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Workplace Incident Report (Ontario)
NextGen Docs form ND-1162. Search ND-1162 on docs.ngz.ca to make this document again.
Record a workplace injury, near miss or violence incident, and see what you must report to the Ministry and WSIB.
Start this document FreeHow it works
What you will fill in
- Employer's legal name and address
- Person involved (name and job title)
- What happened?
- Date of the incident
- Time and exact place
- Describe what happened, step by step
- Injury and body part
- What care was given?
- Did the worker miss time or lose pay after the day of the incident?
- What will be done to stop it happening again?
- Your name and title (person writing this report)
- Date of this report
Good to know
- WSIB Form 7 (Employer's Report of Injury/Disease) must be filed within 3 business days of learning of an injury that needs health care or causes lost time or pay. File online at wsib.ca.
- For a critical injury or death, call the Ministry of Labour, Immigration, Training and Skills Development right away, and send a written report within 48 hours. Do not move anything at the scene except to save a life or relieve suffering.
- If a worker is disabled from work or needs medical attention because of an accident or violence, tell the joint health and safety committee or health and safety rep in writing within 4 days (OHSA s. 52).
Help in your language
Every question comes with help like this. For example, “Employer's legal name and address”:
English: The business name as registered, for example: Khan Logistics Inc., 120 Courtneypark Dr, Mississauga ON.
اردو: آجر (کمپنی) کا قانونی نام اور پتہ۔
ਪੰਜਾਬੀ: ਮਾਲਕ (ਕੰਪਨੀ) ਦਾ ਕਾਨੂੰਨੀ ਨਾਮ ਅਤੇ ਪਤਾ।
हिन्दी: नियोक्ता (कंपनी) का क़ानूनी नाम और पता।
Français: Le nom légal de l'entreprise, par exemple : Khan Logistics Inc., 120 Courtneypark Dr, Mississauga ON.
Questions people ask
How much does the Workplace Incident Report cost?
It is free to fill in, preview and download.
Can I fill in the Workplace Incident Report in Urdu, Punjabi, Hindi or French?
Yes. The finished document is in English, but every question has plain help in English, Urdu, Punjabi, Hindi and French, and you can speak your answers.
Do I need a lawyer?
Many people use this document on their own. If your situation is complicated, or a lot of money or your home is involved, talk to a lawyer or licensed paralegal. In Ontario, the Law Society Referral Service (findlegalhelp.ca) gives a free 30-minute consultation.
Is my information private?
Only you can see your answers. They are saved on your device, and in your own account if you sign in, so you can finish on another device. NextGen Docs is not a law firm and does not give legal advice.