Whscc Form 7 Employers Report Of Injury (Page 3 of 4) in pdf

146 - 148 Forest Rd.

Phone: (709) 778-1000

146 - 148 Forest Rd.

P.O. Box 9000

Instructions for Completing

Toll free: 1-800-563-9000

P.O. Box 9000

St. John's, NL

Employer's Report of Injury (Form 7)

Fax: (709) 778-1302

St. John's, NL

A1A 3B8

Toll free fax: 1-800-276-5257

A1A 3B8

Use this form when:

Section B – Injury / Incident Information

Your employee has a work-related injury / illness or

Did this injury develop over time without a specific

recurring work-related injury / illness that results in

injury / incident?

any of the following:

If the worker is unable to recall when the injury /

medical attention;

incident occurred or pain started, and there is no

loss of earnings; and / or

identifiable event, the injury may have developed

over time. The worker may report discomfort

lost-time from work.

performing their normal duties (e.g., full-time

This includes injuries or illnesses that occurred over

cashier continually scanning products with the left

time as well as those caused by a single event.

arm and begins to experience pain in the left

elbow). However, if the worker is able to say when

If you are a partner, proprietor or independent

their symptoms began, note this date on the form.

operator (also referred to as owner/operator on this

form), you do not need to complete this form.

Did the injury / incident happen on the employer's

Instead, you should complete a form 6 – worker's

property or worksite?

report of injury. Please note that coverage will be

extended only when optional personal coverage

Detailed information as to where the injury /

has been purchased from the Commission.

incident happened is important to process the

claim. For example, if on your premises, where did

Points to remember:

it occur? The shipping area, paint shop or

warehouse? If not, where did it happen? For

Complete and accurate information is important so

example, you operate a cleaning company and

as not to delay processing the claim.

your employee was working at a retail store when

If you have additional information, attach additional

the injury happened. In this case, note the name

pages noting the worker's name and SIN on each

and location of the store.

page.

Describe your understanding of how the injury /

As per the Workplace Health, Safety and

incident occurred or condition developed.

Compensation Act, the form 7 must be forwarded

to the Commission within three days of the injury.

Detailed information about how the injury / incident

happened and what the worker was doing when it

Section A General Information

occurred is important to process the claim. This

may include information such as: sizes, weights

How long has this worker been in your employ?

and names of objects involved; a description of

Workers hired for one year or more before the

any machinery, tools or vehicles used at the time

injury are considered continuously employed

of the injury/incident; any environmental conditions

unless the year was interrupted by a work

(work area, temperature, noise, chemicals, gas,

cessation that ended the employment relationship.

fumes); if another person was involved; or any

For seasonal workers, periods of unemployment

information you think is important.

are not considered work cessation. For example, if

you employed the worker for three years except for

For example: “Bob was moving boxes in the

a seasonal period of five months per year, this

storage room. He lifted a 40-pound box from the

worker is considered to be in your employ for more

floor to put on a shelf. He twisted to the right while

than 12 months, even if the months are not

lifting, and hurt his upper back.”

consecutive.

If the condition developed over time, provide a

What date was the worker initially hired?

description of the worker’s duties. Explain how

often he / she performs a particular task; the sizes

This refers to the date the worker became your

and weights of objects involved; how long he / she

employee. If the worker has been hired in the past

has been doing this work; if there have been any

as a seasonal or temporary worker, record the

recent changes to the schedule and / or tools or

most recent hire date.

products he / she uses.

What occupation was the worker performing at the

time of the work injury / incident?

Additional information on access, release and protection of

In some cases, this may not be the worker's

your information by the Commission can be found in

regular job. For example, if the worker's normal

Policy GP-01: “Information Protection and Access,”

job is a welder, but he/she was temporarily

available at or by calling The Commission’s

working as a shipper / receiver when injured,

Access to Information and Protection for Privacy (ATIPP)

Co-ordinator at 1-800-563-9000.

shipper / receiver would be the occupation at the

time of the injury/incident.

Whscc Form 7 Employers Report Of Injury Page 3

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