Injury Reporting Forms
Placement Accident Report – This is the University’s injury reporting form. The information that is obtained within the form is used to polpulate the insurance claim form. It is crucial that the form be completed in it’s entirety. Of special importance is the the contact information, social insurance number and date of birth for the student trainee, as well as the date and location of where medical assistance was sought. It should be sent to the Office of the Vice-Provost, Students & First-Entry Divisions (OVPS) via email at placements@utoronto.ca or via fax to 416-946-0678 and to the University’s placement coordinator within 24 hours of an injury being reported.
MTCU Claim Form – This form must be filled out for all student injuries that occur where the workplace insurance is covered through the MTCU. It is primarily filled out by the University’s placement coordinator and requires their signature along with the signatures of both the placement site supervisor and the Student Trainee. It should be submitted to the OVPS via email at placements@utoronto.ca or within 48 hours of an injury being reported.
MTCU ACE-INA Claim Form – This form should be filled out in the event that an injury takes place in a workplace that is not covered under the WSIB for a Student Trainee that has workplace insurance through the MTCU. It should be submitted to the OVPS via email at placements@utoronto.ca or within 48 hours of an injury being reported. Please note that this form is not intended to replace the University’s Accident Report.
Authorization to Represent the Employer – This authorizes the University to act on the placement’s site behalf in filing a workplace insurance claim for the Student Trainee. It must be filled out for all student injuries that occur where the workplace insurance is covered through the MTCU. It is jointly completed by the University’s placement coordinator and the placement site supervisor and should be submitted to the OVPS via email at placements@utoronto.ca or within 48 hours of an injury being reported.
Functional Abilities Form (FAF) – This is is an optional WSIB form designed to facilitate return to work discussions between the placement employer and the injured/ill Student Trainee. Either the Student Trainee or the placement employer can request that the form be completed. It should only be used when the Student Trainee is functionally able to return to some kind of work. It is completed by the treating health professional, and provides the placement employer and the injured/ill Student Trainee with a common frame of reference about the Student Trainee’s functional abilities so they can identify jobs that are suitable for them in order to facilitate their return to the placement as soon as possble.