The following forms are available for workers and employers. If you require more information please refer to the contact page.

Mohawk Self Insurance Forms

MSI Policy
Instructions for the completion of MSI-A form
Instructions for the completion of MSI injury forms
Instructions for the completion of the MSI Safe Maternity forms
MSI-A form – MSI Registration Form
MSI-Ae form – Subsidy Program Application Form
MSI-Be form – Subsidy Program Worker’s Information Form
MSI-1 form – Worker’s Claim Form
MSI-4 form – Safe Maternity Program
MSI-8 form – Medical Update Form
MSI-16e form – Employer Subsidy Salary Reimbursement Request Form
MSI 18 form – Accident Investigation Report form
MSI-21 form – Temporary Work Assignment Form

Certification & Competency

Contractors Certification Certificate Application Form
KTCP Competency Card Application
KTCP Construction Trades Criteria and Wage Schedules for Workers on the Mohawk Territory of Kahnawà:ke

Occupational Safety & Health

Notice of Alleged Safety or Health Hazards Form