WHSCC

Forms
If you are a client with a disability needing information in an alternate format,
please email general.inquiries@workplacenl.ca or call 778-1000 or 1-800-563-9000 (toll free).

All

Workers

Employers

PRIME

Health Care

Prevention


	2017 Occupational Health and Safety Statement

	Authorization - Claim Cost Contact

	Authorized Representative (Form 13)

	Clearance Request (Legal Party)

	Connect - Application for External Bookkeepers or Accountants

	Connect - Application for Independent Health Care Providers

	Direct Deposit Authorization

	Early and Safe Return-to-Work Plan (sample included)

	Election to Claim Compensation - Interjurisdictional

	Employer Registration Application

	Fatality Report (Form 7FR)

	Householders' Coverage Application (Form A3)

	Independent Operator Questionnaire - current year

	Independent Operators Questionnaire - prior years

	Injury Report - Employers (Form 7)

	Injury Report - Workers (Form 6)

	Lost Cheque (Form 45)

	Non-Specific Incident Report - Employers

	Payroll Update

	Pre-Authorized Debit (PAD) Agreement

	Request for Internal Review

	Witness Statement

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