Steps to take if you believe you have been exposed to COVID-19 in the workplace

If you believe that you may have been exposed to the coronavirus 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

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