Consent to Disclose Personal Information Complaints and Work Refusals

Complaints and Work Refusals Worker consent to authorize the Ministry of Labour and the Workplace Safety and Insurance Board to disclose personal information for the purposes of administering and enforcing the Occupational Health and Safety Act and Section 40 of the Workplace Safety and Insurance Act.

Need help downloading or filling forms?

Please check our Help page for solutions to common issues.

Alert!

PDF Forms will no longer work with older versions of Adobe Reader including Adobe Reader XI. Please update your free Adobe Reader to the latest version from the Acrobat Reader download page so that you can continue to access these forms.


Download Adobe Reader Free Version

Make the most of your experience with accessing, downloading, and filling forms acquired from the Central Forms Repository by watching this brief video overview.

single frame of the linked video. Click to begin playback in a new browser window
Download English Transcript

Forms, Links, and Information

Additional Information

Form Number 016-0283
Title Consent to Disclose Personal Information Complaints and Work Refusals
Description Complaints and Work Refusals Worker consent to authorize the Ministry of Labour and the Workplace Safety and Insurance Board to disclose personal information for the purposes of administering and enforcing the Occupational Health and Safety Act and Section 40 of the Workplace Safety and Insurance Act.