFOA came into force and effect on October 17, 2018, replacing both the 1994 version of the statute together with the Electronic Cigarettes Act. The SFOA contains provisions aimed at preventing second-hand smoke exposure and regulating the supply, sale and promotion of tobacco and vapour products. In doing so, the SFOA provides for ministerial oversight of the provisions of the Act, including the ability to appoint inspectors for the purposes of the Act.
Who does the SFOA apply to?
The SFOA restricts what a “person” may or may not do under the Act and establishes specific obligations on an “employer”; both of which may include public hospitals within the meaning of the Public Hospitals Act.
What are the key requirements for hospitals under the SFOA?
- Hospitals and psychiatric facilities must be completely smoke-free, subject to limited exceptions under the legislation. (O Reg 268/18, s 6)
- Hospitals cannot sell or offer to sell, and should ensure no person sells or offers to sell, tobacco or vapour products. (s 6)
- Hospitals must ensure compliance with the tobacco and vapour use restrictions under the Act and notify employees of such prohibitions. (s 12; O Reg 268/18, s 6)
- Hospitals must, upon request of an “Indigenous resident”, set aside an indoor area for the use of tobacco for “traditional Indigenous cultural or spiritual purposes”. (s 19)
- Hospitals who operate hospices and/or are licensees under the Fixing Long-Term Care Act, 2021 must ensure compliance with the exempted requirements respecting tobacco use in an “indoor room”. (s 13; O Reg 268/18, s 29).
The Act does not contain any compliance deadlines.
A director or officer of a corporation that engages in the manufacture, sale or distribution of tobacco products, vapour products or a prescribed product or substance under the Act has a duty to take all reasonable care to prevent the corporation from contravening the SFOA. (s 21(8)) The penalty on conviction is a fine of not more than $100,000 and a director or officer may be prosecuted and convicted even if the corporation has not been. (ss 21(9)-(10))
For more information about the SFOA, please refer to the following resources:
The TSSA takes aim at enhancing public safety by establishing technical standard requirements for amusement devices, boilers and pressure vessels, elevating devices, fuels and operating engineers. In achieving this purpose, the TSSA establishes the Technical Standards and Safety Authority, provides the power to appoint inspectors, investigators, and assessors to ensure statutory compliance, and outlines a host of technical requirements through associated regulations.
Who does the TSSA apply to?
For the purpose of this Guide, O Reg 209/01 (Elevating Devices) under the TSSA applies to, among other classes of individuals, “owners” of buildings in which an “elevating device” (which must be licensed) is located.
What are the key requirements for hospitals under the TSSA?
- Hospitals must not operate an elevating device unless it is licensed, complies with regulatory requirements, the respective code adoption documents, and any applicable director’s order. (O Reg 209/01, s 12)
- Hospitals must ensure compliance with design and license requirements prior to installing a new, or majorly altering an existing, elevating device on its premises. (O Reg 209/01, ss 7-8)
- Hospitals must ensure elevating devices are operated in safe conditions and only have registered contractors servicing its elevating devices. (O Reg 209/01, ss 9, 14, 32)
- Hospitals must post its elevating device licence in a conspicuous position in the elevating device, adjacent to the elevating device, or in a more remote location if required by the director. (O Reg 209/01, s 30)
- Hospitals must ensure elevating devices have a notice indicating maximum capacity and installation number securely fastened to the elevating device in a conspicuous location in compliance with regulatory requirements. (O Reg 209/01, s 31)
- Hospitals must maintain a log book for each elevating device it owns in compliance with the regulatory requirements. (O Reg 209/01, s 34)
- Hospitals must report discovered defects, incidents, and outages (if applicable) in compliance with regulatory requirements. (O Reg 209/01, ss 35, 36, 38.1)
Hospitals must retain their elevating device log books for a period of at least five (5) years from the date of the last entry in the log book. (O Reg 209/01, s 34)
All directors and/or officers of a hospital subject to the TSSA are under an obligation to “take all reasonable care to prevent” the hospital from committing an offence under the TSSA. (s 37) A director and/or officer who “fails to carry out” such a duty is guilty of an offence and on conviction is liable to a fine of not more than $50,000 and/or imprisonment for a term not exceeding one year. (s 37)
For more information about TSSA, please refer to the following resources:
