This site will look much better in a browser that supports web standards, but it is accessible to any browser or Internet device.

Customer Support Centre
Phone 604 276-3135
Toll-free 1 888 855-2477
Select a tab below to find forms for employers, workers, or health care providers. Most forms are PDFs designed to be printed out and completed. Others can be completed and submitted online, and some are available as an online application. Printed forms can also be ordered from the WorkSafeBCstore.
![]() |
To view PDF documents you must have Adobe Acrobat Reader 6.0 or greater installed on your system. To obtain a copy of the free reader visit the Adobe web site. |
| Form# | Name | Date |
|---|---|---|
| 8/11 | Physician's report (fillable PDF 117kb/2 pages) Quick reference guide (PDF 150kb/22 pages) |
R03/06 |
| 8/11 Addendum | Practitioner's
report / Additional information (PDF 64kb/2 pages) |
R08/03 |
| 8C/11C | Chiropractor's
report (fillable PDF 121kb/2 pages) |
R03/06 |
| 8N | Naturopathic
physician's first report (fillable PDF 202kb/2 pages) |
R05/08 |
| 11A | Physician's
invoice (fillable PDF 134kb/1 page) |
R12/07 |
| 11AN | Naturopathic
physician's invoice (fillable PDF 139kb/1 page) |
R02/08 |
| 11H | Hospital
account (fillable PDF 159kb/1 page) |
R05/08 |
| 11N | Naturopathic
physician's progress/final report (fillable PDF 184kb/2 pages) |
R05/08 |
| 11RC | Chiropractor's
x-ray report (PDF 130kb/2 pages) |
R11/07 |
| 267 | Invoice
for treatment services (fillable PDF 162kb/1 page) |
R01/08 |
| 268 | Physiotherapy report (fillable PDF 142kb/3 pages) or (fillable MS Word 251 kb/2 pages) |
R10/07 |
| 382 | Dentist's
report (PDF 123kb/2 pages) |
R05/08 |
| 10D4 | Invoice
for psychology services (fillable PDF 162kb/1 page) or (fillable MS Word 229kb/1 page) |
R05/08 |
| 10D5 | Psychology assessment report (fillable MS Word 221kb/1 page) |
R09/07 |
| 10D6 | Mental health treatment report (fillable MS Word 228kb/2 pages) |
R09/07 |
| 25W38 | Forwarding
form regarding eyeglasses (PDF 53kb/1 page) |
R06/04 |
| 51D3 | Hearing
aid battery invoice (fillable PDF 99kb/1 page) |
R01/08 |
| 51D4 | Audiological diagnostic report (fillable MS Word 236kb/2 pages) |
R09/07 |
| 51M1 | Employer
authorization for submission of construction industry hearing
test (PDF 45kb/1 page) |
R06/05 |
| 51M12 | Request
for extension to industrial audiometric technician authorization (fillable PDF 95kb/1 page) |
R07/08 |
| 51M13 | Application
for authorization to conduct hearing tests under Occupational
Health & Safety Regulation 7.8 (PDF 52kb/1page) |
11/05 |
| 51M14 | Order form for
hearing loss prevention materials (fillable PDF 107kb/1 page) |
R07/06 |
| 51W6 | Hearing
aid replacement information (fillable PDF 92kb/1 page) |
R03/08 |
| 51W12 | Hearing
aid provision and services invoice (fillable PDF 132kb/1 page) |
R06/08 |
| 83B100 | Memo
to diagnostic imaging records (fillable PDF 93kb/1 page) |
R11/04 |
| 83D2 | Diagnostic
imaging requisition (fillable PDF 109kb/1 page) |
R04/08 |
| 83D3 | WorkSafeBC nerve blocks (fillable PDF 139kb/2 pages) |
R05/08 |
| 83D4 | Request
for magnetic resonance image (MRI) consultation (fillable PDF 83kb/2 pages) |
R10/07 |
| 83D5 | Surgical
facility invoice (fillable PDF 127kb/1 page) |
R11/07 |
| 83D6 | Authorization
request for expedited surgery (PDF 53kb/1 page) |
R09/04 |
| 83D8 | Summary
invoice for expedited surgery (fillable PDF 58kb/1 page) |
R12/07 |
| 83D9 | Summary
invoice for assist (fillable PDF 46kb/1 page) |
R12/07 |
| 83D10 | Summary
invoice for anesthesia (fillable PDF 138kb/1 page) |
R12/07 |
| 83D11 | Activity-related soft tissue disorder (ASTD) services invoice (fillable PDF 68kb/1 page) |
R12/07 |
| 83D12 | Board-sponsored
rehabilitation services fax cover sheet (fillable PDF 485kb/1 page) |
R10/07 |
| 83D13 | Invoice for prosthetic services (fillable PDF 155kb/1 page) |
R01/08 |
| 83D16 | Invoice for orthotic services (fillable PDF 63kb/1 page) |
R01/08 |
| 83D18 | Head
injury assessment and treatment services referral confirmation
(fillable PDF 60kb/1 page) |
R05/08 |
| 83D19 | Request for authorization for prosthetic services (fillable PDF 169kb/2 pages) |
R04/08 |
| 83D20 | Request for authorization for orthotic services (fillable PDF 116kb/1 page) |
R03/08 |
| 83D21 | Return
to work support services referral confirmation (fillable PDF 90kb/1 page) |
R12/07 |
| 83D22 | Wound
care and IV services invoice for WorkSafeBC (fillable PDF 136kb/1 page) |
R02/08 |
| 83D23 | Permanent
