4Safety Excellence Enrollment

Choose the applicable option:

I am a COR™ or ISO Certified Organization.

My organization is COR™ or ISO in progress.

My organization belongs to the industrial/retail/services sector.

My organization is a large corporation with 500+ staff and/or multiple locations.

Registration is for:

One WSIB Firm Number

Multiple account and firm numbers.

Please select the appropriate fee category that applies to your firm's WSIB account (Estimate fees based on your 2019 premium amounts):

$1000.00+HST per WSIB firm account up to $1,000,000 in premium

$1000.00+HST per WSIB firm account + 0.1% of total premium over $1,000,000

WSIB Firm Number

WSIB Account Number

WSIB Annual Premium For 2019

Full name of primary contact for your company for the WSIB Excellence program:

Email Address

Company's Legal Name

Phone Number

Cell Number

How did you hear about us?

Please note that your response to this question helps us best serve you with timely information and updates on occupational health and safety

I, the undersigned, agree to enroll for the 4Safety Excellence Program.

I consent to receive email communication & newsletter updates from the 4S team for the same.

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Date

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