On this page:
Form 7 layout
- Worker information
- Employer information
- Accident/illness dates and details
- Health care
- Lost time – no lost time
- Return to work
- Base wage/employment information
- Additional wage information
- Work schedule
- Declaration
- Additional information
Each section contains a number of data fields. Each field has been analysed to determine mandatory or optional rules and as to data characteristics.
Field attribute definitions
| Field attribute | Definition |
|---|---|
| Alpha | Non-numeric field i.e. alphabetic and special characters such as dashes, apostrophes and French upper and lower case characters |
| Alphanumeric | Field that can contain numeric, alphabetic or character such as, but not limited to brackets, dashes, back-slashes, forward slash-es, etc. |
| Monetary | Field defined as dollars and cents i.e. $4.25 is represented as 3(2) |
| Numeric | Field restricted to numeric character 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 in-cluding decimal points i.e. 4.25 is represented as 3(2) |
| Non-numeric | Alpha field that accepts “a to z” and special characters such as dash, slash, ampersand, apostrophe, etc., numbers not permitted |
| Text | Freeform text field i.e. similar to alphanumeric |
NOTE: Please use upper- and lower-case letters (not all capitals) and avoid using the caps lock key when entering information.
Field characteristics and business rules – Form 7
| Label field name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
|---|---|---|---|
| No. Input name | |||
| Claim number | O | 8 numeric | N/A |
| Job title/occupation | M | 40 alphanumeric | Minimum input is 1 character |
| Length of time in this position working for you | M | 12 alphanumeric | Minimum input is 1 character |
| Social Insurance Number | M | 9 numberic | N/A |
| Please check if this worker is a: | O | Check boxes: Executive, elected official, owner, spouse or relative of the employer | Allow more than one box to be checked |
| Is worker covered by a union/collective agreement? | M | Check boxes: yes, no 1 alpha | Either/or rule |
| Worker reference number | O | 15 alphanumeric | Field may be blank |
| Worker's preferred language | M | Checkboxes: English, French, Other 1 alpha | Either/or rule |
| Other | O/M | 20 alpha | Field is mandatory if "other" box checked. Minimum input is 1 character if field is mandatory |
| Date of birth – ddmmyy | M | 8 numeric | Convert "year" field to 4 numeric - ddm-myyyy 00000000 not allowed |
| Telephone number | M | 13 alphanumeric | (NNN)NNN-NNNN |
| Sex | M | Checkboxes: M, F 1 alpha | Either/or rule |
| Date of hire - ddmmyy | M | 8 numeric | Convert "year" field to 4 numeric - ddm-myyyy |
| Last name | M | 25 non-numeric | Minimum input is 1 character |
| First name | M | 20 non-numeric | Minimum input is 1 character |
| Address (number, street, apt., suite, unit) | M | 45 alphanumeric | Minimum input is 1 character |
| City/town | M | 30 non-numeric | Minimum input is 1 character |
| Province | M | 10 alphanumeric | Minimum input is 1 character |
| Postal code | M | 10 alphanumeric | 1 minimum to 10 maximum alphanumeric character required (mailing address may be out of Canada) |
| Label field name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
|---|---|---|---|
| No. Input name | |||
| Trade and legal name (if different, provide both) | M | 45 alphanumeric | Minimum input is 1 character |
| Mailing address | M | 45 alphanumeric | Minimum input is 1 character |
| City/Town | M | 30 non-numeric | Minimum input is 1 character |
| Province | M | 3 non-numeric | Minimum input is 1 character |
| Postal code | M | 10 alphanumeric | 1 minimum to 10 maximum alphanumeric character required (mailing address may be out of Canada) |
| Telephone number | M | 13 alphanumeric | (NNN)NNN-NNNN |
| Fax number | O | 13 alphanumeric | (NNN)NNN-NNNN |
| Check one: | M | Check boxes: Firm number or Account number 1 alpha | Either/or rule |
| Provide number | M | 8 alphanumeric, or 7 numeric | If firm number box checked, field is alphanumeric and a minimum input of 1 numeric character and a maximum of 6 numeric plus 2 alpha characters allowed If account number checked, field is numeric and minimum input of 1 to maximum of 12 numeric characters allowed (do not display leading zeroes) |
| Rate group | O/M | 3 numeric | NNN (if Class/Subclass and NAICS Code are provided, rate group is not required) Rate group and classification unit code must be submitted together |
| Classification unit code | O/M | 8 alphanumeric | NNNN-NNN (if class/subclass and NAICS code are provided classification unit code is not required). Rate group and classification unit code must be submitted together |
| Class code [class/subclass] | O/M | 3 alphanumeric | NNN (if rate group and classification unit code are provided class/subclass is not required) class code and NAICS code must be submitted together |
| NAICS code | O/M | 6 alphanumeric | NNNNNN (if rate group and classification unit code are provided NAICS code is not required) Class code and NAICS code must be submitted together |
| Description of business activity | M | 40 alphanumeric | Minimum input of 1 alphanumeric character |
| Does your firm have 20 or more employees? | M | Check boxes: Yes, No 1 alpha | Either/or rule |
| Branch address where worker is based (if different than mailing address - no abbreviations) | O | 45 alphanumeric | N/A |
| City/town | O | 30 alpha | N/A |
| Province | O | 3 alpha | N/A |
| Postal code | O | 10 alphanumeric | 1 minimum to 10 maximum alphanumeric character required (mailing address may be out of Canada) |
| Alternate telephone number | O | 13 alphanumeric | (NNN)NNN-NNNN |
Label field name
| ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| 1 | Date and hour of accident/ awareness of illness | M | 8 numeric (date) 5 alphanumeric (hour) | Convert "year" field to 4 numeric – ddmmyyyy do not allow 00000000 |
| a.m. p.m. | M | Check boxes for a.m., p.m. 1 alphanumeric | NN:NN Either/or rule 01:00 to 12:59 | |
| Date and hour reported to employer | M | 8 numeric (date) 5 alphanumeric (hour) | Convert "year" field to 4 numeric – ddmmyyyy Do not allow 00000000 | |
| a.m. p.m. | M | Check boxes for a.m., p.m. 1 alpha | NN:NN Either/or rule 01:00 to 12:59 | |
| 2 | Who was the accident/illness reported to? (name and position) | M | Line one – 45 alphanumeric | Minimum input is 1 character |
| O | Line two – 12 alphanumeric | |||
| 3 | Was the accident/illness: | M | Check boxes for: Sudden specific event/occurrence, Gradually occurring over time, Occupational disease, Fatality 1 alpha | Either/or rule |
| 4 | Type of accident/illness: (Please check all that apply) | M | Check boxes for: Struck/caught, Overexertion, Repetition, Fire/explosion, Fall, Harmful substances/environmental, Assault, Slip/trip, Motor vehicle incident, Other | Allow more than one box to be checked |
| Other | O/M | 35 alphanumeric | Mandatory, if “Other” box checked Minimum input of 1 character required if field mandatory | |
| 5 | Area of injury (body part) - (Please check all that apply) | M | Check boxes for: Upper back, Left toe(s), | Allow more than one box to be checked |
| Other | O/M | 25 alphanumeric | Mandatory if "other" box checked. Minimum of 1 character required if field is mandatory | |
| 6 | Describe what happened to cause the accident/illness and what the worker was doing at the time | M | 600 alphanumeric | Minimum of 1 character required. 6 lines @ 86 alphanumeric characters, and 1 line @ 84 alphanumeric characters |
| 7 | Did the accident/illness happen on the employer's premises (owned, leased or maintained)? | M | Check boxes: Yes, No | Either/or rule |
| Specify where (shop floor, ware-house, client/ customer site, park-ing lot, etc. | M | 55 alphanumeric | Minimum of 1 character required | |
| 8 | Did the accident/illness happen outside the province of Ontario? | M | Check boxes: Yes, No | Either/or rule |
| If yes, where (city, province/state, country) | O/M | 55 alphanumeric | Mandatory, if "Yes" box checked Minimum of 1 character required if field mandatory | |
| 9 | Are you aware of any witnesses or other employees involved in this accident/illness? | M | Check boxes: Yes, No | Either/or rule |
| If yes, provide name(s), posi-tion(s), and work phone numbers. | O/M | 200 alphanumeric | (Two fields of 100 alphanumeric characters per field) 1st line mandatory if "Yes" box checked Minimum of 1 character required in 1st field | |
