Workplace Safety Insurance Board Reconciliation Form
This file is a reconciliation form from the Workplace Safety and Insurance Board that calculates total insurable earnings and employer premiums. It provides detailed instructions for reporting earnings, deductions, and premiums. Employers must fill out this form accurately to comply with WSIB regulations.
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How do I fill this out?
Filling out this form involves several steps to ensure accuracy. Start by gathering your gross earnings details and deductions. Follow the sections carefully to allocate insurable earnings by classification.

How to fill out the Workplace Safety Insurance Board Reconciliation Form?
1
Gather all relevant earnings and deduction documents.
2
Fill out Section A with gross earnings before deductions.
3
Complete Section B to allocate total insurable earnings by classification.
4
Calculate premiums in Section C based on classifications and rates.
5
Certify the form in Section D and submit it by the due date.
Who needs the Workplace Safety Insurance Board Reconciliation Form?
1
Employers who have employees in Ontario require this form to report earnings and calculate premiums.
2
Business owners need this form to ensure compliance with WSIB regulations.
3
Accountants may use this file to accurately prepare financial reports for clients.
4
HR departments utilize the form to keep track of employee earnings and deductions for benefits.
5
Organizations that hire contractors need to report earnings accurately to WSIB.
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1
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2
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What are the instructions for submitting this form?
To submit this form, send it to the WSIB at P.O. Box 4115, Station A, Toronto ON M5W 2V3 or fax it to 416-344-4684. Ensure that you include all necessary documentation and your account number for reference. Always check for the submission deadline to avoid penalties.
What are the important dates for this form in 2024 and 2025?
The WSIB Reconciliation Form requires submission by your designated due date, generally specified in your employer guidelines. Important dates include the end of your reporting period and the last day to submit the form to avoid penalties. For 2024 and 2025, please refer to the WSIB for specific deadlines.

What is the purpose of this form?
The purpose of this form is to calculate total insurable earnings for your employees and report them to the WSIB. It ensures that employers contribute the correct premiums to the insurance fund based on reported earnings. This compliance helps protect both employees and employers under workplace safety regulations.

Tell me about this form and its components and fields line-by-line.

- 1. Gross Earnings Before Deductions: Total income before any deductions are applied.
- 2. Deductions From Gross Earnings: List of amounts deducted from the gross earnings.
- 3. Total Insurable Earnings: Net total after deductions that can be covered by insurance.
- 4. Premium Calculation: Calculates the amount due based on insurable earnings.
- 5. Certification: Acknowledgment by the employer of the accuracy of submitted information.
What happens if I fail to submit this form?
Failing to submit this form by the due date may result in WSIB calculating an estimated premium, and penalties may apply.
- Late Penalties: A penalty of 1% of unpaid premiums per month may accrue, up to a maximum of $1000.
- Potential Audit: The WSIB may audit your records if forms are not submitted properly.
- Inaccurate Reporting: Failure can lead to incorrect assessment of premiums, impacting cash flow.
How do I know when to use this form?

- 1. Annual Reconciliation: Use the form for yearly reporting of employee earnings.
- 2. Premium Assessment: Required for calculating employer premiums based on declared insurable earnings.
- 3. Compliance Verification: Essential for proving compliance during audits or inspections.
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Is there a specific format I need to follow?
Follow the WSIB guidelines for accuracy in your submissions.
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What details should I include in the form?
Include accurate earnings, deductions, and other required information.
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