Registration |
| Register online | Learn more about registering with us. |
1208WA (PDF) 1209WA (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 (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. |
| 0137A (PDF) | Employer's Report Occupational Noise Induced Hearing Loss |
| 0009C (PDF) | Employer's Subsequent Report |
| 0042A (PDF) | Employer's Progress Report Form 42 |
| New 2399A (PDF) | Intent to Object form
Our Intent to Object form is available for employers who intend to file an objection to a worker claim, only.
Note: Please DO NOT use the Intent to Object form if you disagree with a decision relating to your employer account. You should instead contact Employer Account Services at 416-344-1000 or 1-800-387-0750 for information on the objection process for employer account decisions.
Read our instructions for employers (PDF) on how to fill out the Intent to Object form. |
| 0156C (PDF) | Treatment Memorandum |
| 2233A and 2235A (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 (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 (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 (PDF) |
| 2819A (PDF) | Report on Needlestick Injury |
| 3959A (PDF) | Employer's Exposure Incident Reporting Form - PEIR |
| 3886A (PDF) | Employer's Exposure Incident Reporting Form - CEIR |
| PDIF (PDF) | Physical Demands Information Form: contains forms 2828A, 2829A, 2830A, 2851A, and 2852A. |
Employer Coverage |
| 2929A (PDF) | WSIB Policy Manuals Order Form |
| 0090C (PDF) | Employer by Application Does your firm have voluntary by-application workplace safety and insurance coverage? |
1208WA (PDF) 1209WA (PDF) | Partner or Executive Officer in Construction - Exemption from Coverage Request for Rate Group 755, Non-Exempt Partners and Executive Officers in Construction |
| 2642A (PDF) | Application for Alternative Assessment Procedure for Interjurisdictional Trucking |
| 1034A (PDF) | Optional Insurance Consent Form under Schedule 2 |
| 0095C (PDF) | Employer by Application Entertainment Industry |
| 1149A (PDF) | Determining Worker/Independent Operator Status Questionnaire - Trucking Industry |
| 1152A (PDF) | Determining Worker / Independent Operator Status - Taxi Industry |
| 1155A (PDF) | Determining Worker / Independent Operator Status - Retail Industry |
| 1157A (PDF) | Determining Worker/Independent Operator Status Questionnaire - Courier Industry |
| 1158A (PDF) | Determining Worker/Independent Operator Status General Questionnaire |
| 1168A (PDF) | Determining Worker/Independent Operator Status Questionnaire - Logging Industry |
| 1238A (PDF) | Purchase Certificate Worksheet |
| 1574A (PDF) | Optional Insurance Request/Change, Schedule 1 Employers |
| 1797A (PDF) | Direction of Authorization - Employer Accounts (Legal Representation) This form allows an employer to authorize a third party representative, to provide legal representation to
• Appeal an employer account decision
• Represent the employer in relation to the employer's account (i.e. Sale of business, Bankruptcy, etc.) 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. |
| 0793A (PDF) | Firm File/Account Access Consent – Employer Accounts (Non-Legal Representation) This form can be used for either employer firm file access or consent to share the employer’s account information with a third party who will not be a legal representative to the employer.
If a third party representative wishes to provide legal representation including disputing an employer account decision made by the WSIB, the Direction of Authorization – Employer Accounts form must be completed.
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 (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 (PDF) | Schedule Transfer Request |
| Letter of Credit Schedule 2 Employers (PDF) | Letter of Credit for Schedule 2 Employers |
| Letter of Credit Schedule 1 Employers (PDF) | Letter of Credit for Schedule 1 Employers |
Health and Safety |
| 2600A (PDF) | Health and Safety Information Sessions application form |
| 2601A (PDF) | Building Your Health and Safety Program application form |
| 0236A (PDF) | Safety Groups Program Firm Application Form |
| 3168A (PDF) | Safety Groups Action Plan |
| 3188 (PDF) | Safety Groups Year-end Maintenance Report |
| 0056A (PDF) | Certification Training Reimbursement Request Form |
Premiums |
| 0976A (PDF) | Completing Your Premium Remittance Form |
| 1014A (PDF) | Reconciliation (Working Copy) Reconciliation Form and Reconciliation Guide |
| 3602A (PDF) | Prepayment Request Form |
| 0688C (PDF) | Employer's Order Form |
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