Forms and guides

Worker guides and publications

• Worker handbook
  Your guide to the WCB-Alberta experience; includes injury reporting form, automobile accident report form, and information release form. UPDATED! Nov/20
• Back to basics
  This booklet will help you get to know your back, understand why back pain occurs, how to manage it and how to maintain good back health.
  • Back to basics French
• Office ergonomics
  This booklet contains suggestions to help you work comfortably and avoid injuries at your work.
  • Office ergonomics French
• Modified work wallet card
  A tool to help plan for your return to the job. Use this card to discuss modified work options with your employer.
• The shoulder book
  This booklet will help you better understand the anatomy of your shoulder and your shoulder injury during recovery.

Worker injury reporting form

• Worker report of injury or occupational disease form (form only) - C060
  This form must be completed and submitted to WCB in order for the claims process to begin. UPDATED! Nov/20
• Worker report of injury or occupational disease form (with instructions) - C060
  This guide will help you when completing the paperwork to report your injury. UPDATED! Nov/20
• Progressive questionnaire form - C504
  Injuries that occur over time require more information. Complete this form along with your report of injury or occupational disease form.

Worker forms (A - Z)

• Asbestosis exposure claim forms - C060/C013/C117/C847
  This package includes the worker report of injury or occupational disease (C060), pulmonary history questionnaire (C013), worker's employment record (chemical exposure) (C117) and assignment of damages agreement (C847).
• Assignment of compensation form - C140
  Use this form when your employer has kept you on full pay through your period of temporary disablement.
• Authorize a worker representative/information release form - C622
  Use this form to authorize another party to act on your behalf on your claim.
• Authorize a worker representative for widow/widower form - C622W
  Use this form if you are a widow or widower receiving survivor benefits and wish to authorize another party to act on your behalf.
• Automobile accident report form - L054
  Work-related motor-vehicle accidents require completion of this form along with your report of injury.
• Cardiac questionnaire - C684
  A form used to help get a sense of your cardiac health; taking factors such as lifestyle and medical, family and employment history into consideration.
• Damaged eye glasses form - C697
  Use this form when only your eyeglasses have been damaged in a workplace accident (i.e. you have not injured your eye).
• Dermatitis questionnaire - C437
  This form is used to better understand your skin health; taking factors such as employment, family and medical history into consideration.
• Direct deposit request form - C078
  Use this form to sign up to have your benefit payments deposited directly into your designated bank account.
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• Election to claim fatality form - C876
  Use this form to claim a work-related fatality in Alberta when the accident occurred outside the province.
• Election to claim under the Alberta WCB - C1040
  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 in Alberta.
• Emotional injuries (general information questionnaire) - C844
  This questionnaire helps us better understand your current lifestyle and symptoms that may be contributing to your emotional injury.
• Employment health benefit reimbursement declaration - C1329
  Use this form to report extended health benefits expenses.
• Employment record (chemical exposure) form - C117
  Use this form to outline your work history related to your chemical exposure over time.
• FOIP - request to access information
  Use this form to request the release of your personal information or access general information.
• FOIP - request to correct personal information
  This form can be used to correct your personal information or correct another person's information if you have the authority to act for them.
• Hearing loss forms package - C042/C139/C131
  This package includes a hearing information questionnaire (C042), employer's information questionnaire (C139) and worker's employment record (C131).
• Medical information release form - C463
  Use this form to authorize your health care provider to provide WCB with medical records that are relevant to your claim.
• Personal attendant's wage loss form - C936
  Use this form to request payment assistance for a personal attendant who was required to assist you and has suffered a wage loss.
• Progressive injury questionnaire - C504
  Injuries that occur over time require more information. Complete this form along with your report of injury.
• Pulmonary history questionnaire - C013
  Complete this questionnaire to provide more information about your health history as it relates to your pulmonary injury or illness.
• Request for interim relief - G041W
  Use this form to apply for interim relief (temporary financial support) while a decision is under review or appeal.
• Request for review form - G040
  Complete this form if you require a review of a customer service decision.
• Right of election form - C169
  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.
• Short term home assistance invoice - C1138
  Complete this form if you are in the early stages of recovery from a serious injury and have hired someone to help you with home care tasks (e.g., lawn care, snow removal).
• Translation and interpretation services
  Use these forms if you require translation or interpretation help.
• Travel and expense record form - C688
  Use this form to claim expenses for travel related to your work injury. Discuss available travel payments with your case manager or adjudicator prior to travel.
• Wage loss form - C394
  Use this form to claim wages lost due to attendance at a claim-related appointment.