COVID-19 Update

WSCC’s Iqaluit and Inuvik offices are now open to the public. The Yellowknife office will re-open following necessary safety changes to our office space. Visit our COVID-19 page for important service updates, and the COVID-19 Resource page for essential tools for your workplace.

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Claims Forms for Workers

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.

The WSCC collects personal information to administer programs and services related to your claim. For more information please read our Privacy Statement for Workers.
Worker's Report of Injury
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Election to Claim Compensation
English | Français | ᐃᓄᒃᑎᑐᑦ
Electronic Fund Transfer
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Harvester's Report of Incident
English | Français | ᐃᓄᒃᑎᑐᑦ
Indemnity Guarantee
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Request for Disclosure
English | Français | ᐃᓄᒃᑎᑐᑦ
Statutory Declaration and Claim for Surviving Spouse
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Statutory Declaration for Dependents other than a Surviving Spouse
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Travel Expense Form
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Vocational Rehabilitation Job Search Contact Sheet
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Worker's Continuity Report
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Worker's Repetitive Strain Injury (Upper Limbs) Questionnaire
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Worker's Report of Noise-Induced Hearing Loss
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Worker's Report of Occupational Disease
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun
Worker's Report of Vibration Syndrome
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun

Forms

Request for Review
English | Français | ᐃᓄᒃᑎᑐᑦ | Inuinnaqtun