| 10 | Was any individual, who does not work for your firm, partially or totally responsible for this accident/illness? | M | Check boxes: Yes, No | Either/or rule |
| If yes, please provide name and work number | M | 50 alphanumeric | Mandatory, if "Yes" box checked | |
| 11 | Are you aware of any prior similar or related problem, injury or condition? | M | Check boxes: Yes, No | Either/or rule |
| If yes, please explain | M | 50 alphanumeric | Mandatory, if "Yes" box checked | |
| 12 | If you have concerns about this claim, attach a written submission to this form | O | Checkbox for: submission attached 1 alpha-numeric | Note: Attachments are not within in the scope of the B2B F7 project |
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| 1 | Did the worker receive health care for this injury? | M | Check boxes: Yes, No | Either/or rule |
| If yes, when: | O/M | 8 numeric | Mandatory if yes box checked. Convert "Year" field to 4 numeric – ddmmyyyy Do not allow 00000000 | |
| 2 | When did the em-ployer learn that the worker received health care? | O/M | 8 numeric | Mandatory if "yes" box checked for Section D, question number 1 Convert "Year" field to 4 numeric - ddmmyyyy Do not allow 00000000 |
| 3 | Where was the worker treated for this injury (Please check all that apply) | M | Check boxes for: Other | Allow more than one box to be checked |
| Other | O/M | 70 alphanumeric | Mandatory if "Other" box checked. Minimum input of 1 alphanumeric character required if field is mandatory | |
| Name, ad-dress and phone number of health pro-fessional or facility who treated this worker (if known) | O | 190 alphanumeric | 1 line @ 50 alphanumeric characters per line 2 lines @ 70 alphanumeric characters per line | |
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| 1 | Please choose one of the following indicators. After the day of accident/awareness of ill-ness, this worker: | M | Check boxes for: Returned to their regular work and has not lost any time and/or earnings (complete sections G and J) Returned to modified work and has not lost any time and/or earnings (complete sections F, G, and J) - Has lost time and/or earnings (complete all remaining sections) 1 alpha | Either/or rule If section E, 1st box checked, invoke rules for sections G and J If section E, 2nd box checked, invoke rules for sections F, G and J If section E, 3rd box checked, invoke rules for sections F, G, H, I and J |
| Provide date worker first lost time | O/M | 8 numeric | Mandatory if section E, 3rd box checked. Convert "Year" field to 4 numeric - ddmmyyyy Do not allow 00000000 | |
| Date worker returned to work (if known) | O | 8 numeric | Convert "Year" field to 4 numeric - ddmmyyyy Do not allow 00000000 | |
| O/M | Check boxes for: Regular work, Modified work | If there is input in "Date worker returned to work" field, one checkbox must have input | ||
| 2 | This lost time-no lost time-modified worker information was confirmed by: | M | Check boxes for: Myself, Other | Either/or rule |
| Name | M | 35 non-numeric | Assumption is that "Myself" is the signato-ry/submitter of form 7 If, "Other" box checked, "Name" field is mandatory. | |
| Telephone | M | 13 alphanumeric | (NNN)NNN-NNNN | |
| Ext. | O | 6 numeric | N/A | |
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| No. | Input name | M | Check boxes for: Yes, No 1 alpha | Either/or rule |
| 2 | Has modified work been discussed with this worker? | M | Check boxes for: Yes, No 1 alpha | Either/or rule |
| 3 | Has modified work been offered to this worker? | M | Check boxes for: Yes, No 1 alpha | Either/or rule |
| If yes, was it | O/M | Check boxes for: Accepted, Declined 1 alpha | Either/or rule if "Yes" box checked | |
| If declined please attach a copy of the written offer given to the worker | N/A | N/A | Attachments to the form 7 are not within the scope of this project | |
| 4 | Who is responsible for arranging work-er's return to work | M | Check boxes for: Myself, Other 1 alpha | Either/or rule |
| Name | O/M | 35 non-numeric | Assumption is that "Myself" is the signatory/submitter of form 7 If "Myself" checked, "Name" field is optional If, "Other" box checked, "Name" field is man-datory | |
