Skip to Main Content Change text size Welcome Log In Exit  
WSIB Logo
Help for eForm 6 - worker’s report of injury - WSIB

Form 6 (worker’s report of injury)

Welcome

Our eForm 6 application offers a convenient and secure way to submit injury/disease report and meet your reporting obligations in a timely way.

Benefits of submitting online

You will:

  • automatically receive a four digit confirmation number, and the time and date we received the report
  • have an opportunity to view, save or print the submitted form in PDF format
  • avoid having to submit a paper copy.

System Requirements

The eForm 7 application is supported in the following configuration:

  • Microsoft Internet Explorer version 6.0 or higher
  • Adobe Acrobat Reader version 6.0 or higher
  • 1024 ×768 screen resolution

What To Do If You Have An Accident at Work

What do I do if I get hurt or sick at work?

A worker who is injured at work or becomes sick because of his/her job should:

  1. Get first aid immediately, or health care if needed.
  2. Tell your employer about the accident or illness as soon as possible.

How is the injury reported to the Workplace Safety and Insurance Board (WSIB)?

Your employer is responsible, by law, to report the accident or illness to the WSIB. That is why it is important to tell your supervisor about the incident or illness. The employer must complete and submit a special WSIB form called the Employer’s Report of Injury/Disease (Form 7). There is a time limit for them to report so it is important for you to let the employer know as quickly as possible.

The employer is also required to do the following:

  • pay you full wages for the day or shift the accident/illness occurred, and
  • arrange and pay for transportation (on the day of accident) to get you to health care, if needed, and
  • give you a copy of the Employer’s Report of Injury/Disease (Form 7) once it is completed.

When can I make a claim for WSIB benefits?

As a worker, you can claim benefits for a work-related accident or illness if you have:

  • received health care, and
  • lost time or wages from work beyond the day of accident/illness, or
  • continued to work but on partial hours only.

If you had to do different work due to the accident/illness for more than seven days and did not see a health professional, you can also make a claim.

There is a time limit for you to report. It is important to claim benefits as soon as possible. You have six months from the date of the accident to claim benefits or, for occupational diseases, from the time you learn of the disease.

Do I always have to claim?

You do not have to make a claim if all four of the following apply:

  • only first aid treatment was needed, and
  • you did not take any time off work, and
  • your pay was not affected, and
  • your job duties did not change.

How do I make a claim if I do not think my employer has reported the accident/illness?

A worker can make a claim by calling the WSIB General Number Toll Free at 1-800-387-0750 or (416) 344-1000 and ask for assistance. One of our representatives can help you.

A worker should also do one of the following:

  • submit a Worker’s Report of Injury/Disease (Form 6) or
  • tell the health professional (chiropractor, dentist, physician, physiotherapist or registered nurse extended class) who first treats you that the accident/illness is work-related so they can complete and submit a Health Professional’s Report (Form 8), or
  • visit your local WSIB Office to report in person,or
  • contact your employer, or
  • if you have a union, ask them for help.

What do WSIB benefits cover?

If you have an accident/illness at work, you may be entitled to WSIB insurance benefits. The WSIB insurance benefits may pay for:

  • health care to treat the injury/illness (for example – physiotherapy, chiropractic treatment, etc…)
  • medications prescribed for your injury/illness and
  • temporary income (wages lost while recovering).

Please note: If your claim is approved, the wage loss benefit pays you for time missed beginning after the day of accident/illness. Your employer must pay your full wages for the day of accident/illness.

What if I have to go to a health professional or hospital because of the accident/illness?

  1. Tell the person treating you that the injury happened at work.
  2. If you are ill and you think it was caused by something at work, tell the person treating you:
    • when you first noticed the symptoms
    • what the work conditions are and how long you have worked in these conditions.
  3. The person treating you needs to complete a WSIB report (Health Professional’s Report – Form 8) and send it to the WSIB. On the form there are places for you to give information about yourself and your employer.

What about returning to work?

