Canada WSIB 3959a 2020-2025 free printable template

ESIB.ca200 Front Street West, Toronto ON M5V 3J1 Telephone: 4163441000 or 18003870750 TTY: 18003870050 Fax: 4163444684 or 18883137373Employer's Exposure Incident Reporting Form Perth attached Employer's

How to fill out ca wsib exposure reporting form

How to fill out Canada WSIB 3959a

1. Obtain the Canada WSIB 3959a form from the WSIB website or your employer.
2. Begin filling out the form by providing your personal information, including your name, address, and contact details.
3. Indicate your date of birth and Social Insurance Number (SIN).
4. Describe the incident or injury, including the date, time, and location of the event.
5. Provide details about how the injury occurred, including any relevant circumstances.
6. List any witnesses to the incident, including their names and contact information.
7. Include information about the treatment you have received for the injury and the name of the healthcare provider.
8. Carefully review your completed form for any errors or omissions.
9. Sign and date the form to certify the information is accurate.
10. Submit the completed WSIB 3959a form to your employer or the appropriate WSIB office.

Who needs Canada WSIB 3959a?

1. Any worker in Ontario who has suffered a work-related injury or illness and is seeking benefits.
2. Employers who need to report incidents or injuries of their employees to WSIB.
3. Healthcare providers who are involved in the treatment of workers' injuries may also need the form for documentation purposes.

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What is Canada WSIB 3959a?

Canada WSIB 3959a is a form used by employers in Ontario to report workplace injuries or illnesses to the Workplace Safety and Insurance Board (WSIB).

Who is required to file Canada WSIB 3959a?

Any employer in Ontario who has employees and is registered with the WSIB is required to file the WSIB 3959a if an employee reports a work-related injury or illness.

How to fill out Canada WSIB 3959a?

To fill out the WSIB 3959a, employers must complete the required sections, including details about the injured employee, the nature of the injury, and the circumstances surrounding the event, ensuring all information is accurate and complete.

What is the purpose of Canada WSIB 3959a?

The purpose of the WSIB 3959a is to document work-related injuries and illnesses, which assists in the processing of claims for benefits and helps the WSIB monitor workplace safety.

What information must be reported on Canada WSIB 3959a?

The information that must be reported on the WSIB 3959a includes the employee's personal details, the date and time of the incident, description of the injury or illness, and any specific circumstances that led to the incident.