Forms

Type
Keywords
Sort By

Your search returned 50 results. Page 3 of 5

  • 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).

  • Long-term Disability Questionnaire
    Type: Workers
    Date: March 10, 2020 Last Revised: March 10, 2020
    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.

  • Permanent Partial / Total Disability
    Type: Workers
    Date: March 10, 2020 Last Revised: March 10, 2020
    Description:

    In accordance with the Workers' Compensation Act, a review of your Permanent Partial/Total Disability award will be made on the anniversary month of your accident and if applicable, adjusted in accordance with the changes in the New Brunswick Industrial Aggregate Earnings.

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

  • 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. 

  • 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.

  • 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

Page 3 of 5

E-News Sign-up