Health and Safety Declaration Form

Process for Workplace Insurance Claims for Postsecondary Students on Unpaid Work Placements

The Government of Ontario pays the WSIB for the cost of benefits provided to Student Trainees enrolled in an approved program at Mohawk College and participating in unpaid work placements with employers who are either compulsorily covered or have voluntarily applied to have Workplace Safety and Insurance Board (WSIB) coverage.

The Ministry also covers the cost of private insurance coverage (Chubb) for Student Trainees enrolled in an approved program at Mohawk College and participating in unpaid work placements with employers that are not required to have compulsory coverage under the Workplace Safety and Insurance Act.

The Postsecondary Student Unpaid Work Placement Workplace Insurance Claim Form must be completed when submitting an insurance claim (WSIB or Chubb). (The below link for reference, only needs to be filled out if an accident were to occur)

The Guidelines for Workplace Insurance for Postsecondary Students on Unpaid Work Placements

The Postsecondary Student Unpaid Work Placement Workplace Insurance Claim Form is available here:https://forms.mgcs.gov.on.ca/dataset/bfcf23ab-fa13-408a-afd9-306b4a9e2f…13-1352e[1].pdf