Forms

The WSIAT created forms to collect the information needed to start an appeal, have an oral hearing, update a file, and make requests. Each form is available here in two formats depending on how you want to send it to the WSIAT:

  1. Fax or Print and Mail (left side below)
  2. E-file (right side below)

The WSIAT forms are available in PDF format. To view and print them, you must have Acrobat Reader software (version 4 or higher), a free utility created by Adobe. If you do not have the Adobe Acrobat or Acrobat Reader DC, you can download the version you need for your computer.

Fax or Print and Mail

You may either complete the form electronically before printing it, or you may print it first and then complete it with a pen. Once complete, please send the form to the WSIAT by fax, courier, mail, or deliver it in person.

WSIAT Fax Number: 416-326-5164
WSIAT Address:
Mailroom
Workplace Safety and Insurance Appeals Tribunal
505 University Avenue
5th Floor
Toronto, ON M5G 2P2

E-File

Please complete the form electronically, save and name it, and e-file it with the WSIAT: E-File

Starting an Appeal

Fax or Print and Mail E-file
Notice of Appeal for Workers Notice of Appeal for Workers
Notice of Appeal for Employers Notice of Appeal for Employers

Address Change

Fax or Print and Mail E-file
Worker Change of Address Form Worker Change of Address Form
Representative and Employer Change of Address Form Representative and Employer Change of Address Form

Authorizing a New Representative

Fax or Print and Mail E-file
Worker Authorization to Represent Worker Authorization to Represent
Employer Authorization to Represent Employer Authorization to Represent

Preparing for the Oral Hearing

Fax or Print and Mail E-file
Readiness Form Readiness Form
Confirmation of Appeal for Workers Confirmation of Appeal for Workers
Confirmation of Appeal for Employers Confirmation of Appeal for Employers
Respondent's Confirmation of Appeal Respondent's Confirmation of Appeal
Agreed Statement of Facts (General) Agreed Statement of Facts (General)

After the Hearing

Fax or Print and Mail E-file
Hearing Expense Claim Hearing Expense Claim
Hearing Expense for Teleconference and Videoconference Claim Hearing Expense for Teleconference and Videoconference Claim
Application for Direct Deposit Application for Direct Deposit
WSIAT Request Form for Audio Recordings WSIAT Request Form for Audio Recordings
WSIAT Request Form for Transcripts of Recorded Hearings WSIAT Request Form for Transcripts of Recorded Hearings

Reconsiderations and Clarifications of WSIAT Decisions

Fax or Print and Mail E-file
Request for Reconsideration / Clarification Request for Reconsideration / Clarification
Reconsideration / Clarification Response Reconsideration / Clarification Response

If you have any questions about the WSIAT forms, please Contact Us.