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Employee Incident Report

WSIB Forms

Spill Report Form

Incident and Accident Reporting

Types of Incidents

Near Miss

A near miss is an unplanned event that did not result in injury, illness, or damage – but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage

All near misses should be reported to Environmental Health and Safety using the Incident Report Form

If the near miss resulted in a chemical, radioactive or biological spill please contact the Department of Environmental Health and Safety at 32999 and complete the Spill Report Form.

First Aid

If an employee only requires first aid as a result of an incident, it should be reported to Environmental Health and Safety by completing the Incident Report Form

WSIB

If an incident results in:
  • Employee obtaining health care (Not first aid)
  • Lost Time
  • Requires modified duties at less than regular pay
  • Requires modified duties at regular pay for more than 7 calendar days after accident
  • Employee earning less than regular pay at regular work

The incident must be reported to Environmental Health and Safety using WSIB Form 7

The Form 7 must:
  • be submitted to Environmental Health and Safety within 24 hours of becoming aware of the accident
  • The Form 7 must be completed by the supervisor/safety officer (Not the employee)
  • Environmental Health and Safety will investigate the accident
  • Environmental Health and Safety will forward the Form 7 to the WSIB

Other WSIB Forms

Form 6
This is the worker's report of injury/disease and the employee will receive it fro the WSIB. It must be completed by the employee and returned to the WSIB
Link to Form 6

Form 8
The health care professional will complete Form 8 and forward it directly to the WSIB

Rainbow Line

Queen’s is committed to an inclusive campus community with accessible goods, services, and facilities that respect the dignity and independence of persons with disabilities. The above Adobe Acrobat (pdf) and Word (doc) files are available in an accessible format or with appropriate communication supports upon request.

Please contact us in one of the following ways: