Submit the report to bookmark an exposure in the event the worker experiences illness or disease in the future, and to help identify clusters of occupational disease in the workplace, even if the employer has gone out of business.
WHAT TO REPORT
An UNEXPECTED workplace incident exposure from:
» leaks, spills, ruptures, unanticipated emissions, explosions, release of dangerous chemicals or physical substances,
» contact with infectious substances, biological agents or illness.
THINGS TO REMEMBER!
» It’s VOLUNTARY.
» Exposure forms should only be submitted for an unexpected workplace exposure event with NO LOST TIME and NO ILLNESS.
» No diagnosis or symptoms are required to complete this form.
» It’s CONFIDENTIAL. The WSIB does not notify the employer upon your submission. Note: The information might be released in the event of a future WSIB claim, as part of your claim file.
» If you are experiencing an illness and need medical treatment as a result of the incident, you should file a Worker’s Report of Injury/Disease (FORM 6).
» If you experience regular, continuous exposure to chemicals and other substances, contact your union for guidance.
» ALWAYS KEEP A COPY of everything you submit to the WSIB.
WHERE TO FIND
The worker may complete one of these forms:
Worker’s Exposure Incident Form ( 3958A) (PEIR)
Worker’s Exposure Incident Reporting Form for Construction (3885A ) (CEIR)
The employer may complete one of these forms:
Employer’s Exposure Incident Form (3959A ) (PEIR)
Employer’s Exposure Incident Reporting Form (Construction) (3886A ) (CEIR)
You can also report online at the WSIB website.
The information above is also available as a card. Keep this handy resource at your workplace: click here to download.
