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  • Form 1 – Complaint
    Type: Workers
    Date: January 21, 2020
    Description:

    Under section 25 of the Occupational Health and Safety Act, an employee may file a complaint against an employer or union if the employer or union has taken, or threatens to take, a discriminatory action against the employee because the employee complied with the Act, the regulations or an order or because the employee sought the enforcement of the Act, the regulations or an order. 

  • Application for Optional Personal Coverage
    Type: Employers
    Date: January 6, 2020
    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.

  • Instructions for completing Form 100
    Type: Employers
    Date: January 6, 2020
    Description:

    The pre-printed Form 100 must be completed (even if the employer ceased operating) and returned no later than February 28, 2020. Any Form 100 received after this deadline will be subject to a late filing penalty.

  • Subcontractor Form
    Type: Employers
    Date: January 6, 2020
    Description:

    Form to report contractors and subcontractors must be completed and returned no later than February 28, 2020.

  • Travel Expense Form
    Type: Workers
    Date: March 20, 2016 Last Revised: January 1, 2020
    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.

  • Hearing Loss Package
    Type: Workers
    Date: December 3, 2019
    Description:

    Noise-induced hearing loss (NIHL) is the most common permanent work-related disease in Canada. Though hearing loss typically happens gradually, damage is permanent.  WorkSafeNB hearing loss questionnaire.

  • Audiometric Report
    Type: Health Care
    Date: August 28, 2019
    Description:

    Audiometric testing of a worker’s hearing is important to the success of a hearing conservation program because it helps determine if occupational hearing loss is being prevented by the noise control measures.

  • Medical Form 8-10
    Type: Health Care
    Date: August 20, 2019 Last Revised: August 20, 2019
    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. 

  • Estimate of Required Dental Services
    Type: Health Care
    Date: June 27, 2019 Last Revised: June 27, 2019
    Description:

    Estimate of required dental services to be completed by attending dentist/denturist and forwarded promptly to WorkSafeNB.

  • Form 33 – Claimant 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

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