Yukon Workers' Compensation Health and Safety Board

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You’ll find our most commonly used forms listed here. If you can’t find the form you need on this page, please contact us. 

Injuries and Incidents 


Worker's Report of Injury/Illness 

Signalement d’une blessure ou d’une maladie professionnelle par l’employ√©

Immediate Incident Reporting for the Worker

Worker Report of Injury - Hearing Loss

Request to Reactivate Claim

Direct Deposit Authorization Form

Gradual Onset Musculoskeletal Disorder Risk Assessment

Statutory Declaration and Claim: Spouse or Common-law Partner of a Deceased Worker


Employer’s Report of Injury/Illness 

Supervisor’s Incident Report 

Medical Professionals 

Appendix 1: Barriers to Return to Work

Assistive Device Request

Chiropractor's First Report and Assessment

Chiropractor's Progress Report

Chiropractor's Discharge Report

Dentist First Report

Doctor’s First Report 

Doctor’s Progress Report 

Functional Abilities Form

Massage Therapy Report

Physiotherapy Discharge Report

Physiotherapy Initial Assessment Report

Physiotherapy Progress Report

Prior Approval Request (Hearing Claims)

Psychological Functional Abilities Form

Psychological Initial Assessment Report

Psychological Progress Report

Schedule A - Fee Structure (Hearing Claims)

Service Provider Report (Hearing Claims)


Application for Registration

Demande D'enregistrement

Optional Coverage Application Form for Sole Proprietors, Partners in a Partnership, on Non-Incorporated Employers 

Application for Coverage Outside 

Application for Registration of an Inactive Corporation

Director's Exemption Application

Application for the Alternative Assessment Procedure (AAP) for Interjurisdictional Trucking and Transport

Temporary Employers in Yukon

Workplace Safety 

Asbestos Control Pre-Project Safety Meeting

Job Hazard Analysis

Field Level Risk Assessment

Workplace Risk Assessment

Compliance Report

Application for Variance of an OH&S Regulation


Application for Yukon Blaster's Certificate

Application for Yukon First Line Supervisor's Certificate

Application for Mine Rescue Certification

Application to Operate Diesel Engine Underground

Application for Explosives Magazine Storage and Use Permit

Notice of Project 


Surface Mines 

Underground Mines 



Claims Appeals/Reviews 

Request for Review by a Hearing Officer 

Demande de Revision par un Agent Enqueteur 

Authorization of a  Representative 

Request for Disclosure 

Demande D’Access au Dossier 

Employer Request for Disclosure 

Application to Withdraw a Review or Appeal

Request to Reschedule a Hearing 

Occupational Health and Safety Appeals 

Notice of Appeal of an Occupational Health and Safety Decision 

Authorization of a  Representative 

Application to Withdraw a Review or Appeal 

Request to Reschedule a Hearing 

Request for Reconsideration of Appeal Panel Decision 

Assessment Appeals 

Notice of Appeal of an Assessment Decision 

Authorization of a Representative 

Application to Withdraw a Review or Appeal 

Request to Reschedule a Hearing 

Request for Reconsideration of Appeal Panel Decision