Employer’s report of injury/disease (Form 7): Reference guide for businesses

Business reporting obligations

What are my reporting obligations and when should I complete Form 7?

Businesses must report a work-related injury/illness to the WSIB if they learn that an employee requires health care and/or

• is absent from regular work, or
• earns less than regular pay for regular work (e.g., working fewer hours), or
• requires modified work at less than regular pay, or
• requires modified work at regular pay for more than seven calendar days following the date of the injury/illness

You must report even if it’s unknown whether an injury/illness was caused by work. The WSIB has exclusive jurisdiction to determine “work-relatedness” and will consider the individual facts and circumstances of each injury/illness reported.

You should report injuries/illnesses when:

• an employe reports they believe the injury is work-related, regardless of whether you agree, or
• you and/or the employee are unsure if the injury is work-related

For example:

• an employee loses consciousness while working and an ambulance is called
• an employee complains of pain during their shift and leaves to get medical care

Report your employee’s injury/illness through our online services or fill out a

The WSIB must receive the complete accident report within three business days after the business learns of the reporting obligation (business days are Monday to Friday, and do not include statutory holidays). 

You must make every reasonable effort to obtain the information requested on the Form 7 and complete and submit it within three business days. If you can’t get complete information within the allotted time period, please submit the Form 7 along with an explanation of what’s missing and what’s being done to obtain it. You can also attach supporting documents if needed.

You should also provide a copy of the completed form to the employee and keep a copy for your records.

You must report the injury/illness to meet your reporting obligations even if an employee indicates they don’t want a claim established. Otherwise, you may be fined even if the WSIB determines the injury/illness wasn’t work-related. You can share any concerns you have about the injury/illness and challenge the WSIB’s decisions.

Consequences of not meeting your reporting obligations

The WSIB will charge a late reporting penalty of $250 for any injuries/illnesses reported after three business days. For injuries/illnesses reported after more than 30 calendar days, we’ll charge a penalty of $1,000. We may also charge separate $250 penalties for each of the following: 

• incomplete information
• failing to provide a copy of the completed Form 7 to the employee
• reporting on a version of this form that the WSIB hasn’t approved

We may again levy these penalties if the business fails to respond to subsequent requests for information. 

Failing to comply with this reporting obligation is an offence under the Workplace Safety and Insurance Act. Individuals may also be liable, on conviction, for a fine of up to $25,000 or up to six months in jail, or both. A corporate entity, if convicted, may be fined up to $500,000.

What does the WSIB consider health care?

Health care includes:

• services provided at hospitals and health facilities, or
• services requiring the professional skills of a health-care practitioner (e.g., doctor, nurse, dentist, chiropractor or
• physiotherapist), or 
• prescription drugs

You should also complete this report if dentures, glasses and/or artificial appliances (e.g., prosthetic arm) were damaged while being worn in a work-related accident.

What does the WSIB consider first aid?

First aid is the one-time treatment or care and any follow-up visit(s) for observation purposes only. First aid includes, but is not limited to:

• cleaning minor cuts, scrapes or scratches
• treating a minor burn
• applying a cold compress, cold pack or ice bag
• applying a splint
• changing a bandage or a dressing after a follow-up observation visit

Do I have to report first aid treatment?

You don’t need to complete this report for first-aid-only injuries handled by an in-house/work-site health-care professional or person trained in first aid.

However you must keep a record of all first aid details.

Need help completing Form 7?

Please call us at 1-800-387- 0750 if you need help completing this form. 
The Office of the Employer Adviser can also help. You can call them at 1-800-387-0774.

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1. Submitting Form 7

Please download the PDF Form 7, complete the fields and submit your completed form and supporting documents online at wsib.ca/submit.

2. Claim number

We’ll send the business the claim number once the claim is established. Please include the claim number on all pages if you already have the claim number when completing the Form 7. Write the employee’s name and claim number (if known) on all pages if you include attachments to the Form 7.

3. Employee name, claim number and social insurance number

On the top of each page, you’ll find a space to provide the employee’s legal name, social insurance number and claim number (if known). Please provide it in this space – this helps make sure the pages remain together as they’re processed.

Section A – Employee information

This information is required to establish the employee’s claim.

Job title/occupation at the time of injury/illness (don’t use abbreviations)

Input the employee’s job at the time of the injury/illness and the name of the job they were doing, even if it wasn’t their regular job.

Example:

Normally, Linda is a welder, but was temporarily working as a shipper/receiver in the warehouse when injured. In this case, you’d give the job title of shipper/receiver.

Length of time in this position while working for you

Input the length of time (in years, months or weeks) that the employee has been performing the job where they were injured.

Example:

The employee may have been employed by your firm for seven years, but, at the time of injury, they had only been doing that job for two years. So, the answer is two years.

