Audit Registration

Legal Company Name

Full Company Address

Certifying Partner (Enform, AASP, ACSA)

Company Contact Name *

First

Last

Contact Phone Number

Contact Email *

Proposed audit start dates

Province’s Included in the Audit

WCB Account Number (AB)

WCB Industry Code (AB)

Scope of work Performed (AB)

Additional Account Number (BC)

WCB Industry Code (BC)

Scope of work Performed (BC)

Additional Account Number (SK)

WCB Industry Code (SK)

Scope of work Performed (SK)

Additional Account Number (MB)

WCB Industry Code (MB)

Scope of work Performed (MB)

Previous audit Dates

Previous audit Scores

Existing COR Number AB

Existing COR Number BC

Existing COR Number SK

Existing COR Number MB

Alberta

British Columbia

Saskatchewan

Manitoba

Total No. of Active Worksites

Total Number of Employees

Total Workers Breakdown

Locations

Sr. Manager

Mid. Managers

Supervisors

Workers

Locations

Sr. Manager

Mid. Managers

Supervisors

Workers

Locations

Sr. Manager

Mid. Managers

Supervisors

Workers

Locations

Sr. Manager

Mid. Managers

Supervisors

Workers

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Phone