Workers who are exposed to a harmful substance at work may not experience immediate ill effects, as many occupational diseases are latent for years and only develop after long periods of exposure.

To address this, we have created an exposure registry form that allows you to record any workplace exposure you may have had. We maintain it as a permanent record that could help you if you need to file an occupational disease claim in the future.

How to submit your form online:

1. Download the form and open it in Acrobat Reader (a free application). If you’re using a mobile device, please download the free Adobe Acrobat Reader app for iOS or Android.
2. Complete the form.
3. At the bottom of the form, select Validate and save to ensure you’ve filled all required fields.
   1. If you haven’t filled in one or more required fields, you’ll be prompted to do so.
   2. Once your form is validated, save it to your desktop or mobile device.
4. Once you save your form to your desktop or mobile device, open the form and select Submit to access a tool that will allow you to submit your completed form.