Worker's Report of Injury Form

The following errors occurred:

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. This includes work-related psychological injuries. 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

Please be advised that employers cannot complete this report on behalf of their injured workers. Instead, employers are legislated to complete an Employer's Report - Form 7 in the event a workplace accident occurs.

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. I've been harassed at work.

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.