It may be possible for you to return to work while you are in treatment and recovering. To help in returning to work, you need to:

  1. Participate fully in your treatment plan
  2. Talk to your health professional about your progress in treatment and about returning to work
  3. Stay in contact with your employer and keep them up-to-date on your progress and
  4. Talk with your employer about ways you can return to work early and safely. This may include:
    • making temporary changes to your regular job
    • doing different work
    • working shorter or different hours or
    • any other options you and your employer may come up with.

What to do if you think the WSIB has not been notified?

We can tell you if the accident/illness was reported or help establish a claim. Call us directly Toll Free at 1-800-387-0750 or (416) 344-1000. If you are hearing impaired call TTY 1-800-387-0050.

When should I claim?

It is important to claim benefits as soon as possible. You have six months from the date of the accident to claim benefits or, for occupational diseases, from the start of the illness.

Getting Started

To use eForm 6 you will have to:

  • Know the claim number associated with your current injury/disease
  • Be 16 years of age or older
  • Ensure you have all the required injury/disease information to complete the report.
  • Log into the system by entering your current claim number and your date of birth.

About Login

To log in, enter your current claim number and date of birth in the fields provided, then select Login

You may see the following errors when trying to log into eForm 6:

  • ‘If you are under the age of 16, you must submit your Form 6 via a hard copy (paper) submission, along with your parent or guardian authorization to release functional abilities information. Please use this PDF form to submit’. If you are under age 16 you need your parent or guardian’s signature to permit the release of your functional abilities. You may not submit online.
  • ‘Your claim number and/or date of birth was invalid’. You have entered the numbers incorrectly—check the numbers and try again. Or, you have not entered a valid claim number or date of birth—if your claim is older than one year from the date of registration, send us your report via fax or mail.

Who do I call for help?

If you need more assistance, please contact the WSIB at 416-344-2242 in the Toronto area or 1-866-542-9742 outside of Toronto weekdays between the hours of 8:30 a.m. to 4:30 p.m.

Start

Start a new report of injury/disease

To start a new report of injury/disease, select Create a new report. This will bring you to the first section of the report Worker Information.

Save your work in progress

If you are unable to complete the entire form in one session, you can save your work in progress. To do this, select the save button located at the bottom of each page. The system will prompt you to choose where to save the document on your computer or network.

Due to the sensitive nature of the information contained within this form it is advisable that you save this file in a secure location.

Caution: Saving a PDF version of your submitted Form 6 on a public computer may allow others to view your personal information.

Open a saved report

To open a report that you have previously saved, select Browse and locate the previously saved file, select the appropriate file and then select open this report. Your report will open with all of the saved data you entered into the report, so you may continue with your submission.

Worker Information

This information is important to set up your claim accurately. Please make sure all information is complete and correct. Incorrect information may cause delays in handling your claim. Include your:

  • full name
  • complete mailing address
  • phone number
  • date of birth and
  • Social Insurance Number

Date you started with employer

Give us the date that you started to work with your employer. If you worked for them in the past, (you may be a temporary or seasonal worker), give us the most recent (latest) date that you started to work with this employer.

How long have you been doing this job for this employer?

Give the length of time (in years, months, weeks or days) that you have been doing the job that you were hurt at.

Example: You have worked for ABC Company for six years, first as shipper/receiver for two years, then as warehouse lead hand for one year, then as warehouse manager for three years. You were the manager when injured, so put the length of time you have been the manager (three years).

Would an interpreter be useful?

  • Yes
  • No

The WSIB provides translation and interpretation services in several languages to help you communicate with WSIB staff. The service is at no cost to you. To ask for help in another language call 1-800-465-5606.

Do you authorize your union to represent you in this claim?

  • Yes
  • No

If you are a member of a union, you may want to contact them to help you with this claim. If you do, select yes here.

If yes, do you consent to the disclosure of verbal claim file status information to your union representative?

