Steps to take if you believe you have been exposed to an illness in the workplace

If you believe that you may have been exposed to infectious disease while performing your work duties, NOTIFY YOUR SUPERVISOR IMMEDIATELY. You should also consider completing a WSIB Worker’s Exposure Incident Form (form 3958A).

What is the purpose of the Worker’s Exposure Incident form?

• The form is intended for voluntary use when an unplanned workplace incident exposure has occurred or is believed to have occurred.
• No diagnosis or symptoms are required to complete this form.
• The purpose of this form is to obtain information about the exposure incident experienced by a worker should an illness or disease occur in the future.

Instructions on where to send this form are indicated on the form.

Where to find this form:

• The Worker’s Exposure Incident Form is available on the WSIB’s website. https://www.wsib.ca/sites/default/files/documents/2018-12/3958a_07_16_fs.pdf

For assistance completing the Worker’s Exposure Incident Form please contact:

• Your union steward
• Health and Safety Reps