Yukon Workers' Compensation Health and Safety Board

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You’ll find our most commonly used forms listed here. If you can’t find the form you need on this page, please contact us. 

Injuries and Incidents 

Workers 

Workers’ Report of Injury/Illness 

Signalement d’une blessure ou d’une maladie professionnelle par l’employ√©

Workers’ Incident Report 

Worker Report of Hearing Loss 

Worker Report of Hearing Loss Employment Record

Request to Reactivate Claim

Direct Deposit Authorization Form

Gradual Onset Musculoskeletal Disorder Risk Assessment

Employers 

Employer’s Report of Injury/Illness 

Supervisor’s Incident Report 

Medical Professionals 

Assistive Device Request

Doctor’s First Report 

Doctor’s Progress Report 

Functional Abilities Form

Physiotherapy Discharge Report

Physiotherapy Initial Assessment Report

Physiotherapy Progress Report

Prior Approval Request (Hearing Claims)

Psychological Functional Abilities Form

Psychological Initial Assessment Report

Psychological Progress Report

Schedule A - Fee Structure (Hearing Claims)

Service Provider Report (Hearing Claims)

Registration 

Application for Registration

Demande D'enregistrement

Optional Coverage Application Form for Sole Proprietors, Partners in a Partnership, on Non-Incorporated Employers 

Application for Coverage Outside 

Application for Registration of an Inactive Corporation

Director's Exemption Application

Application for the Alternative Assessment Procedure (AAP) for Interjurisdictional Trucking and Transport

Workplace Safety 

Hazard Assessment Checklist 

Compliance Report 

Application for Variance of an OH&S Regulation

Mining

Application for Yukon Blaster's Certificate

Application for Yukon First Line Supervisor's Certificate

Application for Mine Rescue Training

Application to Operate Diesel Engine Underground

Application for Explosives Magazine Storage and Use Permit

Notice of Project 

Construction 

Lead and Asbestos 

Surface Mines 

Underground Mines 

Diving 

Forestry 

Claims Appeals/Reviews 

Request for Review by a Hearing Officer 

Demande de Revision par un Agent Enqueteur 

Authorization for Representation 

Request for Disclosure 

Demande D’Access au Dossier 

Employer Request for Disclosure 

Application to Withdraw a Review or Appeal

Request to Reschedule a Hearing 

Occupational Health and Safety Appeals 

Notice of Appeal of an Occupational Health and Safety Decision 

Authorization for Representation 

Application to Withdraw a Review or Appeal 

Request to Reschedule a Hearing 

Request for Reconsideration of Appeal Panel Decision 

Assessment Appeals 

Notice of Appeal of an Assessment Decision 

Authorization for Representation 

Application to Withdraw a Review or Appeal 

Request to Reschedule a Hearing 

Request for Reconsideration of Appeal Panel Decision