functional impairment (PFI) referral confirmation
(fillable PDF 96kb/1 page) |
R04/08 |
| 83D24 | Community occupational therapy initial assessment report and plan (fillable PDF 131kb/2 pages) or (fillable MS Word 136kb/2 pages) |
R04/08 |
| 83D25 | Community occupational therapy file review report (fillable PDF 286kb/2 pages) or (fillable MS Word 113kb/1 page) |
R04/08 |
| 83D26 | Community occupational therapy invoice (fillable PDF 161kb/2 pages) |
R03/08 |
| 83D27 | Community occupational therapy referral confirmation (fillable PDF 43kb/1 page) or (fillable MS Word 136kb/1 page) |
R04/08 |
| 83D29 | Hand program
direct referral information sheet (fillable PDF 77kb/1 page) |
R02/08 |
| 83D30 | Program
interrupt notification: Amputee Multidisciplinary Program (fillable PDF 43kb/1 page) |
R05/08 |
| 83D31 | Head
injury assessment and treatment services (HIATS) invoice (fillable PDF 153kb/1 page) |
R05/08 |
| 83D32 | Medical and return-to-work planning (MARP) assessment services
referral confirmation (fillable PDF 102kb/1 page) or (fillable MS Word 119kb/1 page) |
R03/08 |
| 83D33 | Pre-approved adaptive aids
(fillable PDF 127kb/1 page) |
R04/08 |
| 83D34 | Residential Care Services monthly update (fillable PDF 333kb/3 pages) or (fillable MS Word 269kb/3 pages) |
04/08 |
| 83D36 | Provider pre-authorized travel and expense confirmation (fillable PDF 98kb/1 page) |
11/07 |
| 83D37 | Construction
Safety Training System Invoice (fillable PDF 42kb/1 page) |
R11/07 |
| 83D38 | Complex medication consultation fax cover sheet (fillable PDF 58kb/1 page) |
R10/07 |
| 83D41 | Sympathetically-mediated pain rehabilitation services (SPRS) invoice (fillable PDF 63kb/1 page) |
R11/07 |
| 83D42 | Pain management program invoice (fillable PDF 69kb/1 page) |
R11/07 |
| 83D43 | Community occupational therapy progress report and plan (fillable PDF 121kb/2 pages) or (fillable MS Word 140kb/2 pages) |
R05/08 |
| 83D44 | Community occupational therapy discharge report (fillable PDF 43kb/1 page) or (fillable MS Word 122kb/1 page) |
R05/08 |
| 83D51 | Generic Report - Medical and Health Care (fillable PDF 173kb/1 page) |
03/08 |
| 83D102 | Residential Care Services clinical care plan (fillable PDF 177kb/3 pages) or (fillable MS Word 181kb/3 pages) |
04/08 |
| 83D103 | Residential Care Services invoice (fillable PDF 123kb/1 page) |
12/07 |
| 83D110 | Hearing Aid Program cover sheet (PDF 83kb/1 page) |
02/08 |
| 83D112 | Tinnitus Retraining Therapy (TRT) report (fillable MS Word 241kb/2 page) |
09/07 |
| 83D128 | Generic Invoice - Medical and Health Care (fillable PDF 116kb/1 page) |
11/07 |
| 83D132 | Residential addiction services fax cover sheet (fillable PDF 77kb/1 page) |
01/08 |
| 83D138 | Comprehensive multidisciplinary pain assessment invoice (fillable PDF 63kb/1 page) |
R04/08 |
| 83D139 | Return to work support services invoice (fillable PDF 64kb/1 page) |
R04/08 |
| 83D140 | Amputee multidisciplinary program invoice (fillable PDF 61kb/1 page) |
R04/08 |
| 83D141 | Functional capacity evaluation invoice (fillable PDF 64kb/1 page) |
R04/08 |
| 83D142 | Permanent functional impairment (PFI) assessment invoice (fillable PDF 60kb/1 page) |
R04/08 |
| 83M1 | Pre-operative assessment (PDF 52kb/2 pages) |
10/07 |
| 83M10 | Vehicle
modification assessment (fillable PDF 1.0mb/7 pages) |
05/08 |
| 83M11 | Home care services referral confirmation (fillable PDF 238kb/1 page) or (fillable MS Word 151kb/1 page) |
03/08 |
| 83M12 | Home care services assessment (fillable PDF 505kb/6 pages) or (fillable MS Word 279kb/5 pages) |
04/08 |
| 83M13 | Home care services care plan (fillable PDF 373kb/3 pages) or (fillable MS Word 180kb/3 pages) |
03/08 |
| 83M14 | Home care services invoice (fillable PDF 223kb/1 page) or (fillable MS Word 211kb/1 page) |
03/08 |
| 83M15 | Home care services progress/discharge report (fillable PDF 313kb/2 pages) or (fillable MS Word 185kb/1 page) |
03/08 |
| 83M102 | Independence and home maintenance allowance referral (fillable MS Word 96kb/2 pages) |
R04/08 |
| 83M108 | Self-managed care - care plan cost (fillable PDF 62kb/1 page) or (fillable MS Word 166kb/1 page) |
03/08 |
| 83W5 | Physiotherapy
initial notification (fillable PDF 91kb/1 page) |
R04/08 |
| 83W6 | Self-managed care (SMC) monthly reconciliation report (fillable PDF 114kb/1 page) |
04/08 |
| 83W133 | Self-managed care quarterly update (fillable MS Word 190kb/3 pages) |
01/08 |
| 83W134 | Self-managed care invoice (fillable PDF 95kb/1 page) |
03/08 |