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.


Terms and Conditions
You agree and consent that the WCB may use the email address you provide to transmit to you personal information and/or personal health information about you. While the WCB takes reasonable measures to ensure the security of your information, you understand and acknowledge that communications through the internet including the use of email, has risks to security and privacy of the content of such communications which may result in personal information, or personal health information, being disclosed to third parties.

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.