Worker's Report of Injury Form

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To file a claim with the WCB, you must complete and submit this form. A decision cannot be made without this form having been completed, and it must be submitted within six(6) months from the date of your accident. If you are unable to complete this form online, you can choose the appropriate PDF form by clicking here.

Step 1 of 8

Response required

Do you have an Access Code to restore a draft report? Yes No

Access Code:

Injured Worker's Date of Birth

Are you filling out this report for your own injury or on behalf of someone else? Note: You should only fill out this report for someone else if that person is unable to complete the report themselves.

I was Injured

Someone else was injured

What type of work-related injury occurred?

Acute Incident

Ex. I slipped and fell and injured my ankle. I lifted something heavy and felt pain in my back. I touched a hot stove and burned my hand. A knife slipped and I cut my finger.

Psychological

Ex. I witnessed a work-related death or serious injury. I’ve been repeatedly exposed to traumatic events and situations throughout my career.

Hearing Loss

Ex. I have sustained hearing loss resulting from exposure to occupational noise throughout my career. I have sustained hearing loss as a result of a specific incident, such as an explosion or sudden blast of noise.

Occupational Disease

Ex. I was exposed to asbestos in the workplace. I developed asthma after being exposed to irritants at work. I developed contact dermatitis after being exposed to a specific substance or material. As a firefighter, I developed cancer after being exposed to the hazards of a fire.

Fatality

Ex. I am filing a claim on behalf of someone who sustained a fatal work-related injury or illness.

I Want To Reopen A Previously Closed Claim

Ex. I had a previously-closed claim for a work-related injury, and because I’m once again experiencing symptoms directly related to that injury, I would like to have my claim reopened. (Please have your claim number ready, if available.)

Repetitive Strain

Ex. I developed shoulder tendonitis as a result of prolonged overhead work. I developed carpal tunnel syndrome resulting from my repeated use of tools. I developed epicondylitis as a result of repetitive work on a production line.

If you have questions, please contact the WCB Claims and Compensation Division at 902-368-5680 or toll-free 1-800-237-5049 in Atlantic Canada.