
Wsib.ca200 Front Street West, Toronto ON M5V 3J1 Telephone: 4163441000 or 18003870750 TTY: 18003870050 Fax: 4163444684 or 18883137373Employer 's Exposure Incident Reporting Form PEIRThe attached Employer.
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How to fill out the Canada WSIB 3959a online
Filling out the Canada WSIB 3959a Employer's Exposure Incident Reporting Form is essential for documenting unplanned workplace exposure incidents. This guide will provide you with clear and detailed instructions to navigate the online process effectively.
Follow the steps to complete the form with confidence.
- Click the ‘Get Form’ button to obtain the form and open it in the online editor.
- Begin completing the form by entering the employer's information, including the name, firm number, class/subclass, NAICS code, and the addresses for correspondence and location of the incident.
- Describe the nature of the business and list all workers involved in the exposure incident. Make sure to provide details such as last name, given name, date of birth, date of hire, address, telephone number, and social insurance number for each worker.
- Proceed to the details of the incident section. Select whether the exposure was to infectious substances (Section A) or chemical/other substances (Section B) by checking the appropriate box.
- In Section A, enter the date and time of exposure and choose the type of exposure involved. Indicate the source of exposure and specify any infectious substances suspected.
- In Section B, similarly enter the date and time of exposure, and provide a detailed account of what occurred, including any leaks, spills, or explosions. Describe the chemical or substance involved and any protective measures or emergency measures taken.
- Answer the questions concerning any WSIB claims related to the incident, and if applicable, provide details about formal reports made to the Ministry of Labour or Ministry of the Environment.
- Complete the report by including the name of the person completing it, their official title, and signature. Enter a telephone number and the date of filling out the form.
- Once all sections are complete, save your changes, and you can then download, print, or share the completed form.
Complete the Canada WSIB 3959a form online today to ensure accurate reporting of workplace exposure incidents.
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What is Workers Exposure Incident Form Form 3958A?
You should use the Worker's Exposure Incident Form (form 3958A) to voluntarily report an unexpected workplace incident exposure from a leak, spill, rupture, unanticipated emission, explosion or a release of a dangerous chemical or physical substance or contact with an infectious substance or biological agent.
Is WSIB mandatory in Canada?
WSIB coverage is mandatory for independent operators, sole proprietors, partners in a partnership and executive officers in a corporation who work in construction. Most will have to register with us (some exemptions apply).
What does the WSIB stand for?
About the Workplace Safety and Insurance Board.
What is an exposure incident form?
You should use the Worker's Exposure Incident Form (form 3958A) to voluntarily report an unexpected workplace incident exposure from a leak, spill, rupture, unanticipated emission, explosion or a release of a dangerous chemical or physical substance or contact with an infectious substance or biological agent.
What is the WSIB in Ontario Canada?
We provide wage-loss benefits, medical coverage and support to help people get back to work after a work-related injury or illness. We are funded by premiums paid by Ontario businesses. We provide no-fault collective liability insurance and access to industry-specific health and safety information.
How do I file WSIB?
How to report Sign up for online services and report through your account. Report your injury, illness or exposure incident through our secure online services. ... Download the WSIB app. ... Fill out a Form 6 PDF and submit online. ... Fill out a Form 6 PDF and fax or mail it.
Is WSIB mandatory for employers in Ontario?
WSIB coverage isn't mandatory for everyone in Ontario. The Government of Ontario decides which industries and which types of employees have to have WSIB coverage, and lists them in the Workplace Safety and Insurance Act (WSIA).
What are the WSIB rates in Ontario?
Maximum insurable earnings ClassClass description2023 Class Rates ($)F2Air, Transit, Ground Passenger, Recreational and Pipeline Transportation, Courier Services and Warehousing1.59G1Residential Building Construction2.47G2Infrastructure Construction1.81G3Foundation, Structure and Building Exterior Construction3.6031 more rows
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