Social insurance number

The employee’s nine-digit social insurance number is required to meet the WSIB’s reporting obligations. Requesting it is authorized under the Income Tax Act.

Please check if the employee is an:

• executive officer
• elected official
• owner, spouse or relative of the employer

This won’t apply to most employees. But these people may need optional insurance to be covered under the Workplace Safety and Insurance Act. If you’re unsure of the status, check the one you think is correct and the case manager will follow-up with you. Don’t delay sending the form even if you’re unsure.

Definitions

Executive:

• delegated the authority to act independently on behalf of the organization
• responsible for the overall direction and control of the company’s operations or financial affairs
• exercises a broad scope of authority to make decisions or formulate policies for the organization, rather than authority that’s strictly limited to a specific branch or division
• able to bind the organization

Executives may include:

• a member of the Board of Directors
  • Chair
  • Vice-Chair
  • President
  • Vice-President 
• Chief Executive Officer
• Corporate Secretary
• Treasurer
• Director
• General Manager
• Manager

Please refer to our policy on who can obtain optional insurance for more information about executive officers.

Elected official:

• elected to the position
• temporarily appointed to an elected position
• member of the governing board, either appointed or elected
• the equivalent thereof

Please refer to our policy on who can obtain optional insurance for more information about elected officials.

Owner: 

• person who’s listed as the owner/proprietor of the business

Spouse or relative of the employer;

• this person may be listed as an executive officer

Please call us at 1-800-387-0750 for more information or clarification.

Employee reference number

You might want to record the firm’s employee identification number (e.g., the employee’s payroll number) in this space. We don’t require this number – it’s here for the business’s own internal tracking purposes.

Mining companies, including contractors doing mining work, may enter the employee’s Miner’s Certificate Number here.

Employee name and address (number, street, apt./unit city/town, province, postal code), telephone

Input the employee’s last name followed by their first name, and then their current, complete home address.

Is the employee covered by a Union/Collective Agreement?

Check “yes” if the employee is a member of a recognized union/association that has a negotiated collective agreement with your firm. The name/local isn’t required; we’ll ask for it if we need it.

Employee’s preferred language

Check the language the employee prefers. We’ll provide all services in English unless you indicate the employee prefers French. Please specify the employee’s spoken language if they don’t speak English or French. We can communicate with people in many languages.

Sex

Check M (male) or F (female).

Date of birth

Give the employee’s date of birth in the following format: DD/MM/YY (e.g., 26/01/89)

Date of hire

Give the date the employee was hired at your firm. If the employee was hired in the past (e.g., seasonal or temporary worker), provide the most recent date of hire.

Section B – Business information

Trade and legal name

Input the business’s name. The trade name is the commonly used name; the legal name is what appears on legal documents. Please provide both if they’re different. This helps to establish and administer the claim, avoid delays and minimize postal errors.

Example: 

The company’s trade name is “Sam’s Pizza” and the legal name is “123456 Ontario Inc.” So, you would provide both names.

Check one:

Check either firm number or account number and input the number in the space provided.
We’ll use this number to assign the claim to the correct business. We can establish a claim using either number, but the firm number is preferred.

Definitions

Firm number

A six-to-eight-digit code (may have numbers and letters) used to identify and track accident costs for both Schedule 1 and Schedule 2 businesses and to bill Schedule 2 businesses.

For Schedule 1 businesses, this number appears on the top right corner of your premium rate summary statement or monthly statement, which you can access through our online services.

For Schedule 2 businesses, this number appears on the top left corner of your monthly statement or on the top right hand corner of their statement of account.

Account number

A seven-digit number used to identify and bill Schedule 1 businesses. This number appears on the top right corner of your premium rate summary statement or monthly statement of account, which you can access through our online services.

Many businesses have several account and/or firm numbers, depending on the type of business they conduct. Providing the correct number associated with this employee will ensure the claim is charged to the correct business and minimize problems in the future.

Mailing address, city/town, province, postal code, telephone and fax number

Input the business’s full mailing address, including the postal code. We’ll send all correspondence for this claim to this address.

Class/subclass and NAICS code

All claims will report under a class/subclass and NAICS code adapted from the North American Industry Classification system (NAICS), a standard structure by which Statistics Canada and the Canada Revenue Agency classify all businesses across Canada.

Class/subclass

Our classification structure is comprised of 35 industry classes and subclasses which contains the six-digit NAICS codes.

Example: 

Class/Subclass: G1 Description: Building construction

If your business belongs to more than one class/subclass, select the class/subclass of the business activity the person who is injured or ill was engaged in at the time of the injury/illness.

