This table summarizes employees and/or Self-Employed individual characteristics. Upon completion, the worker's employment status is determined.
Name of worker:
Worker's social insurance number:
Has the SIN been obtained? Yes
Name of Ocer:
If not, did you document a proof of refusal (this is mandatory)? Yes No
Factors of RC4110
1. The payer controls the result of the work and the method used to do the work.
2. The payer determines and controls the method and amount of pay in an employer-employee relaonship.
3. The worker requires permission to work for other payers while working for you.
4. The worker receives training at the expense of the payer.
5. If the work schedule is irregular, you are the worker's priority.
6. The worker cannot choose when he or she will provide his or her services.
7. The worker cannot refuse work from the payer.
8. The payer performs monitoring in the acvies surrounding the work.
9. The payer decides on the territory to be covered for the work.
10. The payer decides on the reports to hand in (wrien or verbal).
Tools and Equipment
1. The work is done in the payer's workplace.
2. The payer supplies the tools and equipment.
3. The payer is responsible for repair maintenance and insurance costs.
Subcontracng work or hiring assistants
1. The worker cannot hire helpers or assistants.
2. The worker does not have the ability to hire replacements.
1. The worker is reimbursed for any operang expenses.
2. The worker is not nancially liable if he or she does not full the obligaons of the contract.
3. The payer determines and controls the method and amount of pay.
4. The worker is not hired for a specic job (he or she has dierent tasks and projects).
5. The worker receives protecon or benets from the payer.
6. The worker does not adverse and does not acvely market his or her services.
7. The payer covers delivery and shipping costs for the worker.
8. The payer assumes responsibility for ensuring that guarantees relating to materials are honoured.
9. The payer guarantees the quality of work.
Responsibility for investment and management
1. The worker has no capital investment in the business.
2. The worker cannot have his or her own sta.
Opportunity for prot
1. The worker is paid a regular salary (does not incur expenses by performing the services).
2. The worker does not have the chance of prot or risk of loss.
Total columns (the higher number determines the worker's status)
True = Employee False = Self-Employed
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