Report of a workplace fatality, injury, illness or incident (OHSA s. 51, 52 ,53)

If you are an employer or constructor, you can use this form to give written reports and notices to the Ministry of Labour, Training and Skills Development, the joint health and safety committee and the union (if there is one) if there is a fatality, injury, occupational illness, or other workplace incident under sections 51-53 of the Occupational Health and Safety Act.

Need help downloading or filling forms?

Please check our Help page for solutions to common issues.

Alert! Adobe is making changes that affect all PDF forms.

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 on00276
Title Report of a workplace fatality, injury, illness or incident (OHSA s. 51, 52 ,53)
Description If you are an employer or constructor, you can use this form to give written reports and notices to the Ministry of Labour, Training and Skills Development, the joint health and safety committee and the union (if there is one) if there is a fatality, injury, occupational illness, or other workplace incident under sections 51-53 of the Occupational Health and Safety Act.