EMPLOYEE’S REPORTING OF AN ACCIDENT / OCCUPATIONAL DISEASE
COIDA Forms
- Travel Report Questionnaire
- Assault Questionnaire
- Return of Earnings (W.As.8)
- Classification of Industries (W.CI.150T)
- Employer’s Report of an Occupational Disease (W.CI.1)
- Employer’s Report of an Accident (W.CI.2)
- Notice of Accident & Claim (W.CI.3)
- First Medical Report (W.CI.4)
- Final/Progress Medical Report (W.CI.5)
- Resumption Report (W.CI.6)
- Dermatological Report (W.CL.53)
- Notice of Occ Disease & Claim (W.CL.14)
- First Medical Report – Occ Disease
- Final/Progress Med Report (W.CL.26)
- Hand Injury Supplementary Report (W.CL.31)
- Declaration by Guardian/Widow (W.CL.32)
- Medical Report on Health (W.CL.44)
- Burial Expense Account (W.CL.46)
- Final Report on Eye Injuries (W.CL.52)
- Exposure History (W.CL.110)
- Foot Injury Supplementary Report (W.CL.221)
- Sworn Statement by Employee (W.CL.236)
- Lumpsum in Lieu of Pension (W.CL.258a)
- Supplementary Grant Application (W.CL.287)
- Employee Affidavit Occ Disease (W.CL.305)
- Objection Against Decision (W.G.29)
- Additional Compensation App (W.G.30)
Injury at Work
Eg. injured back while lifting a heavy opbject, or fell of a ladder?
Occupational Disease
Eg. Ganglion / Covid?
Delayed Reporting
Complete "Delayed Reporting" Employee or Employer Form
Report Injury / Disease
Report Injury or Onset of Disease (symptoms) to HR, Line Manager or Onsite Occupational Nurse / Safety Officer
Report within 24hrs
Travelling
Did the Injury occur while travelling in a vehicl for work?
Complete an Travelling Questionnaire
Was it as a result of an Assault at Work
Reporting an assault at work?
Complete an Assault Form
Documentation & Submission
Attach All Relevant Documentation
Complete Employer Report (W.CL.2) or Occupational Disease Report (W.CL.1)