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Employer's Report of Injury (E1)

Employer's Report of Injury (E1)

Register for an online account so you can submit employer's payroll statements, view account details, request clearances and manage your automatic clearances verification list. You can also view cost information, request letters of good standings, report injury and review forms you have submitted.

If you have problems completing this form or have questions, please call us at 1.800.787.9288.

To complete this form, you will need the worker's personal health number as well as the worker's personal information including name, address and details of the incident that resulted in injury.

E1V2

Thank you for using our online claim submission process.
To complete this form, you will need:
  • the worker's personal information including name, address, and phone number
  • worker's social insurance number
  • details of the incident that results in injury
  • the worker's wage and employment information
If you have problems completing this form or need questions answered, please call us at 1.800.787.9288.
Let's get started with your claim.

Submit by mail or fax - E1

Submit by mail or fax

If you prefer to submit this form by mail or fax, please download the PDF below. Fill it out in pen and send a copy to:

WCB Regina Office
200-1881 Scarth Street
Regina SK
S4P 4L1

Fax: 306.787.4311
Toll-Free Fax: 1.888.844.7773

 Download E1 PDF

Filling out the above PDF form using a web browser may produce text formatting issues. Please download the PDF form first and then open it using the free Adobe Reader.