Forms

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Long-term Disability Questionnaire
Type: Workers
Date: February 20, 2019
Application for Optional Personal Coverage
Type: Employers
Date: January 7, 2019
Subcontractor Form
Type: Employers
Date: January 7, 2019
Employer Registration – Application for Coverage – Printable Form
Type: Employers
Date: January 7, 2019
Instructions for completing Form 100
Type: Employers
Date: January 7, 2019
Form 33 – Client Prescription Information
Type: Health Care
Date: January 11, 2011 Last Revised: November 8, 2018
Description:
This form is used for the reimbursement of items or drugs purchased by an injured worker.

Pharmacies my use this from to direct bill WorkSafeNB for approved personal items purchased by the client for the compensable injury.

Out of Province pharmacies may also use this form for direct billing of approved drugs. They do not have access to e-pay
Code of Practice – Fall Protection
Type: Employers
Date: August 2, 2018
Description:
This guide can help you comply with Section 50.2 of the General Regulation 91-191.
NOTE: Not for use when a safety monitor is part of the fall protection system on a work site.
Form 67 – Report of Accident or Occupational Disease
Type: Workers
Date: March 1, 2018
Description:
This report must be submitted within three (3) days after the accident
Direct Deposit Information Form
Type: Workers
Date: February 13, 2018 Last Revised: February 27, 2018
Description:
Direct Deposit Information Form
Joint Health & Safety Committee Minutes | Excel Version | Word Version
Type: Workers
Date: February 27, 2017 Last Revised: February 1, 2018
Description:
Joint Health & Safety Committee Minutes

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