Application for Coverage Outside Yukon Form

If you have workers (Yukon resident or usual place of work is in Yukon) performing work outside Yukon and that work is a continuation of the work they normally perform in Yukon, the workers are covered under the Act for work-related injuries. A worker is considered a resident of Yukon if their usual place of permanent residency is in Yukon. This coverage outside Yukon is limited to a consecutive period of less than 6 consecutive months for work outside Yukon, within Canada.

No application is required if the work falls within this time period.

It is your responsibility to ensure that you also contact the other jurisdiction to confirm legal requirements for registration and working in that jurisdiction.

Employer information

Legal Name

Trade Name

Customer Number

12345-12345 (5 digits all numbers - 5 digits all numbers)

CRA BIN Number

Street Number

Street Name

City

Province/Territory

Postal Code

Country

Email

Primary Phone Number

Secondary Phone Number

About the work planned

What province/territory will your workers be working in?

Is the work they are performing for you outside Yukon required to be performed both in Yukon and outside Yukon in the normal course of their employment?

Yes No

I have verified that my workers will have access to health care services similar to Yukon

Yes No

I have verified there are no concerns with civil unrest or other security concerns that affect the personal safety of my workers.

Yes No

How many workers will be working outside Yukon?

Select the number of workers that you would like to register for extended coverage. You must register at least one worker and can register up to 5 using this form.