NAICS code

Your business is assigned at least one NAICS code. Some businesses may be assigned more than one. If your business has more than one NAICS code, please select the NAICS code of the business activity the person who is injured or ill was engaged in at the time of the injury/illness.

Example:

NAICS code: 236110 - Residential Building Construction

If the person who is injured or ill was engaged in an ancillary (incidental) activity (e.g., administration) and you can’t assign the work performed to a specific NAICS code, assign the NAICS code that represents the highest proportion of your annual assessable insurable earnings.

Please sign up or log in to our online services or view our Employer Classification Manual for more information about your firm number, account number, class/subclass, and NAICS codes.

Description of business activity

Please provide a brief, specific description of what your business does. For example:

• retail shoe store
• bicycle repair shop
• automotive manufacturing

Does your firm have 20 or more employees?

Please indicate if your firm employed 20 or more employees at the time of the employee’s injury/illness.

Employee’s branch address if different than mailing address (no abbreviations)

Please provide the address of the location, branch, plant or department where this employee reports if it’s different than the mailing address. This information helps us assign the claim to the correct service delivery team. Claim-related mail will not go here; it will go to the “mailing address” you provide.

You can also provide the phone number of the branch address location in the “alternate telephone” space.

Example:

The company’s head office may be in Ottawa, but the branch office/location where the employee reports is Kingston. So, give the Kingston office address here.

For construction, please give the nearest construction branch office to which the employee reports – not the actual worksite location.

Section C – Injury/illness dates and details

This section is where you’ll provide the important details about the injury/illness. We use these details to help make the initial entitlement decision on a claim. We also use this information to develop prevention strategies that will reduce workplace injuries/illnesses.

Date and hour of injury/awareness of illness

Input the date and time of the injury/illness. This might be a specific date/time (such as in the case of an incident like a trip and fall) or the date/time when the employee says they first started to notice a problem.

Date and hour reported to business

Give the date and time the employee first reported the accident/illness to a business representative. A business representative may include:

• first aid attendant or officer
• immediate supervisor or site official
• time office or dispatcher
• other business official

Who was the injury/illness reported to?

Give the name of the person the employee first reported the injury/illness to. Remember to include this individual’s position with the company as well as their phone number (including extension) if it’s different than the number provided under Section B - Business information.

Was the injury/illness:

Indicate how the injury/illness occurred.

Sudden specific event/occurrence

• a chance event is an identifiable and unintended event
  • you can see what causes the injury (e.g., falling objects, slips, trips, cuts)
  • injury is an expected result of something identifiable and unintended (e.g., a box falling from a shelf hitting and breaking employee’s arm)
• an unexpected result of working duties from particular movements (e.g., lifts, pulls, reaches, etc.) that causes sudden and noticeable pain (e.g., a warehouse picker pulling a stuck box from a shelf causing pain in the employee’s shoulder)
• a willful and intentional act by someone other than the employee that results in an injury (e.g., fights between co-workers, police officer assaulted by an individual, sales clerk assaulted by a thief during a robbery, etc.)

Gradually occurring over time

• an onset of an injury/condition that emerged over a period of time (hours, days or longer), where the employee can’t recall an exact point when the injury/condition or pain started
• no identifiable event; the employee may have started to notice pain or discomfort while performing their normal duties (e.g., full-time cashier continually scanning products with the left arm and begins to experience pain in the left elbow)

Occupational disease

Choose this option only if it’s clear there’s an occupational disease – an injury/illness in which a disease:

• results from an exposure (sudden or over time) to a substance in the workplace
• is peculiar to or characteristic of a particular industrial process, trade or occupation
• in the WSIB’s opinion, requires the employee to be removed from the workplace (temporarily or permanently) as exposure to a substance may be a precursor to an occupational disease
• is mentioned in Schedule 3 or 4 of the Workplace Safety and Insurance Act

Fatality

An injury/illness that results in the death of an employee. Please note, if you experience a workplace fatality, you must call us to report it at 1-800-387-0750, Monday to Friday, 7:30 a.m. to 6 p.m. After reporting it to us, you can then complete the Form 7 online or send us a PDF Form 7.

Type of injury/illness:

(Please check all that apply)

Check the type (or category) of injury/illness. Please check “Other” and give a description if the type of injury isn’t on the list. “Other” can be stress or mental-health related. We use this information to help create and deliver prevention programs. 

Area of injury (body part):

(Please check all that apply)

Check all the areas of injury. Please check “Other” and give a description if the area isn’t listed. Remember to include “left” or “right,” if applicable.

The areas provided are general physical locations of the body. This information is also requested on the Health Professional’s Initial Report (Form 8) and the Worker’s Report of Injury/Disease (Form 6) and will be used by the case manager in the decision-making process.

Describe what happened to cause the injury/illness and what the employee was doing at the time

Provide the details of the injury and its cause as reported by the employee. This is the “story” of what happened and why.

