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  • Decision Review Form
    Type: Workers
    Date: June 10, 2019 Last Revised: April 27, 2022
    Description:

    The Decision Review Office is here to review WorkSafeNB decisions if you disagree with the original decision.  Injured workers, employers or their representatives can request a review. You can request a review by completing the Decision Review form and forwarding it to the Decision Review Office

     

  • Application for Workers' Compensation Benefits
    Type: Workers
    Date: August 6, 2020 Last Revised: February 22, 2022
    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.

  • Caregiver Receipt
    Type: Workers
    Date: January 10, 2022
    Description:

    Use this receipt template for recording informal home care services performed for a worker (the client) receiving WorkSafeNB benefits.

  • Caregiver Disclosure Statement
    Type: Workers
    Date: January 10, 2022
    Description:

    Complete this disclosure statement if you plan to perform informal home care services for a worker (the client) receiving WorkSafeNB benefits.

  • Notice of Appeal (order, advice or administrative penalty)
    Type: Workers
    Date: October 28, 2021
    Description:

    Use this form to appeal an order, advice or administrative penalty (AP) issued under New Brunswick’s Occupational Health and Safety Act or its regulations. The notice of appeal must be filed within 14 calendar days of receiving the order, advice or administrative penalty.

  • Chiropractic Form 8-10
    Type: Health Care
    Date: April 27, 2021
    Description:

    WorkSafeNB has streamlined reporting for chiropractors by combining the Form 8C, Chiropractor’s First Report of Accident and the Form 10C Chiropractor’s Progress Report into one form, the Chiropractic Form 8-10. It is for both initial visits and follow-up (progress) reports. 

  • Medical Form 8-10
    Type: Health Care
    Date: August 20, 2019 Last Revised: March 11, 2021
    Description:

    The new Medical Form 8-10 requires physicians to provide functional abillities recommendations. Evidence shows workplace connection is good for mental, physical and emotional health. Even if a worker is able to work one hour per week, there are positive benefits. 

  • Employer Report of Injury or Illness
    Type: Employers
    Date: August 6, 2020 Last Revised: January 27, 2021
    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 Alternative Assessment Procedure for Inter-Jurisdictional Trucking
    Type: Employers
    Date: January 12, 2021
    Description:

    Application for the Alternative Assessment Procedure (AAP) for Interjurisdictional Trucking and Transport.

  • Application for Optional Personal Coverage
    Type: Employers
    Date: January 12, 2021
    Description:

    Proprietors, partners and spouses of non-incorporated businesses and non-salaried officers of limited or incorporated companies are not automatically covered for compensation purposes under the Workers’ Compensation Act of New Brunswick. To obtain coverage for these individuals, optional personal coverage must be purchased from WorkSafeNB. Please read the Terms and Conditions of Optional Personal Coverage before completing the application.

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