APPEAL FORM FOR WSIB DENIED CLAIM

Please submit your WSIB denied claim as soon as possible. This form is made specifically for Toronto Airport location. *Other base/location employees will need to manually send an email to their own Health & Safety Team with the information below.*

HEALTH & SAFTEY UNIFOR DISTRICT 301 TEAM ( TORONTO AIRPORT)
safety@yyzd301.com | 905-676-2992 | Office Hours: Tues-Fri from 0730-1730

FULL NAME *

First

Last

EMPLOYEE NUMBER *

PHONE *

PERSONAL EMAIL (NOT YOUR COMPANY EMAIL) *

DATE OF INJURY *

BRIEF DESCRIPTION OF INJURY *

RETURN TO WORK DATE (IF APPLICABLE)

PLEASE UPLOAD AN ELECTRONIC OR SCANNED COPY OF YOUR WSIB DENIAL LETTER. *SCREENSHOT OR PHOTO OF THE DOCUMENT WILL NOT BE ACCPETED. *

Click or drag a file to this area to upload.

NOTE: MAXIMUM FILE SIZE FOR UPLOAD IS 3MB. | IF YOU NEED A SCANNER PLEASE DROP BY THE UNION OFFICE FROM MON-FRI 0700-1800.

Submit