Yukon WSCB Doctor's First Report (F-0043) Guide

Yukon physicians send this one-page report after first attending a worker who has, or may have, a work-related injury, and the Workers' Safety and Compensation Act requires it within two days. It records the worker's account of the injury, subjective complaints, objective findings, diagnosis, treatment plan and follow-up, and goes with a Functional Abilities form that the worker also receives. Later updates go on the Doctor's progress report (F-0042).

Who completes it

The attending physician completes the whole form and attaches the board's Functional Abilities form (F-0044), giving the worker a copy. The worker files their own claim for compensation with the WSCB.

How to fill it in

Worker's information

Enter the worker's last and first name, sex, telephone number, date of birth, address, date of injury, employer and occupation. For the health care number, tick Yukon or Other and specify the jurisdiction if the worker's coverage is from elsewhere. Dates on this form are written dd/mm/yy, with the day first.

Doctor's information

Give your name, address and telephone number, or use your health care provider's stamp. Enter the date and time of the visit and the worker's family doctor; WSCB policy notes that the family physician is generally responsible for the worker's ongoing care. In 'Claim # or Body Part', enter the claim number, or the injured body part if no claim number exists yet.

Subjective

Complete two boxes: the worker's description of the mechanism of injury, and their subjective complaints. Record the worker's own account of how the injury happened at work, including the activity and the body part involved, and keep the complaints specific to the injured area so they line up with the findings and diagnosis in the Objective section.

Objective

Describe objective findings, including any diagnostic results, then enter the diagnosis and the treatment plan and medication. When deciding what health care to approve, the board considers the treating provider's recommendation and the intended benefit of the treatment for the work-related injury. Some tests and treatments, such as non-emergency referrals requiring travel outside Yukon, need the board's prior approval.

Any follow-up plan? / Functional Abilities form

Tick yes or no for a follow-up plan and give the date of the follow-up visit. Next to it, the form asks you to attach a Functional Abilities form (F-0044) and give a copy to the worker. Functional abilities means what the worker can and cannot do with respect to the injury; this information goes to the worker, employer and board and is used to develop a return-to-work plan with the worker.

Any factors that might complicate recovery?

Tick yes or no for factors that might complicate recovery, such as a pre-existing condition, and explain any yes, attaching details if needed. The WSCB has a specific policy on pre-existing conditions (Policy 2.3), so name and describe the condition rather than only ticking the box.

Common mistakes

Sending the report more than two days after first attending the worker, the deadline in section 113 of the Act and WSCB Policy 4.4.
Leaving out the Functional Abilities form (F-0044), or not giving the worker a copy, both of which the report asks for.
Ticking yes for factors that might complicate recovery without explaining them; the form asks you to explain and attach details if needed.
Writing dates month first; the Doctor's First Report asks for every date as dd/mm/yy.
Treating workers without a WSCB service agreement, which the board requires of health care providers who support injured workers' recovery.

Submitting and payment

How to submit it: Fax or mail the report to the Yukon WSCB in Whitehorse, using the contact details printed on the form, within two days after your first attendance on the worker, with the Functional Abilities form attached.
Who pays: The WSCB pays health care providers at its standardized rates for each profession and a set amount for information provided under the Act, including functional abilities information on its own form, and providers need a WSCB service agreement.

Good to know

Health care providers who treat injured workers must have a service agreement with the WSCB, applied for through the online Yukon Health Care Provider Application (F-0198).
Section 113 of the Act also requires you to give the worker reasonable information and advice, free of charge, about filing a claim, and it makes your reports the property of the board.
If an employer asks you to complete its own functional abilities form, the employer pays for it and must obtain separate consent from the worker.
Physicians are pre-approved for many services, but some tests and treatments need prior WSCB approval, such as non-emergency referrals requiring travel outside Yukon.

Get the official form

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

Doctor's first report

Official page PDF

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.

Sources for this guide

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Frequently asked questions

How soon must a Yukon doctor send the Doctor's First Report?

Within two days after first attending a worker who has, or may have, a work-related injury, under section 113 of the Workers' Safety and Compensation Act and WSCB Policy 4.4. After that, send progress reports as you consider appropriate or as the board requires; the WSCB publishes a Doctor's progress report (F-0042) for this.

Do I need to attach a Functional Abilities form to the Yukon first report?

Yes. The report asks you to attach a Functional Abilities form (F-0044) and give the worker a copy. The board pays health care providers for functional abilities information given on its own form, shares it with the worker and employer, and uses it to develop a return-to-work plan with the worker.

What if the worker has no claim number yet?

The field is labelled 'Claim # or Body Part', so enter the injured body part when there is no claim number yet. Also record the worker's health care number, ticking Yukon or Other with the jurisdiction for workers covered elsewhere, and the worker's family doctor, who WSCB policy says is generally responsible for ongoing care.