Ontario - Exposure Reporting: Coronavirus in the Workplace
Workplace Exposure to Coronavirus:
If you believe that you may have been exposed to the coronavirus while performing your work duties, you should complete a WSIB Worker’s Exposure Incident Form (form 3958A).
When to complete this form:
- Intended for voluntary use when an unplanned workplace incident exposure has occurred or is believed to have occurred.*
- No diagnosis or symptoms are required to complete this form.
- The purpose of this form is to obtain information about the exposure incident experienced by a worker should an illness or disease occur in the future.
- Instructions on where to send this form are indicated on the form.
Where to find this form:
- The Worker’s Exposure Incident Form is available on the WSIB’s website: https://www.wsib.ca/sites/default/files/documents/2018-12/3958a_07_16_fs.pdf
For assistance completing the Worker’s Exposure Incident Form please contact:
- Your WSIB Rep/WSIB committee member (if you have one in your local) or one of the H&S Reps in your local union.
*Some Examples of possible workplace exposure situations:
- Custodial worker sanitizing healthcare equipment in clinic areas, waiting and patient rooms where confirmed cases of COVID-19 are being treated.
- Grocery store worker stocking shelves or working at the customer check out in a store where it is later confirmed to have had an exposure of coronavirus (customer or
co-worker). - Transit operators providing public transportation where social distancing is challenging, semi-confined space.
What if I am diagnosed with COVID-19 as a result of workplace exposure to Coronavirus?
When an injury or illness happens on the job, the Workplace Safety and Insurance Board (WSIB) provides compensation such as wage-loss benefits, medical coverage and support to help people recover and get back to work.
Created by Prevention Link – www.preventionlink.ca April 2020 sf/cope343