Ins3166 2026

1. Click ‘Get Form’ to open the ins3166 in the editor.
2. Begin by entering the employer’s address of residence where the live-in caregiver will reside. Fill in the number, street, city, province/territory, postal code, and telephone number.
3. Indicate whether the live-in caregiver will have their own bedroom by selecting 'Yes' or 'No'.
4. Specify if the caregiver’s bedroom is located inside the premises where care will be given by selecting 'Yes' or 'No'.
5. Confirm if the bedroom has a door with a lock and a safety bolt by choosing 'Yes' or 'No'.
6. Check if there is a secure exterior window that locks from within by selecting 'Yes' or 'No'.
7. Provide the dimensions of the assigned bedroom (e.g., 9 m² or 2.7 m x 3.40 m).
8. For each item listed regarding bedroom amenities (finished walls, floors, ceilings, heating, lighting, closet, bed with mattress, bedding), select 'Yes' or 'No'.
9. Add any additional details about furniture and services available for the caregiver's bedroom.
10. Finally, ensure both employers print their names and sign along with dates at the bottom of the form.

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