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WorkSafeBC

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Forms inquiries

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.

WorkSafeBC Forms

Form# Name Date
6/7 Independent operator's application for compensation and report of injury or occupational disease
(PDF 76kb/2 pages) 		R03/06
7 Online incident and injury report  
7 Employer's report of injury or occupational exposure
(PDF 270kb/2 pages) 		R01/08
7A The First aid report form is no longer in use. The information on it has been consolidated into the online and paper versions of Form 7. Find out more.  
7F Employer's report of injury or occupational disease — Fishing
(PDF 106kb/2 pages) 		02/05
9 Employer's statement of return to work
(fillable PDF 113kb/2 pages) 		R03/06
1800 Online WorkSafeBC registration R04/04
1800 Employer's registration application
(PDF 481kb/4 pages) 		R09/06
1801/1800 Personal Optional Protection insurance application package
(PDF 6.3mb/8 pages) 		R01/08
1810 Guide to completing your Employer Payroll and Contract Labour Report
(PDF 624kb/6 pages) 		R12/05
18E3 Application for alternative assessment procedure for interjurisdictional trucking
(PDF 27kb/4 pages) 		R7/01
25M13 Request for disclosure
(fillable PDF 104kb/1 page) 		R07/07
30M33 Assurance of compliance with WorkSafeBC regulation, part 19
(PDF 97kb/7 pages)
Sample only for viewing online. Forms are individually coded and can be ordered from WorkSafeBCStore.com. 		R02/07
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
52E40 Incident investigation report
(PDF 157kb/4 pages) 		R01/07
52E40F Fishing incident investigation report
(PDF 315kb/3 pages) 		R05/07
52E48 Notice of project online form  
  Notice of project: Forestry, aircraft, diving, underground workings
(PDF 59kb/1 pages)
Sample only for viewing online. Forms are individually coded and can be ordered from WorkSafeBCStore.com. 		R01/06
52E49 Notice of project online form  
  Notice of project: Construction, asbestos, lead
(PDF 88kb/2 pages)
Sample only for viewing online. Forms are individually coded and can be ordered from WorkSafeBCStore.com. 		R11/05
55B23 First aid record
(PDF 43kb/1 page) 		R01/06
55M7 Order for certification training materials - training agency use only
(fillable PDF 198kb/2 pages) 		R01/08
55M60 Occupational first aid patient assessment
(PDF 46kb/1 page) 		R01/06
57M2 Material Safety Data Sheet - 9 sections
(PDF 43kb/2 pages) 		R6/99
57M6 Material Safety Data Sheet - 16 sections
(PDF 66kb/4 pages) 		R6/99
57M7 Discriminatory action - employer or union response
(PDF 69kb/2 pages) 		02/07
63M1 Request for review
(fillable PDF 150kb/3 pages) 		R03/07
63M2 Notice to participate
(fillable PDF 78kb/2 pages) 		01/03
63M4 WCB authorization of representative
(fillable PDF 207kb/1 page) 		08/04
6A Worker's report of injury or occupational disease to employer
(PDF 81kb/2 pages)
(Provided here so employers can give to workers.)		 R04/05
Form# Name Date
3 WorkSafeBC health care claim
(fillable PDF 92kb/1 page) 		R03/06
4 Application for hearing loss resulting from exposure to long-term occupational noise
(fillable PDF 112kb/2 pages) 		R03/06
6 Application for compensation and report of injury or occupational disease
(fillable PDF 149kb/2 pages) 		R03/06
6A Worker's report of injury or occupational disease to employer
(PDF 81kb/2 pages) 		R04/05
6AB Application of worker - asbestos-related disease
(PDF 153kb/4 pages) 		R01/04
6/7 Independent operator's application for compensation and report of injury or occupational disease
(PDF 76kb/2 pages) 		R03/06
11M7 Request for access to records
(PDF 53kb/1 page) 		R03/07
19W1 Direct deposit/address change (for monthly pension benefits)
(PDF 77kb/1 page) 		R10/06
19W153 Stop payment request
(PDF 42kb/1 page)
R10/04
25M13 Request for disclosure
(fillable PDF 104kb/1 page) 		R07/07
25W40 Hearing loss and employment questionnaire
(PDF 103kb/4 pages) 		R03/06
25W100 Request for income loss
(PDF 96kb/1 page) 		04/07
25W112 Change of name, address, or contact information
(PDF 177kb/1 page) 		R08/04
57W1 Worker complaint of discriminatory action
(PDF 209kb/9 pages) 		R01/08
57W2 Discriminatory action - worker election
(PDF 51kb/1 page) 		04/06
57W4 Discriminatory action - worker consent
(PDF 44kb/1 page) 		04/06
63M1 Request for review
(fillable PDF 158kb/3 pages) 		R07/06
63M2 Notice to participate
(fillable PDF 78kb/2 pages) 		01/03
63M4 WCB authorization of representative
(fillable PDF 207kb/1 page) 		08/04
63M5 Review Division submission
(PDF 145kb/2 pages)
Information sheet to 63M5
(PDF 78kb/1 page) 		08/04
66W5 Death information of pensioner/widow(er)
(PDF 54kb/1 page) 		10/03
69W1 Worker's authorization for release of personal information
(PDF 344kb/1 page)		 09/06
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
Form# Name Date
65D2 External provider network service invoice
(PDF 340kb/2 pages)
R06/07
  Individualized job placement intake report: Action plan
(Word 152kb/3 pages) 		R09/07
  Individualized job placement monthly report
(Word 134kb/2 pages)
R09/07
  Individualized job placement follow-up report
(Word 167kb/3 pages) 		R09/07
  Individualized job placement report
(Word 101kb/2 pages)
R09/07
  Job-finding club final report
(Word 178kb/4 pages) 		R09/07
  Job-finding club intake report
(Word 101kb/2 pages)
R09/07
  Job-search skills final report
(Word 140kb/2 pages) 		R09/07
  Psycho-vocational testing/assessment final report
(Word 155kb/3 pages)
R09/07
  Resume and cover letter preparation final report
(Word 128kb/2 pages) 		R09/07
  Supported job placement intake report: Action plan
(Word 153kb/3 pages)
R09/07
  Supported job placement monthly report
(Word 125kb/2 pages) 		R09/07
  Supported job placement follow-up report
(Word 169kb/3 pages)
R09/07
  Supported job placement report
(Word 169kb/3 pages) 		R09/07
  Vocational interest and aptitude testing final report
(Word 153kb/3 pages)
R09/07