This form is used by physicians and nurse practitioners to document patient information, injury details, treatment plans, and return-to-work assessments for workers' compensation claims in Nova Scotia.

This form is for out-of-province providers to complete. 

Form to be completed by physicians for the request of an assistive device. 

This form is required in order to assess the worker’s claim regarding hand/wrist symptoms being causally related to the workplace.

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). 

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.

WCB protects Nova Scotia’s workforce. We are the province’s provider of workplace injury insurance. Every day, we prevent workplace injury. When it happens, we help the people whose lives it touches, supporting an early and safe return to work.