Worker's Report of Injury/Disease

About this form

A form workers complete when injured or diagnosed with an occupational disease. Used alongside the employer's Form 7.

A form workers complete when injured or diagnosed with an occupational disease. Used alongside the employer's Form 7.

Who needs this form

Workers in Ontario who are injured or develop an occupational disease

What's in this form

• Worker personal information
• Employer information
• Accident/disease details
• Injury description
• Medical treatment
• Work status

Published by

Workplace Safety and Insurance Board (WSIB)