Yukon Workers' Compensation Health and Safety Board
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Forms & Reports

Forms

Safety

Hazard Assessment Checklist


Online Compliance Form

OHS Notice of Project Forms

Construction

Lead & Asbestos

Surface Mine Projects

Underground Mines

Diving

Forestry


Assessments

Online Employer Registration Form

Employer Registration Form

Optional Coverage Registration Form

Online Application for Extended Coverage Outside Canada

Application for Extended Coverage Outside Canada

Demande de garanties annexes pour employés travaillant à l'extérieur du Canada

Formulaire de demande de couverture facultative pour les entreprises à propriétaire unique, les associés d'une société de personnes ou les employeurs non constitués

Demande D'Enregistrement

CHOICES - Click here for changes in the CHOICES program

starting January 1, 2011


Injury

Employers, it is mandatory the the Injury Reporting Poster be permanently placed in a common area of your workplace.

Injury Reporting Poster (English and French versions)

 

Download Forms:

Online Worker's Report of Injury/Illness

Worker's Report of Injury/Illness

Online Employer's Report of Injury/Illness

Employer's Report of Injury/Illness

                   Physicians First Report

Physicians Progress Report

Functional Abilities Form    Signalement D'une Blesseur ou D'une Maladie Professionnelle Par L'Employe'          

Signalement D'une Blesseur ou D'une Maladie Professionnelle Par L'Employeur

Incident

Download Forms:

INCIDENT REPORTING - Worker

INCIDENT REPORTING-Supervisor

Hearing Loss (you must fill out all three forms: Workers' report of injury/illness, background information and employment history, in order to file a claim)

Download Forms:

             Prior  Approval Request

             Service Provider Report

             Fee Structure


Extended Coverage Outside of Canada

 

Application for Extended Coverage Outside of Canada


Appeals


File Disclosure