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.
• 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.
  No print copies available.
  • Office ergonomics French
• 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.
• Worker report of injury or occupational disease form (with instructions) - C060
  This guide will help you when completing the paperwork to report your injury.
• 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.

Send your completed form(s) to WCB via fax or mail*. For the fastest and most convenient service, submit reports via our mobile app or electronic injury reporting.

*WCB-Alberta PO Box 2415, Edmonton, AB T5J 2S5 or Fax: 780-427-5863

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.
• 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.
• Childcare invoice
  Submit this form to claim childcare expenses. Please discuss any childcare needs with you case manager or adjudicator ahead of time.
• 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).
• Dependent spouse or partner’s authorization of a representative 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.
• 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.
  Select another language...
  French | Spanish | Chinese (Traditional) | Chinese (Simplified) | Hindi | Punjabi
• 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 WCB-Alberta - 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.
• 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.
• 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 PDF request 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.
• Fraud report online form
  If you believe someone is misusing the workers’ compensation system, you can use this online form to let us know.
• 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.
• 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.
• Request to access information
  Use this form to request the release of your personal information or access general information.
• 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.
• 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.
• Worker Post Injection Report
  Use this form after pain management injections to track efficacy and post-injection function.