Please provide as much detail as possible. We’ll consider the individual facts and circumstances of each injury/illness. Providing complete details will ensure we don’t need to follow up over the phone to gather the required information.

You can use page 4 of this form or attach a separate sheet to provide more details, if necessary. Please note, any attachment to the Form 7 is considered part of the Form 7 and you must provide a copy of this to the employee.

Examples:

• the employee slipped on a wet floor, landing on their right arm
• the employee was struck in the face by debris dropped by a coworker working above them
• the employee twisted their left ankle while walking on uneven ground

If you’re not aware of a specific accident/incident that caused the injury/illness, please describe what the employee was doing, and the effort involved when the pain began, or they first noticed the disease.

Examples:

• the employee was in an awkward position when their low back began to ache
• the employee reports shoulder pain after moving to a new role with repetitive lifting
• the employee isn’t sure what caused their leg pain but believes it could be from extended walking

Include any details about the work area, materials or equipment used, other people involved or any detail you believe is important or your employee has reported.

Please attach a copy of a physical demands analysis of the work the employee was doing at the time of injury/illness if applicable. You can download the physical demands information form, along with how to complete it, from our website.

Did the injury/illness happen on the business’s premises (owned, leased or maintained)

Please check if the injury/illness occurred on property the business owns, leases or maintains. 

If yes, please indicate where on your premises the injury/illness occurred. If no, give the actual location of where it happened. The case manager may contact you for more details.

Examples:

• yes – assembly line, shop floor, warehouse storage area, parking lot
• no – delivery driver making a delivery to a restaurant slips on greasy kitchen floor; provide the name of the restaurant

Did the injury/illness happen outside of Ontario?

Check “yes” if the injury/illness occurred outside of Ontario. If yes, the employee may have the choice of claiming benefits in Ontario or where the injury/illness happened.

If claiming in Ontario, the employee must sign an election form. This question prompts us to send an election form to the employee at the time of claim registration, avoiding potential delays. Although a claim can be established, we can’t make a decision until we’ve received and approved the election form. The employee has three months from the day of the injury/illness to submit the election form.

Example: 

An Ontario truck driver has a motor vehicle incident in Alberta. The employee has the choice of claiming benefits in Alberta or Ontario and uses the election form to indicate that choice.

Are you aware of any witnesses or other employees involved in this injury/illness?

Check yes if:

• anyone saw what happened
• other employees were involved in the injury/illness
• anyone has knowledge of the injury/illness

If yes, give the name(s), position(s) and work phone number(s) in the space provided.
For injuries that occurred gradually over time, it might be helpful to provide the names of employees who may be aware of the person who is injured or ill’s condition. We may need to speak with them as part of the claim decision-making process.

Was an individual who doesn’t work for your firm partially or totally responsible for this injury/illness?

Check “yes” if any individual(s) not employed by your firm had any part in this employee’s injury/illness. If yes, write their name(s) and work phone number(s) in the space provided. We may need to speak with them as part of the claim decision-making process.

We’ll investigate and review if we should transfer the costs associated with this claim, either in whole or in part, from your firm to the other responsible party.

Example:

John is making a delivery of produce at Joe’s Fast Food Restaurant. John slips due to grease on the restaurant kitchen’s floor, injuring his right ankle. Joe’s Fast  Food Restaurant may be responsible for all or part of the costs associated with John’s claim. (This only applies to Schedule 1 businesses.)

Are you aware of any prior similar or related problems, injuries or conditions?

Check “yes” if you’re aware that this employee has had prior similar problems, injuries or conditions that may be related or contributing to their current reported injury/condition. Write a brief outline of what you believe these prior problems, injuries or conditions are in the space provided.

We may investigate further to determine if the these have any impact on the employee’s present problems. You can use page 4 of the form or attach a separate sheet if you need more space.

Attach a written submission to this form if you have concerns about this claim

Please attach a separate submission to the Form 7 and check if you (the business) have concerns about the injury/illness. Any attachments to the Form 7 are considered part of the Form 7, so you should provide copies to the employee. If you’re objecting to the claim, please provide a description or attachment explaining why you object.

Please include the employee’s name and Social Insurance Number or the claim number (if available) on all attached pages.

Provide supporting information if you have reason to doubt this claim. We’ll investigate further before making a decision. We’ll make a decision with the existing information on file if you don’t provide supporting information about why you doubt the claim.

Section D – Health care

The employee has the right to make the initial choice of health professional. A health-care professional includes a chiropractor, physician, physiotherapist, registered nurse (extended class) or dentist. Please read our Choice and change of health professional policy for more information.

