Other Registration

This information is being collected for the purposes of administering and enforcing the Workers’ Safety and Compensation Act and is collected under the authority of that Act and the Access to Information and Protection of Privacy Act. If you have any questions about the collection of this information, please contact the Privacy Officer at WSCB at the above listed address or at (867)667-5645 or 1-800-661-0443.
You will need the following information to complete this form:
  • a) legal name of your business
  • b) CRA business number if you have one;
  • c) description of business activities and primary business purpose;
  • d) full names of owners, birth dates and addresses of proprietor or partners
  • e) payroll information, estimate of annual payroll;
  • f) information about contractors or subcontractors.

Employer Information

Business Contact Information

Employer Business Information

Your home jurisdiction is where your head office is.
“Workplace” means a building, site, project site, workshop, structure, vehicle or mobile equipment, or any other location where one or more workers perform or have performed work.

Payroll Information

Your total estimate is the amount of payroll for each worker for the time they are working in the Yukon (do not exceed the maximum annual earnings per worker). Requested coverage amount, not to exceed the maximum annual earnings of $98093 for 2023 and $102017 for 2024. Only enter the numeric value, no added symbols, i.e. 91500

Signature, consent and declaration