Employee's Workers' Compensation (Canada only)

Select the reference number for this incident from the OHS case numbers.

Displays the employee's last name and first name from the Demographics page.

Displays the employee's address, city, province, and postal code from the Demographics page.

Select whether or not the employee is covered by a union or collective agreement.

If applicable, select if the employee is an executive, elected official, owner, or spouse or relative of the employer.

Displays the employee's ID number.

Displays the employee's SIN number from the Demographics page.

Displays the employee's job title from the Current Job page.

Displays the employee's years of experience, which is calculated using the current system date minus the job start date.

Displays the employee's birth date from the Demographics page.

Displays the employee's gender from the Demographics page.

Displays the employee's hire date from the HR Status page.

Displays the employee's language from the Demographics page.

Displays the employee's telephone number from the Demographics page.

Displays the employer's last name from the Employer Setup page.

Displays the employer's address, city, province, and postal code from the Employer Setup page.

Displays the industrial sector of the employer from the Employer Setup page.

Displays the location that the employee was working in at the time of the incident from the OHS page.

(If the branch address where the employee is based is different from the employer's address shown near the top of this tab) Enter the branch address, city, province, postal code, and alternate telephone number.

Select whether the number provided for Provide Number is a firm number or account number.

Enter the appropriate number for the firm or account.

Enter the Workers' Compensation rate for the classification code the employee was working in at the time of the incident.

Enter the Workers' Compensation classification code the employee was working in at the time of the incident.

Displays the employer's telephone number and fax number from the Employer Setup page.

Select whether or not the employer employs 20 or more workers.

Displays the Incident Date/Time and the Notified Date/Time from the OHS page.

Enter the name, position, telephone number, and telephone extension of the person to whom the employee first reported the accident or illness.

Click More >>, select the appropriate check box for how the accident or illness occurred for 3., select the appropriate check boxes for

4. Type of accident / illness, and then click OK.

Note: If the type of accident is not listed, select Other and give a description of the accident or illness.

Click More >>, select the check boxes for all areas of injury, and then click OK.

Note: If the area of injury is not listed, select Other and give a description of the area. Also select Left or Right if applicable.

Enter a description of what happened to cause the accident or illness and a description of what activities the employee was doing at the time. For example, lifting a 50 lb. box. Include any details concerning the equipment, materials, or environmental conditions that may have contributed.

Select Yes if the accident or illness occurred on property that is owned, leased, or maintained by the employer.

If yes, enter where on the premises the accident or illness occurred (such as the assembly line, shop floor, warehouse storage area, or parking lot).

Select Yes if the accident or illness occurred outside of Ontario.

If yes, enter the city, province, and country where the accident or illness occurred; the employee may have the choice of claiming benefits either in Ontario or where it happened.

Select Yes if anyone saw the accident or illness, if other employees were involved in the employee's accident or illness, or anyone has knowledge of the accident or illness.

If yes, enter each person's name, position, and work phone number.

Select Yes if any individual who is not employed by your employer was responsible (even partially) for the employee's accident or /illness.

If yes, enter each person's name and work phone number.

Select Yes if the employee had a previous similar problem, injury, or condition.

If yes, enter the details of that problem, injury or condition.

Select the check box if a written submission is attached.

Select Yes if the employee received health care.

If yes, enter the date the employee received the health care.

Enter the date the employer first learned that the employee received health care for the incident.

Select the appropriate check boxes for all the places the employee received health care for the incident.

Also enter the name, address, and phone number of the health professional or facility who treated the employee.

Note: If this information is already on the Treatment tab , the information appears as one line in the address field. In order for this information to appear correctly on the WSIB Employers Report Form 7, you must move the treatment center name to the Name and leave the street address, city, province, and postal code for Address, separated by spaces.

Select one of the check boxes to describe what the employee did after the day of the incident.

Select Myself or Other. Also enter the person's name and phone number .

Click More >> to access questions F1 - F4. When done, click OK to save and return to the Lost Time tab.

Select Yes if the employer was provided with any work limitations for the employee.

Select Yes if the employer discussed modified work for the employee's return to work, including limitations, job duties, accommodations, or other options to facilitate the employee's return to work.

Select Yes if the employer offered modified work to the employee.

If yes, select Accepted or Declined if the employee accepted or declined the offer.

If the employee declined the offer, select the check box and provide the WSIB with a written copy of the return to work offer.

Indicate the person responsible for arranging the employee's return to work. Enter the name, telephone number, and extension of that person.

Select the check boxes for all the employment types that apply to this employee. You must select at least one employment type.

If you select Other, enter information about the type of employment.

Displays the unit pay rate from the Current Pay page.

Select the check box if the rate of pay is hourly, daily, weekly, or other. If the rate of pay is difficult to provide (such as commission sales or piecework), select Other and enter the type of pay and any base pay, if applicable.

Click 1-7 More >> to access questions H1 - H7 or click 8 More >> to access question H8. When done, click OK to save and return to the Lost Time tab.

Enter the Federal and Provincial net claim codes or amounts.

Select Yes if vacation pay is given to the employee on each pay cheque.

Also enter the actual percentage of the cheque that is vacation pay.

Displays the Last Worked Date / Time from the OHS page.

Enter the employee's normal start and end time on the last day worked .

Enter the employee's actual earnings for the last day worked.

Enter the employee's normal earnings for the last day worked.

Select Yes if the employer continues to pay the employee during recovery.

If yes, select either:

• Full/Regular if the payment is the employee's full salary.
• Other if the payment is a percentage of their regular salary, if the payment is a loan or lump sum advance, or if there is any other arrangement; then enter information about this other payment.

Use this table to provide additional earnings information for the four weeks prior to the employee's incident.

1. In columns 1 and 2, enter the From Date and To Date for each week.
2. In columns 3 and 4, enter the total weekly gross amount for Mandatory Overtime Pay and Voluntary Overtime Pay.

3. In the remaining four columns, select the earnings type from the drop down list, and then enter the total weekly gross amount. Additional earnings types include:

   • bonuses
   • commissions
   • differentials
   • in-lieu of payments
   • premiums
   • tips and gratuities
   • Other (such as room and board) that you enter

Click More >> to access questions IA - IC. When done, click OK to save and return to the Earnings tab.

Enter the employee's normal work hour totals for each day of the week.

If the employee is a repeating rotational shift worker, enter the number of days on, the number of days off, the hours per shift, and the number of weeks in a cycle.

If the employee has a varied or irregular work schedule, enter the dates of the four weeks prior to the incident, the total number of hours worked during that week, and total number of shifts worked during that week.

Displays the name of the person who filed the report (from the OHS page).

Displays the position of the person who filed the report (from the OHS page).

Displays the telephone number of the person who filed the report (from the OHS page).

Displays the report date (from the OHS page).

Select the code for this type of attachment.

Enter the title for the attachment.

Displays the file name of the attachment.

To select the attachment file, click this Upload File icon to open the Select file to attach window, locate and select the file, and then click Open.

Displays the date and time when the file was last uploaded.

Select this check box if you want the employee to be able to view this attachment in Employee Self Service.