A. Patient and Employer Information (patient to complete)
The patient fills in their name, address, telephone, Social Insurance Number, date of birth, sex, preferred language and employer name, plus the claim number at the top if they know it. Review it before you send the report. WSIB says Form 8 payments are delayed when Section A is incomplete, illegible or incorrect, so make sure every identifier is filled in and readable.
B. Incident Dates and Details Section
Describe how the injury, reinjury or illness occurred at work, and record the patient's occupation and the date of the incident or when symptoms started. Use the form whether the patient says the condition is work-related or you believe workplace factors caused it. The worker and employer report the injury to the WSIB separately; your obligation is to provide information about the worker's health care.
C. Clinical Information Section
Check all that apply. Mark each area of injury or illness, with right or left where the form asks. Under physical examination findings, tick items such as fracture, sprain/strain, laceration or reduced range of motion, note pain at rest or night pain and a 0 to 10 pain rating, and mark exposures such as fumes, needle stick, hearing loss or hand-arm vibration. Then note any pre-existing or other conditions that may affect recovery, and record your diagnosis.
D. Treatment Plan
Describe the treatment plan, including type of treatment, duration and prescribed medications. Item 2 is for physicians only: list up to four work injury or illness medications with dose, frequency and duration. Item 3 records investigations (labs, X-rays, CT, MRI, EMG, ultrasound) and referrals the patient would benefit from, such as physiotherapy, psychology, a specialist, an occupational health centre or a Regional Evaluation Centre, with the referral name and appointment date if known.
E. Billing Section
Tick your designation (chiropractor, physician, physiotherapist or registered nurse in the extended class) and enter your WSIB Provider ID, invoice number, service date, name, address and telephone. The service code is pre-printed as 8M; the chiropractor, physiotherapist and nurse practitioner fee schedules list 8M1 for this report. Complete the HST fields (code ONHST) only if HST applies. WSIB lists an incomplete, illegible or incorrect Section E as a cause of payment delays.
F. Return To Work Information: must be completed by a Health Professional
This is page 2, the only page the employer sees. Record whether you discussed return to work, then tick regular or modified duties with start dates and any graduated hours, or explain why the worker cannot work. Mark functional abilities (bend/twist, climb, kneel, lift, sit, stand, walk, push/pull, upper extremities, driving, heavy equipment, public transit), other limitations, how long they will apply (from 1 to 2 days up to 14+ days) and the follow-up plan, then print your name and sign.
G. Worker's Signature
The worker signs and dates this box to authorize you to give their employer a copy of page 2 outlining their functional abilities, and acknowledges that a copy goes to the WSIB. The page repeats the worker's name, birth date, areas of injury and incident date at the top so it can be handed over on its own. Give the worker a copy of this page only, never page 1.