Forms

Type
Keywords
Sort By

Your search returned 57 results. Page 4 of 6

  • Psychology Progress Report | Word Version
    Type: Health Care
    Date: June 18, 2020
    Description:

    The Psychology Progress Report (PPR) asks for information necessary to help us understand a worker’s recovery, accommodation options and more. This helps us review progress and opportunities for additional support.

  • Psychology Discharge Report | Word Version
    Type: Health Care
    Date: June 18, 2020
    Description:

    The Psychology Discharge Report (PDR) asks for information necessary to close a course of treatment. It helps us understand the outcomes of that treatment and review overall improvement and possible need for additional support. 

  • Form B
    Type: Health Care
    Date: May 27, 2020
    Description:

    Form B - if you were ever exposed to noise while working outside of New Brunswick, you must choose the province/territory/state in which you want to apply for compensation. List the other provinces/territories/states where you worked, and then indicate which province/territory/state you choose.

  • 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).

  • 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

  • Code of Practice – Fall Protection
    Type: Employers
    Date: August 2, 2018
    Description:

    This guide can help you comply with Section 50.2 of the General Regulation 91-191.
    NOTE: Not for use when a safety monitor is part of the fall protection system on a work site.

Page 4 of 6

E-News Sign-up