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  • SUCCEED Mental Health Questionnaire
    Type: Health Care
    Date: May 30, 2022
    Description:

    Administer this form to workers participating in the SUCCEED program within one week of starting treatment. Re-administer at the end of treatment. 

  • SUCCEED Discharge Report
    Type: Health Care
    Date: May 25, 2022
    Description:

    Complete and submit this form within one week of treatment end date.

  • 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.

  • 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. 

  • 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.

  • Discomfort Survey
    Type: Workers
    Date: December 16, 2020
    Description:

    To help determine whether your computer workstation requires adjustments

  • Employer Report of Occupational Hearing Loss
    Type: Employers
    Date: November 2, 2020
  • Application for Benefits_Occupational Hearing Loss
    Type: Workers
    Date: November 2, 2020 Last Revised: November 2, 2020

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