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  • Form 1 – Complaint of Discriminatory Action
    Type: Workers
    Date: January 21, 2020 Last Revised: November 29, 2024
    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. 

  • Notice of Appeal (order, advice or administrative penalty)
    Type: Workers
    Date: October 28, 2021 Last Revised: September 30, 2024
    Description:

    Use this form to appeal an order, advice or administrative penalty (AP) issued under New Brunswick’s Occupational Health and Safety Act or its regulations. The notice of appeal must be filed within 14 calendar days of receiving the order, advice or administrative penalty.

  • Ketamine/Esketamine Review
    Type: Health Care
    Date: August 16, 2024
  • Patient Health Questionnaire (PHQ-9)
    Type: Workers
    Date: May 25, 2022 Last Revised: August 7, 2024
  • Sample Respiratory Protective Equipment Code of Practice
    Type: Employers
    Date: March 20, 2016 Last Revised: July 9, 2024
    Description:

    This code sets out requirements this company will follow for the proper selection, use and care of respiratory protective equipment at this workplace.

  • Travel Expense Form
    Type: Workers
    Date: March 20, 2016 Last Revised: July 3, 2024
    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.

  • Decision Review Application
    Type: Workers
    Date: June 10, 2019 Last Revised: March 14, 2024
    Description:

    A decision review is the required first step in the appeals process. It takes a second look at your claims-related decision to ensure that it is compliant with legislation, policy, and individual merits of your claim. You need to request a decision review before making an appeal to the Workers’ Compensation Appeals Tribunal.

  • Long-term Disability Questionnaire
    Type: Workers
    Date: March 10, 2020 Last Revised: February 22, 2024
    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: February 22, 2024
    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: February 22, 2024
    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.

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