Reporting work-related injury or illness: Federal government employers – How to fill out the form

3. How to fill out the forms

To avoid delays, include the following information on the Employer’s Report of Injury or Disease form:

  • name of employee
  • date and time of injury
  • incident location
  • employee's gross earnings
  • description of incident and injury
  • names of witnesses and their statements

Provide complete details about the incident and the nature of the injury on the form, and attach any additional relevant information. If you and the employee disagree on the details of the incident, include their statement and your comments about their statement on the form.

The form must be signed by the supervisor or other person in charge who has first-hand knowledge of the incident.

Note: If the form is incomplete, there will be delays in processing the claim.

For assistance, please contact the Federal Workers' Compensation Service.

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: