Forms

Type
Keywords
Sort By

Your search returned 44 results. Page 1 of 5

  • Employer Report of Occupational Hearing Loss
    Type: Employers
    Date: November 2, 2020
  • Application for Benefits_Occupational Hearing Loss
    Type: Workers
    Date: November 2, 2020 Last Revised: November 2, 2020
  • Initial Psychological Assessment Report – Instructions
    Type: Health Care
    Date: August 13, 2020
  • Employer Report of Injury or Illness
    Type: Employers
    Date: August 6, 2020
    Description:

    Complete this form if an employee experiences a work-related injury or illness. You must submit this to WorkSafeNB within three days of the: date of the accident if the injury or illness may entitle the worker and/or their dependent(s) to wage  replacement or medical treatment under New Brunswick’s Workers’ Compensation Act; date the employee is diagnosed with an occupational disease; or date you are notified of the accident/injury or illness by the employee.

  • Application for Workers' Compensation Benefits
    Type: Workers
    Date: August 6, 2020 Last Revised: August 6, 2020
    Description:

    Submit this form when applying for WorkSafeNB benefits, such as lost wages and/or medical treatment (physiotherapy, medication, etc.), due to a workplace injury or illness. You must complete this form and send it to WorkSafeNB within one year from the date of the accident/injury or illness.

  • Initial Psychology Assessment Report (IPAR) | Excel Version | Word Version
    Type: Health Care
    Date: June 18, 2020 Last Revised: June 18, 2020
    Description:

    The Initial Psychological Assessment Report (IPAR) asks for information necessary for WorkSafeNB to make an acceptance decision on a claim. WorkSafeNB must determine whether the worker’s injury meets requirements for acceptance under the Workers’ Compensation Act.

  • Psychology Progress Report | Word Version
    Type: Health Care
    Date: June 18, 2020
    Description:

    The Psychology Progress Report (PPR) asks for information necessary to help us understand a worker’s recovery, accommodation options and more. This helps us review progress and opportunities for additional support.

  • Psychology Discharge Report | Word Version
    Type: Health Care
    Date: June 18, 2020
    Description:

    The Psychology Discharge Report (PDR) asks for information necessary to close a course of treatment. It helps us understand the outcomes of that treatment and review overall improvement and possible need for additional support. 

  • Direct Deposit Enrolment Form - Worker
    Type: Workers
    Date: April 8, 2020 Last Revised: April 8, 2020
    Description:

    We encourage clients to sign up for direct deposit if they haven’t already done so. Registration is simple and quick.

  • Direct Deposit Enrolment Form: Provider
    Type: Health Care
    Date: April 8, 2020 Last Revised: April 8, 2020
    Description:

    Sign up for direct deposit (health care providers).

Page 1 of 5

E-News Sign-up