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Customer Support Centre
Phone 604 276-3135
Toll-free 1 888 855-2477
Select a tab below to find forms for employers, workers, or health care providers. Most forms are PDFs designed to be printed out and completed. Others can be completed and submitted online, and some are available as an online application. Printed forms can also be ordered from the WorkSafeBCstore.
*New: Vocational Rehab forms have been added.
Form# | Name | Date |
---|---|---|
8/11 | Physician's report (fillable PDF 117kb/2 pages) Quick reference guide (PDF 150kb/22 pages) |
R03/06 |
8/11 Addendum | Practitioner's
report / Additional information (PDF 64kb/2 pages) |
R08/03 |
8C/11C | Chiropractor's
report (fillable PDF 121kb/2 pages) |
R03/06 |
8N | Naturopathic
physician's first report (fillable PDF 115kb/2 pages) |
R03/06 |
11A | Physician's
invoice (fillable PDF 88kb/1 page) |
R03/06 |
11AN | Naturopathic
physician's final report and account (fillable PDF 210kb/2 pages) |
R03/06 |
11H | Hospital
account (fillable PDF 95kb/1 page) |
R03/06 |
11RC | Chiropractor's
x-ray report (PDF 93kb/2 pages) |
07/03 |
267 | Invoice
for treatment services (fillable PDF 98kb/1 page) |
R03/06 |
268 | Physiotherapy report (fillable PDF 117kb/2 pages) or (fillable MS Word 217 kb/2 pages) |
R10/07 |
382 | Dentist's
report (PDF 79kb/2 pages) |
R04/05 |
10D4 | Invoice
for psychology services (fillable MS Word 207kb/1 page) |
R07/06 |
10D5 | Psychology
assessment report (fillable MS Word 175kb) |
R05/07 |
10D6 | Mental
health treatment report (fillable MS Word 182kb) |
R07/06 |
25W38 | Forwarding
form regarding eyeglasses (PDF 53kb/1 page) |
R06/04 |
51D3 | Hearing
aid battery invoice (fillable PDF 106kb/1 page) |
R05/06 |
51D4 | Audiological diagnostic report (fillable MS Word 236kb/2 pages) |
R09/07 |
51M1 | Employer
authorization for submission of construction industry hearing
test (PDF 45kb/1 page) |
R06/05 |
51M12 | Request
for extension to industrial audiometric technician authorization (PDF 49kb/1 page) |
11/05 |
51M13 | Application
for authorization to conduct hearing tests under Occupational
Health & Safety Regulation 7.8 (PDF 52kb/1page) |
11/05 |
51M14 | Order form for
hearing loss prevention materials (fillable PDF 107kb/1 page) |
R07/06 |
51W6 | Hearing
aid replacement information (fillable PDF 92kb/1 page) |
R03/06 |
51W12 | Hearing
aid provision and services invoice (fillable PDF 103kb/2 pages) |
R08/06 |
83B100 | Memo
to diagnostic imaging records (fillable PDF 93kb/1 page) |
R11/04 |
83D2 | Diagnostic
imaging requisition (PDF 60kb/1 page) |
R04/05 |
83D3 | WCB
nerve blocks (PDF 69kb/2 pages) |
R09/04 |
83D4 | Request
for magnetic resonance image (MRI) consultation (PDF 69kb/1 page) |
R11/04 |
83D5 | Surgical
facility invoice (PDF 87kb/1 page) |
R12/06 |
83D6 | Authorization
request for expedited surgery (PDF 53kb/1 page) |
R09/04 |
83D8 | Summary
invoice for expedited surgery (PDF 60kb/1 page) |
R09/04 |
83D9 | Summary
invoice for assist (PDF 58kb/1 page) |
R09/04 |
83D10 | Summary
invoice for anesthesia (PDF 58kb/1 page) |
R09/04 |
83D12 | Board-sponsored
rehabilitation services fax cover sheet (fillable PDF 89kb/1 page) |
R09/06 |
83D18 | Head
injury assessment and treatment services referral confirmation
(fillable PDF 156kb/1 page) |
R04/06 |
83D21 | Return
to work support services referral confirmation (fillable PDF 47kb/1 page) |
R12/05 |
83D22 | Wound
care and IV services invoice for WorkSafeBC (PDF 66kb/1 page) |
11/05 |
83D23 | Permanent
functional impairment (PFI) assessment referral confirmation
(PDF 58kb/1 page) |
R01/06 |
83D24 | Community occupational therapy report and plan (fillable PDF 120kb/2 pages) or (fillable MS Word 198kb/2 pages) |
06/06 |
83D25 | Community occupational therapy file review report (fillable PDF 78kb/2 pages) or (fillable MS Word 177kb/2 pages) |
06/06 |
83D26 | Community occupational therapy invoice/travel log (fillable PDF 142kb/1 page) or (fillable MS Word 178kb/1 page) |
01/07 |
83D27 | Community occupational therapy referral confirmation (fillable PDF 61kb/1 page)or (fillable MS Word 178kb/1 page) |
06/06 |
83D30 | Program
interrupt notification: Amputee Multidisciplinary Program (fillable PDF 61kb/1 page) |
03/06 |
83D31 | Head
injury assessment and treatment services (HIATS) invoice (fillable PDF 167kb/1 page) |
04/06 |
83D32 | Medical and return-to-work planning (MARP) assessment services
referral confirmation (fillable PDF 97kb/1 page) or (fillable MS Word 181kb/1 page) |
04/06 |
83D34 | Residential Care Services monthly update (fillable PDF 333kb/3 pages) or (fillable MS Word 269kb/3 pages) |
01/08 |
83D37 | Construction
Safety Training System Invoice (PDF 74kb/1 page) |
06/07 |
83D102 | Residential Care Services clinical care plan (PDF 191kb/3 pages) |
12/07 |
83D103 | Residential Care Services invoice (PDF 123kb/1 page) |
12/07 |
83D110 | Hearing Aid Program fax cover sheet (PDF 83kb/1 page) |
10/07 |
83D112 | Tinnitus Retraining Therapy (TRT) report (fillable MS Word 241kb/2 page) |
09/07 |
83M10 | Vehicle
modification assessment (fillable PDF 928kb/7 pages) |
08/06 |
83M11 | Home care services — referral confirmation (fillable PDF 189kb/1 page) or (fillable MS Word 194kb/2 pages) |
06/06 |
83M12 | Home care services — assessment (fillable PDF 455kb/6 pages) or (fillable MS Word 318kb/6 pages) |
06/06 |
83M13 | Home care services — care plan (fillable PDF 145kb/3 pages) or (fillable MS Word 232kb/4 pages) |
06/06 |
83M14 | Home care services — invoice (fillable PDF 176kb/1 page) or (fillable MS Word 209kb/1 page) |
06/06 |
83M15 | Home care services — progress/discharge report (fillable PDF 204kb/2 pages) or (fillable MS Word 185kb/2 pages) |
06/06 |
83W5 | Physiotherapy
initial notification (fillable PDF 74kb/1 page) |
R10/07 |