Workplacement Accident Reporting Procedure

Note: These forms (E1 and W1) have been amended to reflect the unique nature of student work placements. Please use these forms in the event of an injury to a student where the student requires medical treatment from a health care professional and/or will be unable to continue work.


 

  1. Get medical attention if required. The employer should provide appropriate first aid and arrange immediate transportation so that the worker can receive appropriate treatment from a qualified health care professional if required.
  2. Have your health care provider report to the Workers’ Compensation Board (WCB).
  3. Complete the Employer’s Initial Report of Injury E1 Form.

Report the incident to the employer at the work placement and the school based work-placement coordinator immediately.

 


 

This form should be completed by the school’s teacher/work-based learning coordinator in consultation with the employer. The E1 form, along with the completed Schedule B, the Work-based Learning Consent and Agreement form (Appendix G), should be faxed to the Practical and Applied Arts Coordinator at the Ministry of Education (306-787-2223) within 3 days. The Ministry of Education will submit the form to WCB.

Please note that in Section A the workplace employer’s name, address, and postal code should be entered above the Ministry of Education’s address, and fields on the right side should be filled in with the workplace employer’s information. The E1 Form should be signed by the school’s teacher/work-placement coordinator.

Save form as E1-MONTH DAY, YEAR-SCHOOL-STUDENT NAME (ex. E1-April 8, 2009-Campbell-John Smith)

This should be done regardless of whether there are lost wages as a result of the accident or not. (Loss of wages may occur in those cases where the student has a job but will have to miss work due to the injury during their work placement.)

Complete the Worker’s Initial Report of Injury W1 Form.

Complete the Worker’s Initial Report of Injury (W1) as soon as possible.

Please note that Section A should include the requested information and in block letters, the statement: K-12 WORK PLACEMENT STUDENT. Section B of the W1 form should include the employer’s address for the workplace at which the student is placed, the name of the school and school division, and should list the contact name and phone number of the employer AND the work placement coordinator from the school.

The W1 form needs to be signed by the student worker.

Save form as W1-MONTH DAY, YEAR-SCHOOL-STUDENT NAME (ex. W1-April 8, 2009-Campbell-John Smith)

This form must be faxed to the Practical and Applied Arts Coordinator at the Ministry of Education (306-787-2223) as soon as possible. The Ministry of Education will submit the form to WCB.

 

Complete the Marsh Canada School Incident Report Form for Insurance Purposes.

Three copies are needed; one for Marsh Canada, one for the school and one for the Board Office.

E-mail copies of the completed E1 and W1 Forms to Stuart Harris (stuart.harris@rbe.sk.ca).

Note: Please contact Workplace Health and Safety (523-3129) if you have any questions with regard to filling out the E1 & W1 forms.

 

Accident Reporting Procedure Form Checklist: