WSIB Worker Exposure Incident Form

A Message from Your Health & Safety Officer

WSIB Worker Exposure Incident Form

If you have been notified that you may have been exposed to Covid-19 in the workplace, we encourage you to fill out the WSIB Worker Exposure Incident form (3958a) and send it directly to the WSIB as soon as possible to begin building a potential claim (*Note: this does not go to the employer!).

This isn’t the WSIB claim itself, but it starts a paper trail before you do fill out a Form 6 after you’ve been diagnosed with symptomatic Covid-19.

This form is also useful for any type of exposure apart from Covid-19 (chemical or biological).

If you need help filling it out, contact Mikko Kivisto –