Forms and guides

Guides and publications

• Disability management self assessment – WCB-015
  Learn about reporting work-related accidents, communicating with injured employees and return-to-work best practices. This checklist also helps you identify opportunities for improvement.
• Employer handbook
  Learn about injury reporting, best practices and your responsibilities as an employer.
• Occupational injury services
  Find out more about the Occupational Injury Service (OIS), the benefits of going to a clinic that focuses on work-related injuries, and how the program can benefit employers and workers.
• Employer guide for myWCB online services
  Using your online services.
• Online administrator guide for myWCB online services
  Learn how to use WCB online services for online administrators.
• Partnerships in Injury Reduction (PIR) booklet
  Learn how creating safer workplaces for your workers can also help you lower your WCB premiums.
• Premium rate guide
  This guide provides you with a basic understanding of the process we use when setting industry premium rates.
• Pricing guide
  This guide provides you with an overview of WCB's pricing programs and what they mean for you.
• Worker handbook
  A look at the worker's roles and responsibilities in the workers' compensation system.
• WorkSIGHT
  WorkSIGHT showcases the stories of the people we work with every day, highlighting return-to-work success stories and WCB business information.

Forms

Accountability

• Fraud report online form
  If you believe someone is misusing the workers’ compensation system, you can use this online form to let us know.

Appeals

• Fairness review online request form
  If you believe you were treated unfairly, complete this online form to request a formal fairness review by the Fair Process Review Centre.
• Fairness review form - G302
  If you believe you were treated unfairly, use this form to request a formal fairness review by the Fairness Review Officer and the Fair Process Review Centre.
• Request for interim relief - G041E
  Use this form to apply for interim relief (temporary financial support) while a decision is under review or appeal.
• Request for a review form - G040
  Disagree with a decision? Complete this form for a review of a claim or account decision.
• Request for a review deadline extension form - DRBEXT
  Complete this form if you disagree with a decision that is beyond 12 months and you would like to request a deadline extension for a review of the claim or account decision.

Injury reporting

• Cognitive-psychosocial job demands analysis - C1447
  This analysis is used to outline the cognitive demands and psychological factors that pertain to specific roles in your organization and can help support your modified work program.
• Employer report of injury form (form only) - C040
  Submit this form within 72 hours of being advised of the injury.
• Employer report of injury (with instructions) - C040
  This guide will help you when completing the report of injury paperwork.
• Employer's progressive injury questionnaire - C606
  This questionnaire is used to help determine if an injury that happened over a period of time is work-related.
• Hearing loss claims (employer's information questionnaire) - C139
  This questionnaire is used to help determine if the worker's hearing loss is a work-related condition.
• Individual earnings record - A321
  A record of your worker's earnings. Helps you keep an accurate, up-to-date record of all wages earned by yo
• Physical demands analysis - C545
  This analysis will determine the specific physical requirements of a job and can be used to identify possible modified duties for positions at your company.

Modified work

• Employer claim of undue hardship
  Application for your claim of undue hardship.
• Fitness for work form
  Send this form with your injured worker to fill out with his or her health care provider. This will assist in developing a return-to-work plan for your worker. This form isn't required if the injured worker is going to an Occupational Injury Service clinic.
• Offer of modified work agreement form
  A sample modified work agreement that can be signed by your injured employee once you've agreed on modified work duties.
• Notice to injured employee form
  This letter can be filled in and included as part of the information package for your injured employee. Includes important contact information and return-to-work information.

