Forms: Business

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Categories

• Claims
  • Report an injury/illness/exposure
  • Support your employee's recovery and return to work
  • Object to a decision about a claim
  • Re-open a claim
• Your account
  • Get WSIB coverage
  • Manage your premiums, rates and coverage
  • Pay your premiums
  • Determine your independent operator status
  • Verify coverage when buying or selling your business
  • Authorize a third-party representative
  • Object to a decision about your account
  • Email us
• Health and Safety - Training and information
• Recognize a small business
• Order print materials

Claims

Report an injury/illness/exposure

• Report online
  • Report of Injury/Disease Form 7 (PDF 0007A)
  • Form 7 Reference Guide (PDF)
• Exposure Incident Reporting Form – PEIR (PDF 3959A)
• Exposure Incident Reporting Form – CEIR (PDF 3886A)
• Report Occupational Noise Induced Hearing Loss (PDF 0137A)
• Report on Needlestick Injury or Body Fluid Splash (PDF 2819A)

Support your employee's recovery and return to work

• Functional Abilities Form for Early and Safe Return to Work (PDF 2647A)
  • Guide to Completing the Functional Abilities Form (PDF)
• Physical Demands Information Form (PDF 2828A, 2829A, 2830A, 2851A, and 2852A)
  • Example of Section 2: Duties and Physical Demands (PDF)
  • Example of Section 3: General Physical Demands and Section 4: Additional Considerations (PDF)
• Progress Report (PDF 0042A)
• Subsequent Report (PDF 0009C)
  • Please note:  We are reviewing Form 9 for possible discontinuation in 2020. Please use the Progress Report (Form 42) instead.
• Treatment Memorandum (PDF 0156C)

Object to a decision about a claim

• Intent to object form (PDF 2399A)
  • Instructions for completing the form (PDF)

Re-open a claim

• Continuity Report Post-1998 (Form WRE07) / Re-open Claim Earnings Post-1998 (Form WRE07E) (PDF 3233A and 3524A)
• Continuity Report Pre-1998 (Form RE07) / Re-open Claim Earnings Pre-1998 (Form RE07E)  (PDF 2233A and 2235A)

Your account

Get WSIB coverage

• Register online
• Employer by Application (PDF 0090C)
• Employer by Application Entertainment Industry (PDF 0095C)
• Optional Insurance Request/Change for Schedule 1 Employers (PDF 1574A)
• Optional Insurance Consent Form under Schedule 2 (PDF 1034A)
• Application for exemption from coverage for a Partner and Executive Officer in construction (PDF 1208A)
• Application for reduced premium rate for non-exempt partner and executive officers in construction (PDF 1209A)
• Schedule Transfer Request (PDF 3193A)

Manage your premiums, rates and coverage

• Application for Alternative Assessment Procedure for Interjurisdictional Trucking (PDF 2642A)
• Completing Your Premium Remittance Form (PDF 0976A)
• Reconciliation Form – working copy (PDF 1014A)

Pay your premiums

• Prepayment Request Form (PDF 3602A)
• Letter of Credit Schedule 1 (PDF)
• Letter of Credit Schedule 2 (PDF)

Determine your independent operator status

• General - Determining Worker/Independent Operator Status Questionnaire (PDF 1158A)
• Retail Industry - Determining Worker/Independent Operator Status (PDF 1155A)
• Courier Industry - Determining Worker/Independent Operator Status Questionnaire (PDF 1157A)
• Logging Industry - Determining Worker/Independent Operator Status Questionnaire (PDF 1168A)
• Taxi Industry - Determining Worker / Independent Operator Status (PDF 1152A)
• Trucking Industry - Determining Worker/Independent Operator Status Questionnaire (PDF 1149A)

Verify coverage when buying or selling your business

• Purchase Certificate Worksheet (PDF 1238A)

Authorize a third-party representative

• Consent for account information for non-legal representation (Direction of authorization PDF 0793A)
• Consent for account information for legal representation (Direction of authorization PDF 1797A)
• Consent for claim-related information (Direction of authorization PDF 1824A)

Object to a decision about your account

• Objecting to an employer account decision (PDF 3363A)

Email us

• Email consent form (PDF)

Health and safety

• Health and Safety Excellence program

Training and information

• Building Your Health and Safety Program application form (PDF 2601A)
• Certification Training Reimbursement Request Form (PDF 0056A)
• Safety Groups Program Firm Application Form (0236A PDF)
• Safety Groups Action Plan (PDF 3168A)
• Safety Groups year-end maintenance report (PDF 3188)

Recognize a small business

• Small Business Health & Safety Leadership Award Nomination (PDF)

Order print materials

• Print material order form