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Employer forms

If you have any questions about these forms, or would like help filling them out, please call us at 1-800-387-0750 or 416-344-1000 (TTY: 1-800-387-0050) Monday to Friday, 7:30 a.m. to 5 p.m.

Categories

Form Number Form Name

Registration

Register online Learn more about registering with us.

1208WA (110.9kb, PDF)

 

1209WA (84.8kb, PDF)

Partner or Executive Officer in Construction - Exemption from Coverage

Request for Rate Group 755, Non-Exempt Partners and Executive Officers in Construction

Claims

0007A


 

Report online

Form 7 Reference Guide(1.8mb, pdf)

Employer's Report of Injury/Disease Form 7

For a faster, more efficient experience, complete and submit your Report of Injury online or call us at 1-800-387-0750 or 416-344-1000 (TTY: 1-800-387-0050) Monday to Friday, 7:30 a.m. to 5 p.m.

Submitting a No Lost Time claim?

Only complete sections A to D, E (#1) and J.

Learn about our eForm 7.

 

0009C (170.1kb, PDF) Employer's Subsequent Report
0042A (230.8kb, PDF) Employer's Progress Report Form 42
New

2399A (86.0kb, PDF)

Intent to Object form

Read our instructions for employers (82.8kb, PDF) on how to fill out the Intent to Object form.

0137A(311k, pdf) Employer's Report Occupational Noise Induced Hearing Loss
0156C(123k, pdf) Treatment Memorandum
2233A and 2235A (442k, pdf) Employer's Continuity Report Pre-1998 (Form RE07) (For use in claims with an original Accident Date prior to January 1, 1998) and Re-open Claim Earnings Pre-1998 (Form RE07E) (For use in claims with an original Accident Date prior to January 1, 1998)
3233A and 3524A(448k, pdf) Employer's Continuity Report Post-1998 (Form WRE07) (For use in claims with an original Accident Date after January 1, 1998) and Re-open Claim Earnings Post-1998 (Form WRE07E) (For use in claims with an original Accident Date after January 1, 1998)
2647A (147.0kb, PDF)

Functional Abilities Form for Early and Safe Return to Work 

Note: new fee for FAF effective Sept. 10, 2012.

Guide to Completing the Functional Abilities Form(239k, pdf)

Old version (November 2000) of Functional Abilities Form for Timely Return to Work (187k, pdf, view only; Worker's Health number & Social Insurance number not required on form)

2819A (253k, pdf) Report on Needlestick Injury
3959A (300k, pdf) Employer's Exposure Incident Reporting Form - PEIR
3886A (519.6kb, PDF) Employer's Exposure Incident Reporting Form - CEIR
PDIF (1.1mb, pdf)

Physical Demands Information Form: contains forms 2828A, 2829A, 2830A, 2851A, and 2852A.

Employer Coverage

2929A (126.4kb, PDF) WSIB Policy Manuals Order Form
0090C (231k, pdf)

Employer by Application

Does your firm have voluntary by-application workplace safety and insurance coverage?

1208WA (110.9kb, PDF)

 

1209WA (84.8kb, PDF)

Partner or Executive Officer in Construction - Exemption from Coverage

Request for Rate Group 755, Non-Exempt Partners and Executive Officers in Construction

2642A (189k, pdf)Application for Alternative Assessment Procedure for Interjurisdictional Trucking
1034A (155k, pdf) Optional Insurance Consent Form under Schedule 2
0095C (536k, pdf) Employer by Application Entertainment Industry
1149A (533k, pdf) Determining Worker/Independent Operator Status Questionnaire - Trucking Industry
1152A
(488k, pdf)
Determining Worker / Independent Operator Status - Taxi Industry
1155A (134.0kb, PDF) Determining Worker / Independent Operator Status - Retail Industry
1157A (774k, pdf) Determining Worker/Independent Operator Status Questionnaire - Courier Industry
1158A (512k, pdf) Determining Worker/Independent Operator Status General Questionnaire
1168A (466k, pdf) Determining Worker/Independent Operator Status Questionnaire - Logging Industry
1238A (156k, pdf) Purchase Certificate Worksheet
1574A (180k, pdf) Optional Insurance Request/Change, Schedule 1 Employers
1797A (247k, pdf)

Employer's Direction of Authorization

This form allows an employer to authorize a third party representative to

  • represent the employer in relation to the employer's account (firm file), and/or
  • obtain access to confidential employer account-related information.

This form is not acceptable for use for any purpose relating to individual claim files.

For all claim file issues, the employer must provide written authorization in accordance with the requirements for claim file representatives set out in Policy 21-02-04, Disclosure of Claim File Information to Worker or Employer Representatives.

1824A

(128k, pdf)

Direction of Authorization

This is not a request for access or an appeals form. It is used solely to provide authorization for representation in a claim. Only after this authorization is obtained can a representative be given verbal or written information about the claim or make a request to be provided with copies of claim file documents.

3193A (132k, pdf) Schedule Transfer Request
Letter of Credit Schedule 2 Employers (32k, pdf) Letter of Credit for Schedule 2 Employers
Letter of Credit Schedule 1 Employers (21k, pdf) Letter of Credit for Schedule 1 Employers

Health and Safety

0236A (389k, pdf) Safety Groups Program Firm Application Form
3118A (300k, pdf) Safe Communities Incentive Program Firm Application Form
3168A (197k, pdf) Safety Groups Action Plan
3188 (35k, pdf) Safety Groups Year-end Maintenance Report (35k, pdf)

Premiums

0976A (95.3kb, PDF) Completing Your Premium Remittance Form
1009A (195k, pdf)

Reconciliation Form and Reconciliation Guide

Pdf version of the Reconciliation Guide (999.6kb, PDF)

1014A (250k, pdf) Reconciliation (Working Copy)
3602A (541k, pdf) Prepayment Request Form
0688C (183.7kb, PDF) Employer's Order Form