IWAP REGISTRATION

USW LOCAL 1-500 MEMBERS
NEED HELP APPEALING YOUR WSIB CLAIM
START HERE!

INJURED WORKER ASSISTANCE PROGRAM REQUEST FOR ASSISTANCE

USW LOCAL 1-500

* Indicates required field

Member Name *

First

Last

Your Home Address *

City *

Postal Code *

WSIB CLAIM NUMBER *

DATE OF INJURY *

Name of your Workplace *

Email ( if possible please ) *

Phone Number *

Cell Number *

CAN WE TEXT YOU ? *

YES NO

Choose your preferred initial contact method *

MY SERVICE REP IS *

Comments *