WSIB Form 6 Worker's Report of Injury / Disease - Ontario, Canada

How to Fill Out WSIB Form 6?

Follow these steps to prepare WSIB Claim Form 6:

1. Write down the claim number and indicate your personal information - full name, social insurance number, date of birth, sex, preferred language. Add your telephone number and address and describe your job position. If you are an executive, owner, elected official, or a family member of the employer, check the appropriate box. If you belong to a union, check the boxes to request its representation.
2. Name the employer and your immediate supervisor and add the contact information of the company you work for.
3. Describe the illness or injury - state the timeline, name the individual you reported the issue to, check the boxes to specify which body part was harmed, and describe the location of the incident. Use free space to list the specifics of the disease or accident and outline any further problems you have encountered if they are related to the incident. If you have filed any WSIB claims in the past, answer "yes."
4. State what kind of medical help you have received - first aid, hospital admission, medical appointments, etc. Confirm your employer knows you have sought medical care and check the boxes to show you have been prescribed medications or referred for additional treatment.
5. If you have lost any time due to the incident, write down when you have returned to work and explain whether you have discussed the return or modification to your duties with the company.
6. State your usual rate of pay and the number of hours per week. Certify whether you have received any benefits while you were unable to work and whether you have been employed elsewhere.
7. Sign and date the document. If you are younger than sixteen, the document must also have the signature and telephone number of your parent or legal guardian who gives their permission to submit a claim.
8. Enter your full name and social insurance number on every page of the form. In case you have additional information you would like to share, use the last page of the document. The original report must be sent to the WSIB in a paper form, and do not forget to give a copy to your employer.