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   eForm 6
eForm 6  

Worker’s Report of Injury/Disease

Welcome

The eForm 6 application will guide you through the process of submitting an injury/disease report. After you submit the report, you will receive a 4 digit confirmation number. There is no need to fax or mail another copy of this report once submitted online.

If you are under the age of 16 you need your parent or guardian’s signature to permit the release of your functional abilities. You may not submit online. Please use this PDF form instead.

Please note: your employer needs to be aware of your injury or illness. If you have not already reported the details of this claim to your employer, please do so as soon as possible.

Before you start, have the following information ready:

  • The valid 8-digit claim number for this injury/disease (if you have a number - if not, please leave Claim Number field blank)
  • Worker information ( i.e. name, date of birth, address)
  • Employer information ( i.e. name, address)
  • Accident/Illness details ( i.e. date of accident , area of injury)
  • Health care information ( i.e. treatment date & location)
  • Employment information ( i.e. work schedule, earnings)
  • Return to work information (i.e. modified work details)

For all eServices inquiries, including support issues, please contact 1-888-243-1569 or 416-344-4122 (TTY: 1-800-387-0050) between the hours of 7:30am to 5:00pm EST, Monday to Friday.

You will need Adobe PDF Reader to view and print the completed report.

 
 
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