The business is responsible for transporting the person who is injured or ill (if needed) to a facility for health care or treatment at the time of the injury/illness. The business is also responsible for paying the cost of transportation (e.g., ambulance, taxi, etc.).

Did the employee receive health care for this injury?

Check “yes” if the employee received health care because of the injury/illness. If yes, please indicate the date of the health care, including any health care the employee received at the worksite.

Please don’t confuse this with first aid. First aid refers to any care an employee receives that a trained first aider could provide (e.g., washing a wound, applying a dressing, etc.), even if done by an in-house health professional. The business doesn’t need to complete and send a Form 7 if the injury only requires first aid. However, all businesses covered by the Workplace Safety and Insurance Act must keep a record of any first aid administered.

Health care refers to professional services provided by any of the following registered health-care professionals:

• chiropractor
• physician
• physiotherapist
• registered nurse (extended class)
• dentist

The employee can receive health care from a hospital, other facility (emergency department, walk-in clinic, health-care professional’s office, etc.) or the worksite. The business must complete and submit a Form 7 if the employee needs health care.

The business should make every reasonable effort possible to obtain this information. If it’s not possible to get this information, please provide an explanation of what’s being done to get it.

When did the business learn that the employee received health care?

Input the date when the business was first advised, or made aware, that the employee received health care for the reported injury/illness.

Where did the employee receive treatment?

If known, check the place(s) where the employee received health care for their injury/illness. Please check all that may apply.

Definitions

On-site health care

Any health care provided at the workplace or worksite where the injury/illness happened. Please note, this doesn’t include first aid.

Ambulance

Calling an ambulance could indicate how serious the injury/illness is and will trigger special attention by the WSIB. The business is responsible for paying the cost of an ambulance if one is called on the day of the injury/illness.

Emergency department

Health care may be provided within a hospital or a specialized emergency facility outside of a hospital. Please give the name and location of the hospital or emergency facility.

Admitted to hospital

The employee may have been admitted to a hospital for an overnight stay. This could indicate how serious the injury/illness is and will trigger special attention by the WSIB. Please give the name and location of the hospital.

Health-care professional office

A health-care professional’s independent office. 

Clinic

A walk-in clinic or a facility where several health-care professionals provide health care. The clinic may be a multi-disciplinary clinic with several different types of health-care professionals.

Other

Please indicate if the employee sought health care from anyone not listed above (e.g., nursing station).

Name, address and phone number of health-care professional or facility who treated this employee

Please print the name and contact details of the professional or facility who provided the employee with health care, if known.

Section E – Lost time – no lost time

The business is responsible for paying the employee’s full wages for the day of the injury/illness. Following that day, the business must report any lost time or reduction in wages that results from the injury/illness. The employee may be entitled to receive loss-of-earnings benefits.

Please choose one of the following indicators

You must choose one of the options and complete the remainder of the form as indicated.

After the day of the injury/awareness of the illness, this employee:

1. Returned to their regular job and hasn’t lost any time and/or earnings (complete sections G and J).

• employee has returned and continued to do their regular job/work duties without any changes or accommodations after the day of the injury/illness
• employee hasn’t lost any time from work beyond the day of the injury/illness and there’s no reduction or change in wages or earnings

2. Returned to modified work and hasn’t lost any time and/or earnings (complete sections F, G and J).

• employee has returned to work after the day of the injury/illness, but needed changes or accommodations to the work or the workplace in order to do so
• employee may be continuing with modified work or, following a period of modified work, is now back to their regular job/work duties
• employee hasn’t lost any time from work beyond the day of the injury/illness and there’s no reduction or change in wages or earnings
• also includes any temporary changes, alterations or modifications to the employee’s shifts or schedule

Examples:

• a warehouse employee sustains a shoulder injury and returns to work with no above-shoulder level work for one week
• a delivery driver returns to work with no driving for two days, and then resumes regular driving duties

3. Has lost time and/or earnings (complete all remaining sections).

Please check this box if any of the following apply:

• employee is absent from work beyond the day of the injury/illness
  • absence may be for part of a day, an entire day or more
  • includes an absence for a medical appointment or health-care treatment for the injury
  • employee may have returned to work after the absence
• employee has experienced a reduction in earnings
  • reduction may be the result of working at a lower paying job, losing a shift premium or production bonus, or other similar circumstances
• employee is losing time from work, but the business continues to pay them 
  employee returned to work, but couldn’t continue

Please provide the date the employee first lost time and/or earnings. If you’re not sure if this employee will lose time or earnings, you should make every reasonable effort to obtain this information. If you can’t get this information, please provide an explanation of what’s being done to get it.

Please provide the return-to-work date if the employee returned to work before the Form 7 was submitted. Indicate if they returned to regular work or modified work.

