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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.
| Form Number | Form Name |
|---|---|
| Report An Injury/Illness | |
| 0006A |
Worker's Report of Injury/Disease Form 6 For a faster, more efficient experience, you can complete and submit your Report of Injury/Illness 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. If you're under 16 years of age, or are filling out a Report of Injury for someone is under 16, please print a Form 6 pdf (PDF) and fax or mail us your report. Our Reference Guide for Workers (PDF) will give you more information on filling out this form. |
| 0032A (PDF) |
Worker's Report Occupational Noise Induced Hearing Loss |
| 3958A (PDF) |
Worker's Exposure Incident Reporting Form - PEIR
|
| 3885A (PDF) |
Worker's Exposure Incident Reporting Form - CEIR
|
| Claims | |
New2397A (86.0kb, PDF) |
Intent to Object formRead our instructions to workers (PDF) on how to fill out this form. |
|
(148k, pdf) |
WSIB Medication Reimbursement Form |
| 2144A (PDF) |
Request a copy of your claim form (Request for Access to Own Personal Information) |
| 2721A (PDF) |
Worker Health Care Travel Expense Form |
| 2719A (PDF) | Health Care Travel Expense Form - Occupational Disease and Specialized Services |
| 2996A (PDF) |
Complete and submit our work transition travel and related expenses form or fill out our online application. |
| 3072A (PDF) Spanish (PDF) |
Direct Deposit Enrollment form Please do not upload your direct deposit information using the document upload tool. Send your form by email, mail or fax. |
| 3074A (PDF) | Power of Attorney for Property/Guardianship of Property Form |
| 3164A (PDF) |
General Worker Expense Form |
| 3306A (PDF) |
Complete and submit our clothing allowance form or fill out our online application. Read more about the clothing allowance benefit. |
| 3585A (PDF) |
Vision Care Claim Form |
| Employee Coverage | |
| 1824A (PDF) |
Direction of Authorization This is not a request for access or an appeals form. It is only used 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. |
| Return to Work and Recovery | |
| 0041A (PDF) |
Worker's Progress Report |
| 2232A (PDF) |
Worker's Continuity Report (Form REO6) |
| 2647A (PDF) |
Functional Abilities Form for Early and Safe Return to Work version 2006 |