  • Yes
  • No

This means you agree to let the WSIB talk about your claim with your union representative. If you do want your union to help you with this claim, select yes here so we can talk to them about the status of your claim. If your union representative wants access to written material in your claim, they must send us written authorization that you have chosen them to represent you.

If you choose a representative who is not from your union, you will need to provide written authorization for the exchange of any information. You can fax your authorization to 416-344-4684 in the local Toronto dialing area or 1-888-313-7373 toll-free. If you are unable to fax the information, mail it to the address below. Ensure that you include your name and claim number on every page that you send.

Mailing address:

Claim Information
Workplace Safety & Insurance Board
200 Front Street West
Toronto ON M5V 3J1

Employer Information

This section provides us with information about your employer. We will use this information to process your claim and contact your employer if necessary. If you need to, check your pay stub for the correct employer information, including the full company name.

If you work for a temporary employment agency, in this section please give us the name of the agency who sent you to the job, not the name of the worksite employer. You can give us the location information in the next section.

Accident-Illness Dates and Details

This section provides us with the details about your accident/illness.

Date and hour of accident/awareness of illness

If the accident happened suddenly (for example—you slipped on wet floor and twisted your left ankle), give us the date and time the accident occurred.

If the accident did not happen suddenly, but your injury occurred over a period of time (for example—as a cashier, you developed tennis elbow because of scanning groceries) give us the approximate date you first started to notice it.

Date and hour reported to employer

Give us the date and time you first told your employer about the injury/illness. Remember it is important to let them know right away.

Who did you report this accident/illness to? (Name, Position and Telephone number)

You should report your accident/illness, as soon as possible, to your employer. This should be your supervisor, manager, company nurse, or other person your employer has specified. Give the name, position and telephone number of that person.

Area of Injury (Body Part)(Please select all that apply)

Select all of the body parts you may have hurt as a result of this accident/illness. If it is not listed here, select Other and provide us with a written description in the field provided.

Make sure you select if you are left-handed or right-handed as this information can be helpful in getting you back to work.

Did the accident/illness happen on the employer’s property or work site?

  • Yes
  • No
  • Specify where it happened (shop floor, warehouse, client/customer site, parking lot, etc.)

Your accident/illness may or may not have happened on your employer’s property or worksite. If it did, select yes and tell us where it happened on the premises (for example—shipping area, paint shop, assembly line three, etc.)

If no, please tell us the location.

Examples:

  • You work for a cleaning company and are assigned to do cleaning work at a large retail store, where the injury happened—name that store and its location.
  • You work away from a central office/area and are visiting a client site—name the client site and location.
  • You work for a temporary employment agency—name the company where you are placed.

Did it happen outside the Province of Ontario?

  • Yes
  • No
  • If yes, indicate where (city, province/state, country)

Select yes if the accident/illness occurred outside of Ontario. If yes, you may have the choice of claiming benefits either in Ontario or in that other jurisdiction.

The answer yes will prompt the WSIB to send you a form, so you can choose where you want to claim benefits. This is called an election form and it will help avoid potential delays. If you are claiming benefits in Ontario you must indicate this on the election form. Without this information, we can establish a claim but we cannot make any decision about benefits until we receive and approve the election form. You have three months from the date of issue to submit the election form.

Example: A truck driver who lives in Ontario but travels across provincial borders has a motor vehicle incident in Manitoba. The worker has the choice to claim in Manitoba or Ontario.

Have you hurt this/these area(s) of your body before?

  • Yes
  • No

Select yes if you have hurt an area of your body before. It does not mean that we will deny your claim, but it will help us find earlier records that may assist with processing your claim. As well, it may reduce the costs of the claim for your current employer.

Do you have any prior related WSIB/WCB claims?

  • No
  • Yes—In Ontario
  • Yes—Outside Ontario

Select yes if you have had a prior claim, in Ontario or elsewhere, for the same area of injury. This helps us to determine if this may be a re-injury under that prior claim.

