Quick Links
Forms
If you are a client with a visual impairment we may be able to provide you with documents from this website in an alternate format, such as Braille or large print. Please contact us at general.inquiries@whscc.nl.ca, 778-1000 or toll-free 1-800-563-9000.
2012 Occupational Health and Safety Statement    PDF
Access to Information Request    PDF
Affidavit of Income    PDF
Audiologist's Report    PDF
Authorization - Claim Cost Contact    PDF
Authorized Representative (Form 13)    PDF
CEO Safety Charter Nomination Form    PDF
Chiropractor Form 8/10c: a guide for better reporting    PDF
Chiropractor's Report (Form 8/10C)    PDF
Commercial Divers Certificate of Medical Fitness    PDF
Connect - Application for External Bookkeepers or Accountants    PDF
Connect - Application for Independent Health Care Providers    PDF
Connect – Application for Employers    PDF
Crab Asthma Report    PDF
Dentist's Report (DR)    PDF
Direct Deposit Enrolment - Vendor    PDF
Direct Deposit Enrolment - Worker    PDF
Early and Safe Return to Work Plan (sample)    PDF
Early and Safe Return-to-Work Plan    PDF
Election Form (third party - motor vehicle accident)    PDF
Election Form (third party - non-motor vehicle accident)    PDF
Election to Claim Compensation - Interjurisdictional    PDF
Employee Accident/Incident Report Form - Sample    PDF
Employer Registration Application (Form A1)    PDF
Expense Claim - Child Care    PDF
Expense Claim - Travel/Other (Form 95)    PDF
Extended Earnings Loss    PDF
Fatality Report (Form 7FR)    PDF
HA-01 - Hearing Aid Purchase Order Request    PDF
HA-02 - Hearing Aid Fitting Report    PDF
HA-04 - Hearing Aid Repair Request    PDF
HA-05 - Hearing Aid Replacement    PDF
Hand Injury (Form 53)    PDF
Health and Safety Educator Award Application    PDF
Health Care Devices and Supplies Prescription    PDF
Hearing Loss Worker's Report (Form 6HL)    PDF
Householders' Coverage Application (Form A3)    PDF
Independent Operator Questionnaire - current year    PDF
Independent Operators Questionnaire - prior years    PDF
Industrial Hygienist Service Directory Form    PDF
Injury Report - Employers (Form 7)    PDF
Injury Report - Workers (Form 6)    PDF
Invoice - Dentists (Form 96)    PDF
Invoice - Hospitals (Form 94)    PDF
Invoice - Medical Products and Services (sample)    PDF
Invoice - Personal Care (sample)    PDF
Invoice - Physicians (92)    PDF
Lost Cheque (Form 45)    PDF
Non-Specific Incident Report - Employers    PDF
Non-Specific Incident Report - Workers    PDF
Occupational Disease Report (Form 6S)    PDF
Occupational Rehabilitation Provider's Consent to Collect, Use and Disclose of Personal Information    PDF
Occupational Rehabilitation Services Report Information (OR1)    PDF
OHS Minute Reporting Form    PDF
Optional Personal Coverage Application - 2014    PDF
OR4 - Initial Assessment (clinic)    PDF
OR5 - Progress Report (clinic)    PDF
OR6 - Discharge Report (clinic)    PDF
OR7 - Referral Invoice    PDF
Payroll Update    PDF
Physician's Report (Form 8-10)    PDF
Physiotherapist's Report    PDF
Pre-Authorized Debit (PAD) Agreement    PDF
PRIME - Audit Template (large business)    PDF
PRIME - Audit Template (medium business)    PDF
PRIME - Audit Template (small business)    PDF
PRIME Toolbox - Accident Incident Investigation Form    DOC
PRIME Toolbox - Corrective Action Report    PDF
PRIME Toolbox - Corrective Action Report    PDF
PRIME Toolbox - Corrective Action Report    PDF
PRIME Toolbox - Employee Accident Incident Investigation    PDF
PRIME Toolbox - Employers Assessment Invoice    PDF
PRIME Toolbox - Hazard Assessment Form    PDF
PRIME Toolbox - Hazard Recognition, Evaluation and Control    PDF
PRIME Toolbox - Orientation Checklist: New & Transferred Employees    PDF
PRIME Toolbox - Practice Incentive Questions    PDF
PRIME Toolbox - Readiness Checklist    PDF
PRIME Toolbox - RTW Evaluation and Communication    PDF
PRIME Toolbox - Safe Work Training Matrix    PDF
PRIME Toolbox - Safety Meeting Participation Form    PDF
PRIME Toolbox - Schedule    PDF
PRIME Toolbox - Status Report    PDF
PRIME Toolbox - Worker Orientation Checklist    PDF
PRIME Toolbox - Workplace Inspection Checklist    DOC
PRIME Toolbox - Workplace Inspection Checklist    PDF
PRIME Toolbox - Workplace Inspection Report    PDF
PRIME Toolbox - Workplace Inspection Report    PDF
Protecting New Workers    PDF
Request for Internal Review    PDF
Witness Statement    PDF
Workplace Inspections Corrective Action - Sample 1    PDF
Workplace Inspections Corrective Action - Sample 2    PDF
Workplace Inspections Corrective Action - Sample 3    PDF

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.