Service Provider – Assistive Devices Request Form
Form to be completed by service provider for request of assisted devices.
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Assistive_Devices_Form_ServiceProvider.pdf
(35.08 KB)
CTS - Physician Hand/Wrist Report
This form is required in order to assess the worker’s claim regarding hand/wrist symptoms being causally related to the workplace.
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Eye Injury Report
The form is required in order to assess the level of eye impairment, if any, with respect to the worker’s traumatic eye(s) injury(s).
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Eye Injury Report Aug2105 Final.pdf
(78.97 KB)
Primary and Emergency Care Report
This form is completed by physicians or nurse practitioners to report injury details, treatment, and return-to-work status for workers receiving primary or emergency care. Fax completed form to 902-491-8001.
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WCB-Primary-and-Emergency-Care-Report.pdf
(149.36 KB)
Psychology Progress Report-Only Form
Use this version of the form if you are sending it by secure message attachment
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Psychology Progress Invoice and Report Form
Use this version of the form if you are sending it by fax
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Psychology Assessment Report-only Form
Use this version of the form if you are sending it by secure message attachment
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Psychology Assessment Report-only Form.pdf
(675.99 KB)
Employer Request for File Release – Hearing Officer Appeal
A request form for employers to obtain relevant claim file documents from the WCB for a Hearing Officer appeal, completed by an authorized representative.
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