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Forms
2012 Occupational Health and Safety Statement    PDF
Access to Information Request    PDF
Accident Incident Investigation Form (PRIME sample)    DOC
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
Chronic Pain Reporting Form    PDF
Connect - Application for External Bookkeepers or Accountants    PDF
Connect - Application for Independent Health Care Providers    PDF
Connect – Application for Employers    PDF
Corrective Action Report - PRIME (sample 1)    PDF
Corrective Action Report - PRIME (sample 2)    PDF
Corrective Action Report - PRIME (sample 3)    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    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 Investigation Form - PRIME (sample)    PDF
Employee Accident/Incident Report Form - Sample    PDF
Employer Registration Application (Form A1)    PDF
Employers Assessment Invoice - PRIME (sample)    PDF
Expense Claim - Child Care    PDF
Expense Claim - Travel/Other (Form 95)    PDF
Explanation of Terms - Employer Claim Cost Report    PDF
Explanation of Terms - PRIME Status Report    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
HA-07 - Approved Fee Structure    PDF
Hand Injury (Form 53)    PDF
Hazard Assessment Form - PRIME (sample)    PDF
Hazard Recognition, Evaluation and Control - PRIME (sample)    PDF
Health and Safety Educator Award Application    PDF
Health Care Devices and Supplies Prescription    PDF
Hearing Loss Worker's Report (Form 6HL)    PDF
Hernia Report - (Form 6H)    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
Minute Reporting Form    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 (.pdf)    PDF
Occupational Rehabilitation Services Report Information (word)    DOC
Opiod Therapeutic Agreement    PDF
Optional Personal Coverage Application (Form A2)    PDF
OR4 - Initial Assessment (clinic)    PDF
OR5 - Progress Report (clinic)    PDF
OR6 - Discharge Report (clinic)    PDF
OR7 - Referral Invoice    PDF
Orientation Checklist: New & Transferred Employees - PRIME (sample)    PDF
Participant Registration Training Form    PDF
Payroll Update    PDF
Physician's Report (Form 8/10)    PDF
Physiotherapist's Report    PDF
Practice Incentive Questions - PRIME (sample)    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 Schedule (sample)    PDF
PRIME Status Report (sample)    PDF
Readiness Checklist - PRIME    PDF
Request for Internal Review    PDF
RTW Evaluation and Communication - PRIME (sample)    PDF
Safe Work Training Matrix - PRIME (sample)    PDF
Safety Meeting Participation Form PRIME - (sample)    PDF
Witness Statement    PDF
Worker Orientation Checklist - PRIME (sample)    PDF
Workplace Inspection Checklist (sample)    PDF
Workplace Inspection Checklist - PRIME (sample)    DOC
Workplace Inspection Report - PRIME (sample)    PDF
Workplace Inspection Report 2 - PRIME (sample)    PDF
Workplace Inspections Corrective Action - Sample 1    PDF
Workplace Inspections Corrective Action - Sample 2    PDF
Workplace Inspections Corrective Action - Sample 3    PDF

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