These forms are available for completion and online submission through the Board's website.
After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. It should be saved for your records. DO NOT MAIL THIS FORM TO THE BOARD.
| Form Number | Form Title | Registration required? | Comments |
|---|---|---|---|
| C-3 | Employee Claim | No | Must be filed within two years of injury, or within two years after employee knew or should have known that injury or illness was related to employment. If your injury was the result of the use or operation of a licensed motor vehicle: If you filed a Department of Motor Vehicles Form MV-104 (Report of Motor Vehicle Accident), please submit a copy along with the C-3. This will expedite the process for you to receive potential benefits. Additional instructions on sending information to the board. |
| RFA-1W| | Request for Assistance By Injured Worker | No | The form may be filed at any time after the Board assigns a WCB case number, or any time after the Board has indicated that no further action (NFA) will be taken. Note: When filing required documents (e.g., medical evidence indicating permanency), provide the appropriate document identification if it is already in the case folder. |
| VDF-1 | Loss of Wage Earning Capacity Vocational Data Form | No | Injured Workers who may have a non-schedule permanent impairment and who have not returned to work are encouraged to complete and submit Form VDF-1 as early as possible in the claim. |
If the form you are looking for is not available for online submission, you may print the PAPER version of the form from our list of common forms.