Temporary Status

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.

Business Contact Information

Legal Name

Trade Name

Street Number

Street Name

City

Province/Territory

Postal Code

Is the physical address the same as the mailing address?

Yes No

Email

Secondary phone number

What date will your workers start working in the Yukon

What date will your workers finish working in the Yukon

Are you hiring Yukon workers?

Yes No

By checking this box I declare that the information provided is true and correct and I acknowledge that electronic communication has inherent security risks, as do all forms of communication. Notwithstanding the inherent risks of electronic communication, I consent to the use of electronic methods to transmit and receive information, including confidential and personal information between the board and myself. This consent will remain in effect until written notice to revoke this authorization has been received by the board.