Worker's Report of Injury/Disease - Form 6
This file contains the Worker's Report of Injury or Disease Form 6 required by the Workplace Safety and Insurance Board. It is used for documenting injury or illness for claims and processing benefits. Ensure that all information is filled out accurately to avoid delays in your claim.
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How do I fill this out?
To fill out this form, start by entering your personal details in Section A. Next, provide your employer's information in Section B, followed by the details of the accident or illness in Section C. Lastly, sign the declaration in Section G to confirm the accuracy of the provided information.
How to fill out the Worker's Report of Injury/Disease - Form 6?
1
Complete Section A with your personal information.
2
Fill in Section B with your employer's details.
3
Detail the accident/illness in Section C.
4
Review the form for accuracy.
5
Submit the form as per the guidelines.
Who needs the Worker's Report of Injury/Disease - Form 6?
1
Workers who have sustained injuries at work and need to file a claim.
2
Employers needing to report an injury incident on their premises.
3
Health professionals required to document patient injuries for claims.
4
Union representatives assisting members in filing injury claims.
5
Insurance adjusters reviewing claims for compensation.
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What are the instructions for submitting this form?
To submit this form, you can fax it to the WSIB at 416-344-4684 or toll-free at 1-888-313-7373. Alternatively, you can mail it to the Workplace Safety and Insurance Board, 200 Front Street West, Toronto ON M5V 3J1. Make sure to keep a copy of the form for your records before sending it.
What are the important dates for this form in 2024 and 2025?
Ensure timely submission of this form according to any deadlines set by your workplace or insurance provider. Check for specific cut-off dates in 2024 and 2025 based on your claim processing schedule.
What is the purpose of this form?
The purpose of this form is to document any injury or disease resulting from workplace activities. It serves as an official report to the Workplace Safety and Insurance Board (WSIB), ensuring proper documentation and processing of claims. Completion of this form is a crucial step for workers seeking compensation and benefits for their injuries.
Tell me about this form and its components and fields line-by-line.
- 1. Worker Information: Personal details of the injured worker including name, contact information, and job title.
- 2. Employer Information: Details of the employer including company name and supervisor's information.
- 3. Accident/Illness Details: Information about the accident or illness, including date, time, and nature of the injury.
- 4. Health Care Information: Information on any medical treatment received and healthcare providers.
- 5. Lost Time & Return to Work: Details regarding time lost from work and return dates.
- 6. Earnings: Information regarding the worker's rate of pay and associated benefits.
- 7. Declarations and Signature: Signature field for the worker and guardian if applicable.
What happens if I fail to submit this form?
Failure to submit this form may result in delays in processing your claim or even denial of benefits. It's essential to complete and submit the document accurately and on time.
- Delayed Claims Processing: Your claim may take longer to process, potentially delaying benefits.
- Denial of Benefits: Failure to submit the form can lead to a denial of your claim.
- Legal Implications: There may be legal consequences for not following proper reporting procedures.
How do I know when to use this form?
- 1. Injury at Work: Complete this form to report injuries sustained on the job.
- 2. Illness Related to Work: Use this for any work-related illnesses you may develop.
- 3. Claim Submission: Essential for formally submitting claims to WSIB.
Frequently Asked Questions
How do I fill out the Worker's Report of Injury/Disease?
Start with your personal information, followed by your employer's details, and describe the accident or illness.
Can I edit this PDF after downloading?
Yes, you can edit it using our editing tools on PrintFriendly.
What should I do if I missed a field?
You can go back and fill it in as long as you are editing the document.
Is my information secure when using PrintFriendly?
Yes, PrintFriendly offers secure editing and sharing options.
Can I resend the form if I've made a mistake?
Absolutely, you can edit it and resend the corrected form.
What types of injuries does this report cover?
It covers all workplace-related injuries and diseases.
Who needs to sign the form before submission?
The injured worker must sign the form, along with a guardian if they are underage.
How can I submit this form?
You can submit the form via email, fax, or directly to your employer.
What if I forget to include a witness?
You can still submit the form and add witness information later if needed.
Where can I find help filling out this form?
Resources and guides are available online to assist with filling out the form.
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