If you had a sudden type of accident/illness, describe your injury…

Give us the full details of how the accident/illness happened and specifically what you were doing at the time. Be sure to include details like:

  • sizes, weights and names of any objects involved,
  • a description of any machinery, tools or vehicles used at the time of accident/illness,
  • any environmental conditions (work area, temperature, noise, chemicals, gas, fumes, other person) or
  • any other information you think is important.

Example: I was moving boxes in the storage room. I lifted a 40 lb box from the floor to place on a shelf. I twisted to the right while lifting, and hurt my upper back.

OR

If you had a gradual onset type of injury, describe your injury…

If your injury/illness developed over a period of time, please provide a detailed description of the work you do. Give details about the:

  • frequency of activities (how often you do this task)
  • the sizes and weights involved
  • how long you have been doing this work
  • if there are any recent changes to the work or the workplace
  • any changes to your work schedule and
  • tools or products you use to do this work.

Example: I am a cashier. I continually scan products for my entire six-hour shift using my left arm. The products weigh from a few ounces to up to 10 lbs. The belt has been malfunctioning over the past three weeks forcing me to reach further that I usually do for the products. I recently started to experience pain in my left elbow.

If you run out of room in the space provided please follow these instructions

When did you first start to have problems with this injury/condition?

WSIB may use this information to help determine a day of accident/illness, especially for injuries that have developed over a period of time.

If you did not report this to your employer right away, please tell us the reason why.

You should report accidents/illnesses right away. There may be a reason why you did not report right away and we need to know the reason.

If there were any witnesses to your accident…

This information is used to get a fuller understanding of the accident/illness. Provide the names and positions of any coworkers that you told about the accident, the pain you feel, or who may have seen what happened. The WSIB may need to contact them for further information.

The Workplace Safety and Insurance Act requires your employer to give you a copy of the Employer’s Report of Injury/Disease (Form 7). Did you receive a copy of the Form 7?

  • Yes
  • No

You should have received a copy of the Employer’s Report of Injury/Disease (Form 7) from your employer. If you did not, ask them for your copy. The Workplace Safety and Insurance Act requires you to give a copy of this report (Worker’s Report of Injury/Disease—Form 6) to your employer.

Just like your employer must provide you with a copy of their report, you are also required to give your employer a copy of your report (Form 6). The information you provide may help them in their accident investigation and prevent this type of accident from happening again.

Health Care Information

This section gives us information on any health care you received for your injury/illness. If you get health care treatment, you must tell the person treating you that the injury happened at work. The health professional (chiropractor, dentist, physician, physiotherapist or registered nurse extended class) treating you will then need to complete a report and send it to the WSIB so you can claim benefits. Most health professionals keep copies of the Health Professional’s Report (Form 8) in their office, they can print one from our website, or they can submit it using the same portal solution that they currently use to submit online bills.

To ensure that we receive their reports in a timely way, please tell the person treating you that this accident/illness is work-related. The WSIB may also request reports directly from health professionals. Please ensure you provide your claim number to the health professional treating you.

Remember, on the day of accident, the employer is responsible to pay for transportation to get you to health care, if needed.

Did you get first aid or care at work?

  • Yes
  • No
  • If yes, when and by whom…

First aid refers to any care provided to a worker that could be given by a trained first-aider (e.g. washing a wound, applying a dressing, etc.) even if done by an in-house health professional.

Select yes if someone treated you at work for your injury/illness. Give us the date when you were treated and the name (or title—as indicated in example) of the person who treated you at work.

Example: yes 23/03/2005, company nurse

Where did you go for health care, for your injury, outside of work? (Select all that apply)

Health care refers to any professional services provided by anyone of the following registered health care professionals (chiropractor, physician, physiotherapist, registered nurse extended class or dentist). This health care can be at a hospital or other facility (emergency department, walk-in clinic, health professional office, etc.) or the worksite. Select all the places that you went for health care outside of work.

