OIS Employer Sign Up - WCB Alberta

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Please complete a separate form for each WCB account number that will be participating in the Occupational Injury Service.

Note: * indicates a required field

WCB account number: *

Company legal name: *

agrees to being an Occupational Injury Service (OIS) partner, has been advised of the OIS program, the fees related to the first office visit and shall: *

Have, or establish, a meaningful modified work program.
Attend an OIS orientation with one participating OIS provider (see drop down list below).
Share the OIS process with all employees and ensure they are aware that OIS is voluntary.
Complete all WCB documentation immediately following a work-related injury.
Contact the OIS clinic in advance to advise them that an injured worker is on their way.
Provide transportation for an injured worker to and from the OIS clinic.
Participate (in person or via telephone) in the return-to-work plan conference and support implementation of the plan.
Immediately notify WCB in the event of any change in the information.

Authorization by employer representative with signing authority: *

Please check to indicate agreement with OIS partner responsibilities.

First name: *

Last name: *

Job title: *

Phone number (with area code): * ( ) -

Additional company information:

Trade name (if different from legal name):

Company address: *

Main contact person

First name: *

Last name: *

Job title: *

Phone number (with area code): * ( ) -

Fax number (with area code): ( ) -

Email address: *

To become an OIS partner, you are required to attend an OIS orientation with a provider. Please select the location and provider for your orientation. *

Following your orientation, you may attend any OIS clinic in Alberta for services.

If you have any questions about completing this form, email us at hcs.ois@wcb.ab.ca or phone 780-498-3219.

Postal disruption information and service notifications

Claims

Report your injury in the myWCB worker mobile app

Treatment and Recovery

Access a doctor within 30 minutes of clinic arrival

Return to Work

Employers, get our training-on-the-job (TOJ) program working for you

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myWCB mobile app for employers

Resources

myWCB mobile apps

About WCB

2023 Annual Report

Millard Treatment Centre

Help at every step in your return-to-work journey

We have the information and tools to support you when an injury happens at work.

Resources

Need help?

OIS Employer sign up form - HC-424

Authorization by employer representative with signing authority: *

Additional company information:

Main contact person