Quick Links
Forms
If you are a client with a disability needing information in an alternate format,
please email general.inquiries@whscc.nl.ca or call 778-1000 or 1-800-563-9000 (toll free).
2015 Occupational Health and Safety Statement >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Access to Information Request >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Affidavit of Income >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Audiologist's Report >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Authorization - Claim Cost Contact >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Authorized Representative (Form 13) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
CEO Safety Charter Nomination Form >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Chiropractor Form 8/10c: a guide for better reporting >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Chiropractor's Report (Form 8/10C) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Clearance Request (Legal Party) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Commercial Divers Certificate of Medical Fitness >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Connect - Application for Employers >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Connect - Application for External Bookkeepers or Accountants >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Connect - Application for Independent Health Care Providers >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Crab Asthma Report >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Dentist's Report (DR) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Direct Deposit Authorization >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Early and Safe Return-to-Work Plan (sample included) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Election Form (third party - motor vehicle accident) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Election Form (third party - non-motor vehicle accident) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Election to Claim Compensation - Interjurisdictional >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Employer Registration Application >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Expense Claim - Child Care >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Expense Claim - Travel/Other (Form 95) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Extended Earnings Loss >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Fatality Report (Form 7FR) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
HA-01 - Hearing Aid Purchase Order Request >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
HA-02 - Hearing Aid Fitting Report >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
HA-04 - Hearing Aid Repair Request >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
HA-05 - Hearing Aid Replacement >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
HA-07 - Approved Fee Structure >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Hand Injury (Form 53) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Health Care Devices and Supplies Prescription >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Hearing Loss Worker's Report (Form 6HL) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Householders' Coverage Application (Form A3) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Independent Operator Questionnaire - current year >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Independent Operators Questionnaire - prior years >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Industrial Hygienist Service Directory Form >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Injury Report - Employers (Form 7) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Injury Report - Workers (Form 6) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Invoice - Dentists (Form 96) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Invoice - Hospitals (Form 94) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Invoice - Physicians (92) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Lost Cheque (Form 45) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
MSIP Week "We Care" Activity Ballot >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Non-Specific Incident Report - Employers >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Non-Specific Incident Report - Workers >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Occupational Disease Report (Form 6S) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Occupational Rehabilitation Provider's Consent to Collect, Use and Disclose of Personal Information >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Occupational Rehabilitation Services Report Information (OR1) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Office Work Station Review Guidelines >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
OH&S Minute Reporting Form >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
OH&S Minute Reporting Form (sample) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Optional Personal Coverage Application >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
OR4 - Initial Assessment (clinic) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
OR5 - Progress Report (clinic) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
OR6 - Discharge Report (clinic) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
OR7 - Referral Invoice >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Payroll Update >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Physician's Report (Form 8-10) >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Physiotherapist's Report >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Pre-Authorized Debit (PAD) Agreement >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Request for File Information >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Request for Internal Review >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=
Witness Statement >   PDF</a></a>
					    </td></tr>
                        <tr>
                            <td colspan=

Order Cart
Click the checkbox to the left of the document you wish to add to your cart



You need an Adobe Acrobat Reader to open .pdf files.
The Reader is available free from the Adobe Systems Web site. If you have any difficulties downloading the Reader, the Adobe site also offers customer support.