OIS Employer Sign Up - WCB Alberta

OIS Employer sign up form - HC-424

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

Note: * indicates a required field
Authorization by employer representative with signing authority: *

Additional company information:
Main contact person

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.