Reminder! All Audit Registration forms (online and printed) must be accompanied by a signed Letter of Agreement for Auditing Services. This applies to all audits. It must be signed and returned to Enform before the Auditor can begin the audit. Please fax the signed Letter of Agreement to (403) 250- 1827 prior to starting the audit.

Company Information

Existing COR number:
* WCB registered Company Name required:
* Company Address:
* City:
* Province:
* Postal Code:
* Company Contact Name:
* Phone:
Client Fax:
Email:

Please indicate if the client is a member of one of the listed associations by choosing the appropriate option below.

	No association membership.
	CAODC
	PSAC
	CAPP
	CAGC
	SEPAC
	CEPA

WCB Account Information
The Certificate of Recognition is directly connected to the WCB account number. Please ensure you enter all accounts that will be covered by the audit.

	Province	WCB#	Industry Code
1.
2.
3.

Protocol Being Used

New COR Audit Protocol (Prior training seminar required)

Audit Sampling

	Representative of WCB account(s)
	Site specific audit (permission required)
	One audit covering multiple companies (permission required)

Total Number of Worksites:  
Number of worksites in the scope of the audit:  
(Must be representative of the employer operation - if you require assistance with your sampling please contact corinfo@enform.ca or the call centre at 1-800-667-5557

Total Number of Employees:  
Number of interviews in the scope of the audit:  
(Must be representative of the employer operation)

*All forms to request permission are available on the auditor support site.

Auditor Information

* Auditor Name:
Auditor Cert. Number:
Auditor Fax Number:
* Approximate start date:	< July 2010 > Sun Mon Tue Wed Thu Fri Sat 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7
Auditor Email address:

Type of Audit
Please choose one from Group A and (if necessary) one from Groups B and C:

Group A
	Not applicable
	External
	External - SECOR
	External - Review of non-pass audit
	Renewal
	Maintenance
	Maintenance - SECOR
	PASE
	Limited Scope
	Roll-Up Option

Group B
	Not applicable
	Student Auditor Certification
	Auditor Recertification
	Auditor Certification Maintenance
	ATU Service Rig Audit
	Return to Work

Group C
	Not applicable
	Team Audit (permission required)

Comments or questions:

I have read and understand the Terms of Reference and Policies and Procedures.