You must have JavaScript enabled to use this form. *Indicates required field Online or print * required field request and pay online print and mail-in payment By mail or in person (at any WSIB location): To submit a Freedom of Information request by mail or in person, fill out this request form, print it (using the browser’s print function – shortcut: CTRL+P), and mail or hand deliver it, along with the mandatory $5.00 application fee made payable to the Workplace Safety and Insurance Board. Workplace Safety and Insurance Board 200 Front Street West Privacy and FOI Office, 21st floor Toronto, ON M5V 3J1 What is the request for? * required field access to general records access to own personal information Last name * required field First name * required field Claim number(s) Company name Address (Street/Apt. No./P.O. Box/R.R. No.) * required field City/Town * required field Province * required field Postal code * required field Telephone * required field Email * required field Are you requesting on behalf of yourself? * required field yes no Please provide the name of the client or person on behalf of whom you are acting as a representative Note: We may contact you to verify identity or confirm that you have consent to act as an agent or representative. Description of the records or personal information you are requesting. Please be as specific as possible, including dates. * required field Preferred method of access to records: * required field examine original receive copy Date * required field Signature * required field You can type in your name for the online submission signature To submit Freedom of Information request by mail or in person, fill out this request form, print it (use the browser's print function or the keys Ctrl P) , and mail or hand deliver it, along with a $5.00 application fee (in cash or made payable to the WSIB) to: Workplace Safety and Insurance Board 200 Front Street West Privacy and FOI Office, 21st floor Toronto, ON M5V 3J1 Personal Information collected from this form is in agreement with the Freedom of Information and Protection of Privacy Act (FIPPA) and will be used for the purpose of responding to your request. Questions about the collection of personal information should be directed to our Privacy and Freedom Information Office. Once the form is submitted you'll be directed to a third-party site for payment. Leave this field blank