Confirm the lost time or no lost time modified work information

In many situations, the person completing the Form 7 may not have direct or first-hand knowledge of the injury/illness, lost time/no lost time claim or return-to-work information. Please provide the name of the person who supplied this information. We may need to contact them for further clarification.

Section F – Return to work

An employee may have work or task limitations because of the work-related injury/illness. You’ll need to be aware of those work/task limitations to help get the employee back to work safely. You can use this information to set up modified work that accommodates the employee’s limitations.

You can download a copy of our Functional Abilities Form and give it to the employee to get work/task limitations. Ask the employee to have their health-care professional complete it and return a copy to you.

You can also get work/task limitations by:

• using your own return-to-work form, or
• through a medical/clinical note or report from the health-care professional

Please note: We’ll only pay for completion of our Functional Abilities Form. The business is responsible for paying for any other business-supplied forms.

Do you have work limitations for this employee’s injury?

The employee might have work/task limitations due to the injury/illness after receiving health care. Please check if you’ve received any limitations for the employee and attach them to the Form 7.

If no work/task limitations are available, please discuss how to get the work/task limitations with the employee and any other concerns they might have about return to work.

Please visit our website or call us at 1-800-387-0750, Monday to Friday, 7:30 a.m. to 6 p.m., if you need more help on return to work.

Have you discussed modified work with the employee?

Check “yes” if you’ve discussed return to work with the employee. This discussion can include any work/task limitations, job duties, accommodations or other options to facilitate return to work. It should become clear if return to work is possible based on the discussion.

You should arrange a discussion about return to work with the employee if a discussion about this hasn’t happened. You should also review what work you may have available and what changes you can make to the employee’s duties to accommodate return to work.

Have you offered modified work to this employee?

Check “yes” if you have offered modified work to the employee. This offer should be specific, and everyone should clearly understand all details. If yes, check to indicate the outcome of the return to work.

Please give the employee and the WSIB a written copy of the return-to-work offer if the employee declined it.

You don’t have to provide a written copy, but it’s a recommended best practice. A written offer establishes and documents what you offered the employee. You should be able to demonstrate that the employee received a copy of the written offer. Giving us a copy gives the case manager a clear idea of the modified work offered and helps with further decision-making.

Please contact your case manager if you run into difficulties in the return-to-work process.

Who’s responsible for arranging the employee’s return to work?

In many situations, the person completing the Form 7 may not be directly responsible for arranging the employee’s return to work. The case manager must be able to contact the person responsible for arranging the return to work if problems come up during  
the return-to-work process to prevent potential delays.

Please give the name and phone number (if different from the phone number in Section B) of the person responsible for setting up the return to work.

If the person responsible for setting up the return to work is an external consultant or representative, please provide a Direction of Authorization form and the written authorization of representation for them to act on the business’s behalf.

Section G – Base wage/employment information

We ask for base wage/employment information for all claims. The employee’s employment type and basic rate of pay should be readily available.

For no lost time claims, we don’t expect the business to make elaborate calculations (e.g., commission sales, piecework) regarding rate of pay. For lost time claims, we expect the complete rate of pay information. Please read our No lost time and Lost time claims policies for more information.

When a claim changes from no lost time to lost time, getting the employee’s complete earnings information may take time. This change of claim status may happen several weeks, months or years after the claim is originally allowed. The case manager must be able to issue payment in these claims. The employee’s employment type and basic rate of pay can be used to pay benefits on a temporary basis until the business can give us the complete earnings information.

Employee’s employment status

(Please check all that apply)

Indicate the injured or ill person’s employment status by checking the appropriate box(es). They may have more than one status.

Your employee might also work for another employer. If this is the case, please check the “Other” box and explain.

Examples:

The person who is injured or ill may be a:

• permanent full-time employee
• temporary full-time employee on a contract
• permanent full-time employee who is a registered apprentice

Definitions

Permanent, full-time or part-time (also known as “regular”) employee

An employee who:

• was hired to work 52 weeks a year with no seasonal or cyclical layoffs
• has no set termination date
• typically works a set number of hours per week

Examples:

Permanent full-time:

Bob has worked continuously for over 10 years for the ACME Company, Monday to Friday, 40 hours per week.

Permanent part-time:

Jane has been a cashier with The A & B Supermarket Ltd. for the past seven years, normally scheduled to work 15 hours per week.

Please note: An employee who has permanent employment, whose earnings vary from day-to-day or week-to-week due to irregular hours or method of payment, is also considered to be a permanent employee with “irregular” earnings.

Temporary full-time or part-time

This is an employee who works a set number of hours per week and:

• is hired for a specific period of time, or
• has a termination notice (e.g., contract), or
• is hired for a temporary period through a union hall, or
• has no guarantee of ongoing employment

Temporary employees may include temporary agency employees (employees who work for an agency through which they are hired by other businesses).

