Claims Forms for Workers

Please read each form carefully to ensure you accurately complete it.

Please contact us at 1-800-661-0792 if you need assistance.

Worker's Report of Injury

Election to Claim Compensation

Electronic Fund Transfer

Harvester's Report of Incident

Indemnity Guarantee

Request for Disclosure

Statutory Declaration and Claim for Surviving Spouse

Statutory Declaration for Dependents other than a Surviving Spouse

Travel Expense Form

Vocational Rehabilitation Job Search Contact Sheet

Worker's Continuity Report

Worker's Repetitive Strain Injury (Upper Limbs) Questionnaire

Worker's Report of Noise-Induced Hearing Loss

Worker's Report of Occupational Disease

Worker's Report of Vibration Syndrome

Request for Review