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Worker's Report of Injury (W1)

Worker's Report of Injury (W1)

Register for an Online Account so you can view your claim information and review forms you have submitted. You will also have the ability to view your payments, submit appeals and update personal information.

The following form is for workers who have been injured on the job. This should be the first form you complete and provide to WCB after a workplace injury. If you fill this form out, you will not need to provide a paper copy of the W1 form to WCB. If you have an active claim and need to appeal it or provide additional information this is not the form you need.

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 your provincial health number as well as your employer contact information and details of the incident that resulted in the injury.

W1

Worker Information
The worker's Social Insurance Number is a unique identifier that helps us coordinate incident reports from the employer and worker.
Terms and Conditions
The WCB advises that the email account you provide should be accessible, used, and viewed only by those persons necessary to enable you to fulfill the requirements of providing information to report workplace injuries and processing those claims. To protect the privacy of workers, we recommend the use of an email account that is dedicated to communicating and receiving correspondence with the WCB relating to workplace injury claims. This email account should be associated with an identifiable individual responsible for work injury claims in your business. In submitting this report of injury (E1), you acknowledge that the information provided is accurate to the best of your knowledge.

Do you agree to these terms and conditions?

Submit by mail or fax - W1

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 W1 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.