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

Worker’s exposure claim adjudicative approach

WSIB Form and Explanation