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WSCC Hand Injury Report (CS009): NWT and Nunavut

The WSCC asks for this two-page report when a worker in the Northwest Territories or Nunavut has a work-related hand injury. The provider marks amputations and impaired joints on a hand diagram, then records flexion and extension lag in degrees for each finger joint and thumb measurements, for the injured hand and for the uninjured hand. It closes with other impairments, usefulness of the hand and expected further improvement.

Who completes it

The examining health care provider completes and signs the whole report, including worker details, the WSCC claim number and their WSCC supplier billing number. The worker and employer do not complete any part.

Submitting and payment

How to submit it
Email or fax it to WSCC's NWT or Nunavut claims department as printed on the form; WSCC's invoicing FAQ asks for medical reports within three business days of attending the worker.
Who pays
The form has lines for your WSCC supplier billing number, fee codes, fees submitted and the report form fee, and WSCC pays medical invoices submitted within one year of the service.

Good to know

  • Mark amputations with straight lines showing site and direction, an 'O' on ankylosed joints, and an 'X' on joints with permanently restricted range of movement from the incident.
  • WSCC asks for degrees of lack of extension, not the contained angle: a joint flexing to 90 degrees with full extension is recorded as 90 degrees flexion and 0 degrees lag.
  • For an ankylosed joint, record the fixed position as both the utmost flexion and the lack of extension; the back page explains the method with diagrams.
  • Thumb measures are radial abduction in degrees, and adduction and opposition in centimetres from the thumb IP joint, recorded for left and right hands.

Get the official form

Download the current version from the source each time; forms change without notice.

Hand Injury Report

Rapport de blessure à la main

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Why does the WSCC Hand Injury Report ask about the uninjured hand?

Section 7 asks for the same flexion and extension lag measurements for each finger joint and the thumb of the non-injured hand. The form also asks which hand is dominant and for any previous defects in each hand, so the report records both hands side by side.

How do I measure extension lag on the WSCC hand form?

Measure both flexion and extension as the angle from the distal end of a normal straight finger. Record the position of greatest voluntary flexion, and the angle short of straight at greatest voluntary extension. If flexion reaches a right angle with no extension loss, record 90 degrees and 0 degrees.

Is the WSCC Hand Injury Report available in French?

Yes. WSCC publishes CS009 as a fillable PDF in English and in French, as Rapport de blessure à la main, and the English form notes that a French version is available. The same form, printed code CS009 0824, serves workers in both the Northwest Territories and Nunavut.