| Telephone | M | 13 alphanumeric | (NNN)NNN-NNNN | |
| Ext. | O | 6 numeric | NNNNNN Minimum of 1 character if field entered | |
(Section F requires mandatory input if section E, number one, box two or three checked)
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| 1 | Is this worker (please check all that apply) | M | Is this worker (please check all that apply)Check boxes for: Permanent full time, Permanent part time, Temporary full time, Temporary part time, Casual/irregular, Seasonal, Contract, Student, Unpaid/trainee, Registered apprentice, Optional insurance, Owner/operator or (Sub) contractor, Other | Allow more than one box to be checked |
| Other | O/M | 50 alphanumeric | Mandatory if "Other" box checked Minimum input of 1 character required if field mandatory | |
| 2 | Regular rate of pay $ | M | 7(2) monetary | Greater than or equal to zero and less than or equal to 99999.99 |
| Per | M | Check boxes for: Other 1 alpha | Either/or rule | |
| Other | O/M | 30 alphanumeric | Mandatory if "Other" box checked Minimum input of 1 character required if field mandatory | |
(Section G requires mandatory input if section E number one, box one, two or three checked)
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| 1 | Net claim code or amount: Federal | M | 7(2) monetary Or 2 alphanumeric | Net claim amount: Allow for 1-5 digits of integer part Allow for 0-2 digits of decimal part Decimal point is required only when there are decimal digits Decimal part, including the decimal point, is optional Net claim code: Only allow for the following values: 0, 00, 1, 01, 2, 02, 3, 03, 4, 04, 5, 05, 6, 06, 7, 07, 8, 08, 9, 09, 10, X, 0X, E, 0E The letter X and E are upper-case only. |
| Provincial | 7(2) monetary Or 2 alphanumeric | Net claim amount: The letter X and E are upper-case only. | ||
| 2 | Vacation pay - on each cheque? | M | Check boxes for Yes, No 1 alpha | Either/or rule |
| Provide percentage % | O/M | 4(2) numeric | Mandatory if yes box checked 01.00 to 99.99 | |
| 3 | Date and hour last worked | M | 8 numeric | Convert "year" field to 4 numeric - ddmmyyyy Do not allow 00000000 |
| Hour | M | 5 alphanumeric | HH:MM 01:00 to 12:59 | |
| a.m. p.m. | M | Check boxes for: a.m., p.m. 1 alpha | Either/or rule | |
| 4 | Normal working hours on last day worked From | M | 5 alphanumeric | HH:MM 01:00 to 12:59 |
| a.m. p.m. | M | Check boxes for: a.m., p.m. 1 alpha | Either/or rule | |
| To | M | 5 alphanumeric | HH:MM 01:00 to 12:59 | |
| 5 | Actual earnings for last day worked $ | M | 7(2) monetary | 0.00 to 99999.99 |
| 6 | Normal earnings for last day worked $ | M | 7(2) monetary | 0.00 to 99999.99 |
| 7 | Advances on wages: is the worker being paid while they recover? | M | Check boxes for: Yes, No 1 alpha | Either/or rule |
| If yes, indicate: | O/M | Check boxes for: Full/regular, Other | Either/or rule if "Yes" box checked | |
| Other | O/M | 25 alphanumeric | Mandatory if "Other" box checked Minimum of 1 character required if field mandatory | |
| 8 | Other Earnings (Not regular wages): Provide the total of additional earnings for each week for the four weeks before the accident/illness. *For rotational shift workers - if the shift cycle exceeds four weeks, please attach the earnings information for the last complete shift cycle prior to the date of accident/illness. | O | Input table for: Period - Week 1: From Date 8 numeric To Date 8 numeric Mandatory Overtime Pay $ 7(2) monetary Voluntary Overtime Pay $ 7(2) monetary Period - Week 2: From Date 8 numeric To Date 8 numeric Mandatory Overtime Pay $ 7(2) monetary Voluntary Overtime Pay $ 7(2) monetary Period - Week 3: From Date 8 numeric To Date 8 numeric Mandatory Overtime Pay $ 7(2) monetary Voluntary Overtime Pay $ 7(2) monetary Period - Week 4: From Date 8 numeric To Date 8 numeric Mandatory overtime pay $ 7(2) monetary Voluntary overtime pay $ 7(2) monetary | Convert "Year" field to 4 numeric – ddmmyyyy Do not allow 00000000 in date field 0.00 to 99999.99 If “From date” has input for any period, “To date” is mandatory. Period input does not have to be sequential, allow input for any period, or combinations of periods to be selected. Allow either or both “Mandatory overtime pay $” and “Voluntary overtime pay $” to be selected without selecting any other earnings columns Allow any combination of “Mandatory overtime pay $, Voluntary overtime pay % and other earnings columns to be selected |