Examples:

Temporary full-time – Judy is hired as a full-time executive assistant for a one-year period to cover for an employee on maternity leave.

Temporary part-time – Jasper has been hired to work as a security guard for four hours per day for a one-time special event (e.g., three-day music festival).

Casual/irregular

When an employee has no set schedule or hours of work. This also includes “on-call” employees.

Example: Sara works as a waitress for Black’s Bar. There’s no set schedule for her work and she only knows her upcoming hours and shifts from week-to-week. There’s no minimum guarantee of hours.

Seasonal

Seasonal, or cyclical employees, are employees hired to work for certain times of the year and with periods of layoff expected.

Example: Martin is hired to work at a large amusement park for the summer season only.

Contract

This is when an employee is hired to work at a specific job at a specific rate of pay, usually for a specific period of time.

Example:

Terry has been hired on a three-month contract to work as a data entry operator for 24 hours a week to clear-up a backlog of invoices.

Student

A student is defined as:

• a community college student
• a high school student
• a night school student
• a university student

Secondary school students who are registered in Ministry of Education work education programs and are placed with a business (placement host) to gain practical work experience, and who aren’t paid by the placement host, get WSIB coverage during their placement. The Ministry of Education provides coverage. These students, also referred to as pupils, are deemed to be employees under the Education Act.

Examples:

• Simone is a college student working part-time after school at a local restaurant
• Adrian is a high school student in a co-op program at a local museum

Please read our Pupils in work education programs policy for more information.

Unpaid/trainees

People placed by a training agency (e.g., Goodwill, March of Dimes) with a host business to obtain skills and experience, but who aren’t paid by that business, are called unpaid trainees and/or learners. Although not under a contract of service or apprenticeship, they’re considered employees and are entitled to benefits if they experience a work-related injury/illness.

The host business is responsible for reporting an injury/illness to us. When reporting, use the entry-level pay for the job being done. The host business isn’t responsible for the costs associated with the claim.

Example:

The Ontario Works Program placed Anthony, who has a learning disability, with a local repair shop to gain experience in small engine repair.

Registered apprentice

An apprentice is a person registered under the Trades Qualification and Apprenticeship Act (specified construction trades) or the Apprenticeship and Certification Act (all other trades), who has signed a contract of apprenticeship for training and instruction in a trade, through or from a business.

Please provide the “Registered Apprentice Number” in the space next to “Other.”

Example:

Frank is an apprentice stone mason at ABC Masonry Ltd.

Optional insurance

Check this box to indicate if the person who is injured or ill has optional insurance coverage.

The following people can apply for optional insurance:

• owner/operators (as previously defined)
• executive officials
• elected officials

Example:

Meileen is a physician who has her own practice and has applied for optional insurance coverage.

Please read our optional insurance policy for more information.

Owner-operator or (sub) contractor

Check this box if the following situation applies to you:

1. You’re considered an owner-operator of a business if you’re a(n):

• independent operator
• sole proprietor
• partner in a partnership

You may apply for optional insurance coverage under the Workplace Safety and Insurance Act.

or

2. You’re contracted or commissioned to do work and perform the work personally.

• you’re encouraged to obtain a ruling if either party consider the work arrangements to be that of a purchaser/independent operator relationship

We reserve the authority to determine, on a case-by-case basis, whether the person is an employee, an owner-operator, (sub)contractor or independent operator.

Please call us at 1-800-387-0750 if you need help with this.

Regular rate of pay

Provide the employee’s normal/regular gross rate of pay at the time of the injury/illness. This shouldn’t include any bonuses, premiums, differentials, etc.

Examples:

• $16.00 per hour
• $100.00 per day
• $450.00 per week
• $35,000 per year

We don’t expect the business to make any calculations if the rate of pay is difficult to provide (e.g., commission sales, piecework, etc.) and there’s no lost time or lost pay after the day of the injury/illness. Instead, please describe the type of pay in the “Other” space and include any base pay, if applicable.

Example:

Other – $7.15 per hour + five per cent commission on sales

Section H – Additional wage information

A person who becomes injured or ill at work may be entitled to a loss-of-earnings benefit. We need complete and accurate earnings information to calculate loss-of-earnings.

In certain cases, the benefit rate is recalculated at the thirteenth week to ensure the employee’s long-term earnings are more fairly reflected (e.g., profit sharing, yearly bonuses, vacation accrual). Please read more about our average earnings policies for more information.

We’ve designed this section to allow most businesses to give wage information. However, we understand there are unique situations that can’t be accommodated here. Those businesses should contact the case manager directly to give the required wage information.

