WSIB Worker’s Exposure Incident Form (3958 A)

The Worker’s Exposure Incident Form (form 3958A) is intended for voluntary use when an unplanned workplace incident exposure has resulted from a leak, spill, explosion, release, or an unexpected contact with a chemical or other substance. The event may have exposed workers to an infectious, chemical or other substance.

The purpose of this form is to obtain information about the exposure incident experienced by the worker should an illness or disease occur in the future.


WSIB Worker's Exposure Incident Form (3958 A) (PDF)