| Use these spaces for any other earnings (Indicate commission, Differentials, Premiums, Bonus, Tips, In Lieu %, etc.) | O | Period - week 1 commission $ 7(2) monetary commission $ 7(2) monetary Commission $ 7(2) monetary commission $ 7(2) monetary period - week 2 commission $ 7(2) monetary commission $ 7(2) monetary commission $ 7(2) monetary commission $ 7(2) monetary period - week 3 commission $ 7(2) monetary commission $ 7(2) monetary commission $ | 0.00 to 99999.99 Other earnings type may be: Bonus Commission Differentials In lieu % (converted into an amount that repre-sents the percentage) Other (key in) Premiums Tips Minimum 1 and maximum 15 alpha-numeric characters if “Other (key in)” selected Allow all or any selection of other earnings type headers, i.e. combinations or duplications or duplications and combinations Selection of headers is optional If a From date and To date are provided for any of the four weeks, a value of 0.00 (zero) dollars or greater must be provided in all the "any other earnings" columns (eg. Commission, Tips, etc.) for the week specified. Spaces in these columns will not be accepted | |
(Section H requires mandatory input if section E, number one, box three checked)
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| (Complete either A, B or C. Do not include overtime shifts.) | M | Check boxes for: Regular schedule, Repeating rotational work schedule Varied or irregular work Schedule 1 alphanumeric | Either/Or rule | |
| (A) | Regular schedule - indicate normal work days and hours | O/M | Input boxes for: Sunday Monday Tuesday Wednesday Thursday Friday Saturday 4(2) | Mandatory if "(B)" or "(C)" not checked Input required in at least one day field Greater than 0 and less than or equal to 24 numeric character input |
| or, (B) | Repeating rotation shift Worker - Provide | O/M | Input boxes for: Number of days On 4(2) numeric Number of days Off 4(2) numeric Hours per shift(s) 4(2) numeric Number of weeks in cycle 4(2) numeric | All (B) fields are mandatory if "(A)" or "(C)" not checked Input of greater than 0 and less than or equal to 99.99 days, shifts and weeks required |
| Or, | Varied or irregular work | O/M | Table input fields | Mandatory if "(A)" or "(B)" not checked |
| (C) | Schedule - Provide the total number of regular hours and shifts for each week for the 4 weeks prior to the accident/illness. (Do not include overtime hours or shifts here). | Week 1: From/to dates 8 numeric Total hours worked 5(2) numeric Total shifts worked 5(2) numeric week 2: From/to dates 8 numeric Total hours worked 5(2) numeric Total shifts worked 5(2) numeric week 3: From/to dates 8 numeric Total hours worked 5(2) numeric Total shifts worked 5(2) numeric week 4: From/to dates 8 numeric Total hours worked 5(2) numeric Total shifts worked 5(2) numeric | Convert "year" field to 4 numeric - ddmmyyyy Input required of greater than 0 and less than 168.00 or equal to hours and shifts | |
(Section I requires mandatory input if section E, number one, box three checked)
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| Name of person completing this report (please print) | M | 50 alpha | Minimum input of 1 character required | |
| Official title | M | 50 alpha | Minimum input of 1 character required | |
| Signature | N/A | |||
| Telephone | M | 13 alphanumeric | (NNN)NNN-NNNN | |
| Ext | O | 6 numeric | ||
| Date ddmmyy | M | 8 numeric | Convert "year" field to 4 numeric - ddmmyyyy Do not allow 00000000 or future dates | |
(Section J requires mandatory input if section E, number one, box two or three checked)
| Label field name | ||||
|---|---|---|---|---|
| No. | Input name | Mandatory, optional, verified, selected by list | Field characteristics | Edit rules |
| Additional information | O | 3564 alphanumeric | Free form text field 44 lines @ 81 alphanumeric characters per line Minimum of one (1) alphanumeric per line of user input | |