Net claim code or amount

We need the federal and provincial “net claim for exemption” or “net claim code” to calculate the employee’s benefit rate. Please provide the amount or the code in each space provided. You can use “01” as a default “net claim code” if you’re unsure what the employee’s net claim code is.

Vacation pay

Check whether vacation pay is provided on each pay cheque and provide the actual percentage.

Vacation pay issued on each cheque will be included in calculating the employee’s benefit.

We’ll use the information requested in questions 3-6 to determine when to start paying the employee’s loss-of-earnings benefit.

Please note: The business is responsible for full wages on the day of the injury/illness. WSIB benefit payments may begin after that day.

Advances on wages

Check whether you’re continuing to pay the employee all or part of their salary when they may be entitled to WSIB benefits.

Indicate “full/regular” when you continue the employee’s full salary, or “other” when you:

• continue a percentage of the employee’s regular salary
• give a loan or lump sum advance
• have any other arrangement

In cases where the business provides advances, we’ll redirect benefit entitlement to that business at the rate we’d normally pay the employee, if lost time is allowed.

Other earnings (not regular wages)

Provide the total of additional earnings that line up with your pay periods that represent four full weeks immediately before the injury/illness. Please indicate if the employee took any time off due to vacation or illness during those four weeks. An employee may have additional earnings on top of their regular rate of pay (provided in section G – Question 2). These additional earnings could be:

• overtime pay (mandatory and/or voluntary)
• premiums
• commissions
• bonuses
• differentials
• tips and gratuities
• room and board
• in-lieu of payments

Please read our Determining short-term average earnings policy for a complete list of allowable earnings.

We may include these additional earnings, along with the regular rate of pay, when calculating an employee’s benefit rate.

The “other earnings” chart will help the business provide any additional earnings information based on the pay periods that represent four full weeks immediately before the injury/illness. Please provide the “from date” and “to date” for each week.

There are six columns – two for overtime and four for other earnings. You can use the untitled columns to capture types of earnings, such as:

• premiums
• bonuses
• commissions
• tips and gratuities 

Please provide the total weekly gross amount for each type of earning you indicate.

Definitions

Mandatory overtime:

Hours of work, in addition to regularly scheduled work hours, that the employee can’t refuse.

Voluntary overtime:

Hours of work, in addition to regularly scheduled work hours, where the employee has the option of working the overtime.

Example:

Dennis normally earns $12.58 per hour, working 37.5 hours per week, Monday to Friday. However, before the date of the injury/illness (May 2, 2005), Dennis worked mandatory overtime of six hours per week for two of the four weeks ($18.87 per hour for the weeks of April 4 and 18), and received an evening premium of $1.25 per hour for 20 hours (week of April 11). 

Please refer to the chart to see how to complete this earnings situation.

Rotational shift employee: An employee with a permanent shift schedule, with workdays that vary each week based on a specific rotation.

A rotational shift employee may have a shift schedule in which the complete shift rotation may exceed the four weeks as provided for in the chart. Please provide the employee’s complete earnings for the entire shift rotation before the injury/illness on a separate sheet attached to the Form 7 if this is the case.

Please attach the earnings information for the last complete shift cycle before the date of injury/illness if the shift cycle exceeds four weeks.

Section I – Work schedule

A. Regular schedule – indicate normal workdays and hours

Provide the employee’s normal schedule if they have a regularly established work pattern. Please ensure the number of hours you report is the same as the number of hours the employee is paid per day.

Examples:

The employee regularly works Monday to Friday, 7.5 hours per day, 37.50 hours per week.

The employee works weekends only, Friday to Sunday, 12 hours per day, 36 hours per week.

B. Repeating rotational shift employee

Please provide the employee’s shift rotation if it repeats according to a set schedule. If the rotation can’t be captured by this design, please provide the rotation pattern on a separate sheet attached the Form 7.

Example:

C. Varied or irregular work schedule

Please provide the total number of regular hours and shifts that line up with your pay periods that represent four full weeks immediately before the injury/illness (don’t include overtime hours or shifts here).

A varied or irregular work schedule means the employee’s schedule changes from day-to-day, week-to-week, etc. For  the  pay periods that represent four full weeks immediately before the injury/illness, please provide the “from/to dates,” the “total hours worked” and the “total shifts worked” each week (don’t include overtime here).

Examples:

Bruce is a casual/irregular employee (custodian) who only reports for work when called. For the date of accident of May 2, 2005, the chart may appear as follows:

Charmaine works as a permanent retail store sales clerk part-time 20-24 hours per week, but the days/hours worked per week always change. For the date of accident of May 2, 2005, the chart may appear as follows:

Section J – Business declaration

The person completing this report on behalf of the business should provide their name and contact information here. They must sign the form to indicate the information provided on each page is true. We may contact this person to confirm or clarify information on the Form 7 and get any missing or additional information.