COVID-19

Your health and safety is our number one priority. To help prevent the spread of COVID-19, WSCC offices are closed to visitors. Visit our COVID-19 page for important service updates and to download Risk Assessments and Worksite Precaution Planning for COVID-19 for Employers.

Claims Forms for Workers

Claims Forms for Workers

Please read each form carefully to ensure you accurately complete it.

Please contact us at 1-800-661-0792 if you need assistance.


The WSCC collects personal information to administer programs and services related to your claim. For more information please read our Privacy Statement for Workers.
Worker's Report of Injury
Election to Claim Compensation
Electronic Fund Transfer
Harvester's Report of Incident
Indemnity Guarantee
Request for Disclosure
Statutory Declaration and Claim for Surviving Spouse
Statutory Declaration for Dependents other than a Surviving Spouse
Travel Expense Form
Vocational Rehabilitation Job Search Contact Sheet
Worker's Continuity Report
Worker's Repetitive Strain Injury (Upper Limbs) Questionnaire
Worker's Report of Noise-Induced Hearing Loss
Worker's Report of Occupational Disease
Worker's Report of Vibration Syndrome

Forms

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