Nursing Station
This is a facility that is not part of a hospital, usually found in smaller communities.
Emergency Department
This may be part of a hospital or in a specialized emergency facility outside of a hospital.
Admitted to Hospital
Select this only if you were admitted to a hospital for an overnight stay.
Ambulance
Select this if a paramedic treated you.
Health Professional Office
Many health professionals have their own private practice and this refers to that health professional’s independent office. This includes a:
  • chiropractor
  • physician
  • physiotherapist
  • registered nurse extended practice or
  • dentist.
Clinic
This refers to a walk-in clinic or a facility where several health professionals provide health care.

For Nursing Station, Emergency Department and Admitted to Hospital, please give us their name and address as well as the date of visit. For Ambulance, Health Professional Office, and Clinic, please give us the date of visit only.

Were you prescribed any medications/drugs?

  • Yes
  • No

Please select yes if you received any medication/drugs for your injury/illness. We may pay for medications/drugs prescribed as a result of the accident/illness. You do not need to give the name of the medications/drugs.

Were you referred for any other treatment or tests?

  • Yes
  • No

Please select yes if you were referred for any other treatment (example: physiotherapy, chiropractic, massage, acupuncture), or tests (example: MRI, CT Scan, X-ray, bone scan, etc.)

Did you talk to your health professional about going back to regular or modified work?

  • Yes
  • No

If yes, were you given any work limitations?

  • Yes
  • No

Take the opportunity to talk to your health professional about returning to work. Your health professional may give you work/task limitations. These will help guide you and your employer in your return to work. You have an obligation to tell your employer if you have been provided with any limitations.

You can share these limitations with your employer by having the health professional complete a return to work note or by giving the health professional a Functional Abilities Form for Timely Return to Work form. You can get this form from your employer, your union or WSIB office. Your employer may be able to accommodate you with work based on your work/task limitations.

Did you tell your employer you went for medical treatment?

  • Yes
  • No
  • If yes, when (date field)
  • and to whom? (Name, Position)

If no, you must tell your employer that you went for medical treatment for your injury. If your employer has not already done so, they will need to complete an Employer’s Report of Injury/Disease (Form 7) and submit it to the WSIB . Please provide the date when you told your employer that you went for medical treatment.

Lost Time

This section gives us information about whether or not you have lost time and/or pay because of your accident/illness. If you did lose time and have already returned to work, we need information about your return to work. If you have not returned to work, you need to contact your employer to discuss it.

The employer is responsible to pay you your full wages for the day of accident/illness.

After the day of accident/illness:

  • I returned to work to my regular job and did not lose any time or pay.

Select this if all these are true:

  • you returned to work on your next regularly scheduled shift and
  • you returned to your normal work duties with no changes and
  • you did not miss any time from work or suffered any reduction in your earnings.
  • I returned to modified duties and did not lose any time or pay.

Select this if all these are true:

  • you returned to work on your next regularly scheduled shift and
  • you returned to modified work duties and
  • you did not miss any time from work or suffer any reduction in your earnings.

Modified duties may be any change or accommodation to your work or the workplace to help you do your job because of your work-related injury/illness.

  • I lost time and/or pay (e.g. regular pay, shift differential, bonuses, premiums, etc.)

Select this if you missed any time from work or had any reduction in your earnings even if your employer paid you while you were off work. This lost time may be for a partial day or an entire day or more. This includes time taken for a medical appointment or health care treatment for your injury/illness.

Date you first lost time and/or pay.

Give us the first date that you either missed time or that you had a loss of earnings resulting from the work-related injury/illness.

If you lost time, have you returned to work?

  • Yes
  • No

Select yes if you have lost time but have since returned to work. Select No if you have not yet returned to work.

  • If yes: Date of your return to work (regular work, modified work)

Indicate the date you returned to work and whether you returned to your regular work or to modified work.

Did you discuss return to work with your employer?

  • Yes
  • No

A worker is required to take an active part in the return to work process. This means that you are required to stay in touch with your employer and discuss your safe return to regular or modified work.

