Publications and forms
Handbook (includes injury reporting form, Automobile accident report
form, and Information release form) (pdf,
- Worker fact sheets
- 2014 pension payment calendar (pdf, 132KB)
- Back to basics (pdf,
82KB) This booklet will help you get to know your back better,
to understand why back pain occurs, how to manage it and how to maintain
good back health.
- Office ergonomics (pdf,
273KB) - 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.
- Modified work wallet card (pdf, 2.5MB) - A tool to help plan for your return to the job. Show the card to your employer and discuss modified work options.
- The shoulder book (pdf, 823KB) - This booklet will help you better understand the anatomy of your shoulder and your shoulder injury during recovery.
- Working safely
behind the wheel (pdf, 470KB) - Keeping
Alberta streets and highways safe is everyone’s responsibility. Working
Safely Behind the Wheel is designed to get drivers thinking about their
driving habits and the consequences of bad driving.
Worker injury reporting form
Worker forms (A - Z)
- Alternative Assessment Procedure (AAP) application - A596 (pdf, 49KB)
- Alternative Assessment Procedure (AAP) application - A596 (doc, 53 KB))
- Asbestosis exposure
claim forms (pdf, 287KB) This package
includes the Workers Report of Injury or Occupational
Disease C060, Pulmonary history questionnaire C013,
Workers employment record (chemical exposure) C117,
Assignment of damages agreement C847.
- Assignment of Compensation
form - C140 (pdf, 49KB) Use this form
when your employer has kept you on full pay through your period of temporary
- Authorize a Worker
Representative / Information Release form - C622 (pdf,
this form to authorize another party to act on your
behalf on your claim.
- Automobile Accident
Report form - L054 (pdf,
49KB) Work-related motor-vehicle accidents require completion of
this form along with your report of injury or occupational disease.
- Damaged eye glasses
form- C697 (pdf, 47KB) Use this form
when only eyeglasses have been damaged (an eye injury has not been sustained).
- Direct Deposit Request
form - C078 (pdf, 26KB) Use this form
to sign up to have your benefit payments deposited directly into your
designated bank account.
- Election to Claim Fatality
form - C876 (pdf, 51KB) Use this form
to elect to claim a work-related fatality in Alberta when the accident
occurred outside the province.
- Election to Claim
under the Alberta WCB - C1040 (pdf, 19KB) Use
this form if you reside outside the province of Alberta
but were injured in Alberta, in a work-related accident
and would like to submit a claim for compensation
- Emotional Injuries
- General Information Questionnaire (pdf, 33KB)
- Employment Record -
Chemical Exposure form - C117 (pdf,
- Employment Record -
Noise Induced Hearing Loss form - C131 (pdf,
- Request to access information (pdf, 590KB)
- Request to correct personal information (pdf,
- Hearing loss
forms package (pdf, 58KB)
Use this form if you have sustained a work-related
Release form - C463 (pdf, 17KB) Use
this form to authorize the release of medical information relevant to
your claim to WCB by health care practitioners.
- Personal Attendant's
Wage Loss form - C936 (pdf,
20KB) Use this form to request payment assistance for a personal
attendant who was required to assist you and has suffered a wage loss.
- Progressive Questionnaire
form - C504 (pdf, 29KB) Injuries that
occur over time require more information. Complete this
form along with your report of injury or occupational
- Pulmonary History
Questionnaire - C013 (pdf, 27KB)
- Report of Injury or
occupational disease form only - C060 (pdf,
of Injury or occupational disease form with instructions
- C060 (pdf,
- Request for Review form
- G040 (doc, 53KB) Complete this form
if you require a review of a customer service decision.
of election form - C169 (pdf, 92KB) Use
this form if you were injured outside of Alberta but normally live or work
in Alberta and would like to claim compensation in Alberta.
- Translation and Interpretation
Use these forms if you require translation or interpretation
and Expense Record form- C688 (pdf, 24KB) Use
this form to claim expenses for work-injury related travel. Discuss travel
payment available with your case manager or adjudicator prior to travel.
- Wage Loss form
- C394 (pdf, 20KB) Use this form to
claim wages lost due to attendance at a claim-related appointment.
You can order WCB publications and
forms online and have them mailed to you.
The minimum order for any single type of publication or form
is ten (with
the exception of Worker Handbook). You can also print a pdf of
the publications and forms.