Application to the Worker’s Compensation and Health & Safety Committee Social share icons You must have JavaScript enabled to use this form. Leave this field blank First Name Last Name Street Address Apartment, Suite, etc. City/Town Province - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Personal Email Cell Phone Employer MAP Communications Shaw Stratcom Telus Employee ID # Relevant experience and/or reasons. Relevant courses Work background Submit
