Employer forms
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Categories
| Form Number | Form Name |
|---|---|
Registration |
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| Register online | Learn more about registering with us. |
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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 |
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0007A (619k, pdf) Form 7 Reference Guide(1.8mb, pdf) |
Employer's Report of Injury/Disease Form 7. Submitting a No Lost Time claim?Only complete sections A to D, E (#1) and J. Learn about our eForm 7.
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| 0009C (170.1kb, PDF) | Employer's Subsequent Report |
| 0042A (230.8kb, PDF) | Employer's Progress Report Form 42 |
New2397A (86.0kb, PDF) |
Intent to Object formRead 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 |
| 1087A(165k, pdf) | Voluntary X-Ray & Pulmonary Function Test |
| 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) |
| 2642A (189k, pdf) | Application for Alternative Assessment Procedure for Interjurisdictional Trucking |
| 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 |
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| 2929A (126.4kb, PDF) | WSIB Policy Manuals/Newsletter Order Form |
| 0090C (231k, pdf) |
Employer by Application Does your firm have voluntary by-application workplace safety and insurance coverage? |
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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 |
| 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
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. |
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(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 |
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| 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) |
| 3189A (276k, pdf) | Workplace-Specific Hazard Training |
Premiums |
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| 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 |
