The MT Practicum Office assumes the responsibility for submitting the claim. In order to submit the claim, two forms are completed: completed by both the Placement Letter of Authorization to Represent Employer form, employer [placement site] and the relevant Practicum Coordinator; available from Phillippa Pothemont at p.pothemont@utoronto.ca The completed by Placement employer ACE INA Insurance Accident Report Form, [placement site] and faxed to the MT Practicum Office; available from Phillippa Pothemont at p.pothemont@utoronto.ca The MT Practicum Office submits these two forms along with a photocopy of the signed WSIB Student to the University WSIB Administrator. The contact information is Declaration of Understanding Form provided below. Contact information for the University WSIB Contact information for the MT Practicum Administrator: Office Anne Chreptak Phillippa Pothemont WSIB Administrator Practicum Program Assistant Health & Programs & Services Master of Teaching University of Toronto Ontario Institute for Studies in Education 263 McCaul Street, 2nd Floor Toronto, Ontario University of Toronto M5T 1W7 252 Bloor St. W., Room 11-104D Tel: 416 978-8804 Toronto, Ontario Fax: 416 971-3052 M5S 1V6 Tel: 416 978-0041 Fax: 416 926-4746
The MT Practicum Office assumes the responsibility for submitting the claim. In order to submit the claim, two forms are completed: Letter of Authorization to Represent Employer form, completed by both the Placement employer [placement site] and the relevant Practicum Coordinator; available from Phillippa Pothemont at p.pothemont@utoronto.ca The ACE INA Insurance Accident Report Form, completed by Placement employer [placement site] and faxed to the MT Practicum Office; available from Phillippa Pothemont at p.pothemont@utoronto.ca The MT Practicum Office submits these two forms along with a photocopy of the signed WSIB Student Declaration of Understanding Form to the University WSIB Administrator. The contact information is provided below. Contact information for the University WSIB Administrator: Contact information for the MT Practicum Office Anne Chreptak WSIB Administrator Health & Programs & Services University of Toronto 263 McCaul Street, 2nd Floor Toronto, Ontario M5T 1W7 Tel: 416 978-8804 Fax: 416 971-3052 Phillippa Pothemont Practicum Program Assistant Master of Teaching Ontario Institute for Studies in Education University of Toronto 252 Bloor St. W., Room 11-104D Toronto, Ontario M5S 1V6 Tel: 416 978-0041 Fax: 416 926-4746
Document_1-WSIB_Overview_2018.docx