6 Workers' compensation information (where covered)

Is the current condition due to a work related accident or illness?

Yes No

Has a claim been filed with any type of workers’ compensation board?

Yes No

Please provide the reason.

What is the current status of the application?

Pending Approved Declined

Please provide copies of any information received from the workers’ compensation board*.

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* Includes any type of benefit for work related illness or injury including Workers’ Compensation Board (WCB), Workplace Safety and Insurance Boards (WSIB) and Commission de la sante et de la securite du travail (CSST).