Resources | Workers Compensation Board of Manitoba [PDF]

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Source: www.wcb.mb.ca/resources/worker-form

Instructions for completing downloadable fillable forms: To begin entering data: Place your cursor in the field in which you wish to begin and left mouse click to anchor the cursor. Begin typing the information in the field. If you are unable to enter information in a particular field, it is likely that the form was programmed to receive a numerical response in that particular location. Dates must be entered numerically as DD MM YYYY. To navigate the fields: Use the TAB key to move to the next blank field or left mouse click your cursor into the field in which you wish to enter information. If you miss or need to change a field, use your SHIFT/TAB keys simultaneously to move back to that space and make your change or left mouse click in the appropriate field. To print the form: You can print the form from FILE, PRINT menu and print as you would any other document. If you have fax software available, you may be able to select the software as your printer in order to fax the page. Things to watch for: If the cursor disappears, just left mouse click in the field you would like to be in. Printing Tip: Some of the forms have text or graphics quite close to the edge of the paper. If your printer is cutting off information, try printing at a reduced size or use "shrink to fit" or "fit to page" in the print dialogue box. Have a question or wish to provide feedback? We would like to know how you feel about the forms, your access to the forms, using the PDF format, or whatever you would like to share. Please email us (mailto:[email protected]?subject=Forms%20Questions%20or%20Comments) with your questions and/or comments. All resources available in alternate formats. Contact [email protected] (mailto:[email protected]) to make a request. English Blank Opioid Treatment Agreement (https://www.wcb.mb.ca/sites/default/files/opioidtreatmentagreement-blank.pdf)

(https://www.wcb.mb.ca/sites/default/files/opioidtreatmentagreement-blank.pdf) Read more (https://www.wcb.mb.ca/sites/default/files/opioidtreatmentagreement-blank.pdf) Eyeglass Form (https://www.wcb.mb.ca/sites/default/files/Eyeglass%20form.pdf)

(https://www.wcb.mb.ca/sites/default/files/Eyeglass%20form.pdf) Read more (https://www.wcb.mb.ca/sites/default/files/Eyeglass%20form.pdf) Notice of Injury to Employer (aka Green Card) (https://www.wcb.mb.ca/sites/default/files/resources/WCB%20Notice%20of%20Injury%20Web%20Form%20AC.pdf)

(https://www.wcb.mb.ca/sites/default/files/resources/WCB%20Notice%20of%20Injury%20Web%20Form%20AC.pdf) This resource is also available in French (https://www.wcb.mb.ca/fr/de%CC%81claration-de-blessure-a%CC%80-l%E2%80%99employeur), Spanish (https://www.wcb.mb.ca/es/notificacio%CC%81n-de-lesio%CC%81n-para-el-empleador), German (https://www.wcb.mb.ca/de/verletzungsmeldung-fu%CC%88rarbeitgeber), Mandarin (https://www.wcb.mb.ca/zhhans/%E8%87%B4%E9%9B%87%E4%B8%BB%E7%9A%84%E5%8F%97%E4%BC%A4%E9%80%9A%E7%9F%A5) and Tagalog (https://www.wcb.mb.ca/tl/paunawa-ng-pinsala-para-sa-employer). Read more (https://www.wcb.mb.ca/sites/default/files/resources/WCB%20Notice%20of%20Injury%20Web%20Form%20AC.pdf) Worker Direct Deposit Form (https://www.wcb.mb.ca/sites/default/files/resources/Direct%20deposit%20form.pdf)

(https://www.wcb.mb.ca/sites/default/files/resources/Direct%20deposit%20form.pdf) Read more (https://www.wcb.mb.ca/sites/default/files/resources/Direct%20deposit%20form.pdf) Worker Hearing Loss Report (https://www.wcb.mb.ca/sites/default/files/resources/WorkerHearingLossReportandWorkHistory%20Fillable_1.pdf)

(https://www.wcb.mb.ca/sites/default/files/resources/WorkerHearingLossReportandWorkHistory%20Fillable_1.pdf) Read more (https://www.wcb.mb.ca/sites/default/files/resources/WorkerHearingLossReportandWorkHistory%20Fillable_1.pdf) Worker Incident Report (https://www.wcb.mb.ca/sites/default/files/resources/worker-sp%281%29.pdf)

(https://www.wcb.mb.ca/sites/default/files/resources/worker-sp%281%29.pdf) This resource is also available in French (https://www.wcb.mb.ca/fr/rapport-dincident-de-travail-0), Spanish (https://www.wcb.mb.ca/es/informe-de-incidente-de-trabajopor-parte-delde-la-trabajadora), German (https://www.wcb.mb.ca/de/arbeitsunfallmeldung) and Tagalog (https://www.wcb.mb.ca/tl/ulat-ng-insidente-ng-manggagawa). Read more (https://www.wcb.mb.ca/sites/default/files/resources/worker-sp%281%29.pdf) Worker Request for Review Form (https://www.wcb.mb.ca/sites/default/files/resources/RequestforReviewWorker_2.pdf)

(https://www.wcb.mb.ca/sites/default/files/resources/RequestforReviewWorker_2.pdf) Read more (https://www.wcb.mb.ca/sites/default/files/resources/RequestforReviewWorker_2.pdf) Worker Travel, Parking, Medical and Personal Expense Form (https://www.wcb.mb.ca/sites/default/files/resources/Worker%20Expense%20and%20Travel%20Statement_final.pdf)

(https://www.wcb.mb.ca/sites/default/files/resources/Worker%20Expense%20and%20Travel%20Statement_final.pdf) Use this form to submit expenses related to your injury claim to the WCB for reimbursement. You can submit travel, parking, medical and other personal expenses on this form. Read more (https://www.wcb.mb.ca/sites/default/files/resources/Worker%20Expense%20and%20Travel%20Statement_final.pdf) Find Us The Workers Compensation Board of Manitoba is a mutual workplace injury and disability insurance agency funded by employer premiums. We are here to insure and support safe and healthy work and workplaces. We put workers and employers at the centre of all we do. We provide them with valued services for injury prevention, compensation and return to health and work while maintaining system integrity. Copyright © 2017. All rights reserved.

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