Managing your account

• Alternative assessment procedure (AAP) application - A596
  Application for interjurisdictional trucking and transport.
• Alternative assessment procedure (AAP) renewal form - A596R
  Renewal application for interjurisdictional trucking and transport.
• Authorization of an employer's representative - C966
  This form grants authority to a representative to act on your behalf.
• Business pre-authorized debit plan form - A639
  We offer a pre-authorized debit (PAD) service. You can also request monthly instalments when you pay your invoices using PAD.
• Claims cost transfer form - A638
  Complete this form to initiate a cost transfer review if you believe another employer or their worker was negligent in causing injury to your worker.
• Closing a WCB-Alberta account - A635
  A request to close your account.
• Deeming order application - A632
  Use this form to assume responsibility for a worker not covered under the Act.
• Employer confirmation of interjurisdictional accounts - C1137
  This form is used if it's determined that a worker may be entitled to workers’ compensation benefits in more than one jurisdiction. By completing this form, you confirm that you didn't have any business and/or operations in the province of residency at the time of the worker’s accident and you're not required to have an account with the other Board.
• Direct deposit sign up/change request - C975
  Use this form to sign up for direct deposit/change your information for Compensation on Assignment payments.

Information requests

• Employer request for claim file - C896
  Fill in this form when you're asking for a copy of a worker's claim file (or an update since the last file request) and are intending to file a request for appeal or cost relief purposes.
• Request for claim file documents form - C1096
  This is a request for specific claim file documents.
• FOIP - Request to access information
  This is a request for access to general or your personal information. Personal information on this form is collected under Alberta’s Freedom of Information and Protection of Privacy Act and will be used to respond to your request.

Program sign up

• Partnerships in Injury Reduction (PIR) employer registration form
  Register to participate in the PIR program. Please note: A certifying partner must be included on your registration form or your PIR registration can't be processed.
• Occupational Injury Service (OIS) employer sign-up - HC-424
  This is a voluntary program giving injured workers quick access to medical services at specialized clinics throughout the province.

Posters

When an injury happens

Employers are required by law to display this poster in the workplace. The 1-2-3 poster gives workers the basic steps of who to contact to report a workplace injury. Under the Workers' Compensation Act, Section 145, Employers are required to display this poster where employees can see it.

Printable versions of the 1-2-3 posters are available in 17 different languages. Please print your own copies in any language you choose.

• Arabic
• Chinese (Simple)
• Chinese (Traditional)
• English
• French
• German
• Japanese
• Korean
• Polish
• Portuguese
• Punjabi
• Russian
• Somali
  
• Spanish
  
• Tagalog
  
• Ukrainian
  
• Vietnamese
  

Right to report

This set of posters reminds workers of their rights and encourages reporting injuries.

• Right to report poster 1
  Right to report poster 2
  Right to report poster 3
  
  Select another language...
  • French
  • Spanish
  • Chinese (Traditional)
  • Chinese (Simplified)
  • Hindi
  • Punjabi

Promoting safety in your workplace

Visit the Alberta Construction Safety Association and Alberta Forest Products websites to download free safety posters for your workplace.

Other resources

• Back to basics
  This booklet helps you understand why back pain occurs, how to manage it and how to maintain good back health.
• Back to basics French
  French version of the Back to basics booklet.
• Office ergonomics
  The introduction of an office ergonomics program is a small but significant step toward reducing work injury in the office. This booklet contains suggestions to help get you started.
  No print copies available.
• Office ergonomics French
  French version of the office ergonomics booklet.
  No print copies available.
• Preventing workplace violence resources

  We offer many resources to help you develop workplace violence prevention programs at your worksite.
  You can order them online or you can download the poster below.

  • Preventing violence at work guide ($2.50)

    This 20-page workbook outlines the basic elements of a workplace violence prevention program. It is intended to serve only as a general guide to be used as part of an overall workplace violence prevention program.

  • Workplace violence: It's everybody's business (DVD) ($15.00)

    This 19 minute video is designed for employers to identify and understand workplace violence and devise methods to prevent it.

  • "Respect" poster ($3.00)

    Place this poster in your workplace and let your employees know that respect and safety is a priority at your worksite.

• The shoulder book
  This booklet provides tips to manage shoulder pain and promote shoulder health.

To order print copies of these resources, please email us with your company name, contact name, mailing address, phone number, booklet requested and quantity. You can also call 780-498-8680.

Note: The first 25 copies of all of these booklets, with the exception of the preventing workplace violence resources, are free of charge. Additional booklets cost $2.50 each.