Health and Safety Declaration Form:McKeil School of Business, School of Communications, Creative Industries & Liberal Studies

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 Guidelines for Workplace Insurance for Postsecondary Students on Unpaid Work Placements

The Postsecondary Student Unpaid Work Placement Workplace Insurance Claim Form is available on the Ministry's Website.

Declaration

The Placement Employer hereby agrees to immediately report any workplace injury, illness or disease involving a student on an unpaid work placement to Mohawk College. Where the Placement Employer is covered by WSIB, they will also complete a Letter of Authorization to Represent the Placement Employer that allows Mohawk College to represent the Placement Employer on matters related to the WSIB claim.

The Placement Employer agrees that it will provide the Student Trainee with health and safety training and supervision to protect them from health and safety hazards that may be encountered at the Placement Employer's workplace and assist them with completion of "Student Work Placement Safety Checklist".