Discussing return to work gives you a chance to talk about any concerns or worries you have with your employer about returning to work, especially if you have been provided with work/task limitations by your health professional. It also gives you and your employer a chance to discuss setting up modified work, if necessary.

Does your employer have modified work?

  • Yes
  • No

It is your responsibility to call your employer to find out if they have work that you can do while you are recovering.

If, after you complete and send us this report, there is any change in the information that you gave us in this section, please call your adjudicator right away and let them know what has changed.

Earnings

This section provides basic information about your earnings. This information may be used by the WSIB when paying benefits for time lost from work due to your injury.

Rate of pay

Indicate how much you get paid by the hour if you are paid hourly, weekly if paid weekly, or Other if pay is based on salary, commission, piecework, etc If you choose Other, please indicate the type of pay.

Usual number of pay hours

Provide the usual number of hours you work per week.

If you lost time from work after the day of accident/illness, did your employer continue to pay you?

  • Yes
  • No

If you lost time from work due to your injury, your employer may have continued to pay you for the lost time from work. Please select yes if your employer continued to pay you while you were off work.

Have you applied for, or did you receive, any other benefits (money) while off work…

  • Yes
  • No

You must tell us if you have applied for, or are receiving, any other benefits as a result of your injury and/or lost time from work.

At the time of the accident/illness did you work for more than one employer?

  • Yes
  • No

Select yes if you worked for more than one employer at the time of your accident. This information is important when calculating what the WSIB will pay you in lost earnings benefits.

Additional Information

Sometimes you need to provide information that does not fit in the form. Examples may include: job descriptions, functional abilities form, employer incident report, witness statements, additional earnings information, etc.

Please note that any additional information is considered to be part of the Form 7 and you must also give a copy to the employer.

To provide additional information, you can:

  1. Type or copy and paste the information into the Additional Information page located near the end of your online submission (maximum of 3402 characters.)
  2. Fax us the additional information after you have submitted your online injury/disease report. Include the worker’s name and your confirmation number on every page sent.
    Fax claims information to 416-344-4684 in the local Toronto dialing area or 1-888-313-7373 toll-free. Please save this fax number in your fax machine settings so you have it in the future. It will be useful if you have to send us additional information by fax.
  3. If you are unable to fax the information, mail it to the address below. Ensure that you include the worker’s name and your confirmation number on every page sent.

    Mailing address:

    Claim Information
    Workplace Safety & Insurance Board
    200 Front Street West
    Toronto ON M5V 3J1

Declaration

You must read the declaration and check the box to confirm that the information you have submitted is true. Unlike the paper Form 6, an actual signature is not required. When you check the box it indicates that you have read and agree to the declaration statement, and when you provide your name, it replaces the signature required on the paper form. The WSIB may contact you to confirm or clarify information you submitted, as well as to request any missing or additional information

By adding your name and checking the declaration box , you are also giving permission to the health professional treating you to provide you, your employer and the WSIB with information about your functional abilities, which can be used to help you return to work safely. Eiher you or your employer may request this information by using the WSIB’s Functional Abilities Form for Planning Early and Safe Return to Work.

Your privacy is important to us. You can get a Privacy Statement here or by calling your adjudicator at 1-800-387-5540.

Review and Submit the Injury Report

This page provides you with a final chance to review all the information you have entered before you submit the eForm 6.

If you need to make any changes to the information you entered, return to the appropriate page using the Previous button at the bottom of the page. Do not use the web browser’s Back button or you will lose data you have entered.

When you have finished reviewing the report and are ready to submit, select the Submit button at the bottom of the page. The system will provide you with a:

  • four digit confirmation number and the time and date we received the report
  • version of the submission that you can view/save or print in PDF format

Confirmation

This page tells you that the WSIB has received your submission. Record the time, date and confirmation number for your records.

We recommend that you save a copy of the PDF form for your records unless you are using a public computer, for example in a library. The PDF represents everything you have submitted and will include your confirmation number and the date and time we received your submission.