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  • Application for Compensation Benefits and Report of Injury or Illness – Electronic Form 67
    Type: Workers
    Date: April 22, 2026
    Description:

    The Electronic Form 67 is a convenient online method for employers to report a workplace injury claim 24 hours a day, seven days a week.

  • Surviving Spouse Questionnaire – Deaths Occurring on or After July 1, 2025
    Type: Workers
    Date: March 3, 2026
  • Contractors and Subcontractors Form
    Type: Employers
    Date: January 2, 2025 Last Revised: January 16, 2026
    Description:

    Form to report contractors and subcontractors must be completed and returned no later than February 28, 2025.

  • Initial Psychological Assessment Report
    Type: Health Care
    Date: March 20, 2016 Last Revised: November 7, 2025
    Description:

    The report is due within 14 days of discharge. 

  • Mental Health Provider Report
    Type: Health Care
    Date: November 7, 2025 Last Revised: November 7, 2025
  • Medical Aid Request
    Type: Workers
    Date: November 1, 2022 Last Revised: May 28, 2025
    Description:

    Use this form if you had an approved claim that is now closed (you're no longer receiving any benefits from WorkSafeNB such as loss of earnings or medical aid) and require medical aid for your previously approved work-related (compensable) injury or illness. 

  • Surviving Spouse Questionnaire – Dependents
    Type: Workers
    Date: March 10, 2020 Last Revised: March 10, 2025
    Description:

    The benefits you receive from WorkSafeNB are reviewed annually on the anniversary of your spouse’s death and adjusted in accordance with the percentage increase established by WorkSafeNB.

  • Surviving Spouse Questionnaire – New Spouse
    Type: Workers
    Date: March 10, 2020 Last Revised: March 10, 2025
    Description:

    The benefits you receive from WorkSafeNB are reviewed annually on the anniversary of your spouse’s death and adjusted in accordance with the percentage increase established by WorkSafeNB.

  • Travel Expense Form
    Type: Workers
    Date: March 20, 2016 Last Revised: February 7, 2025
    Description:

    Medical expense related travel is any visit to a medical professional such as visits to physicians, physiotherapists, chiropractors and any other treatment provided to help you recover from your workplace injury.

    Non-medical expense related travel may include appointments with WorkSafeNB staff, at the staff members’ request, appointments for vocational testing or training and WCAT hearings.

  • Long-term Disability Questionnaire
    Type: Workers
    Date: March 10, 2020 Last Revised: February 5, 2025
    Description:

    In accordance with the Workers' Compensation Act, adjustments to Long-Term Disability (LTD) benefits are made on the anniversary month of your injury or recurrence of injury.

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