FORM: Application for a stay (occupational health and safety, prohibited action, or assessment appeals) | Workers' Compensation Appeal Tribunal (WCAT)

IMPORTANT: To apply for a stay you must submit this form no later than 7 days after the date that WCAT receives your notice of appeal. If the application for a stay is received more than 7 days after the notice of appeal is received, WCAT will deny the stay and process the appeal as usual. WCAT will not process your stay application if your notice of appeal is late (more than 30 days after a Review Division decision or more than 90 days after a WorkSafeBC prohibited action decision), or if your stay application is missing important information.

A “stay” is when WCAT orders WorkSafeBC to delay its implementation of a decision (such as an order that you pay a penalty or other money) until we make a decision on the appeal. A stay is an extraordinary remedy. WCAT will consider the following factors when determining whether to issue a stay:

whether the appeal, on its face, appears to have merit;
whether the applicant would likely suffer serious harm if the stay were not granted (e.g. loss of a business);
which party would likely suffer greater harm or prejudice from granting or denying a stay; and,
in the context of occupational health and safety, whether granting a stay would likely endanger worker safety.

It takes about 10 to 15 minutes to complete this form. Make sure you have the following information ready:

The Review Division or prohibited action decision number and date for the decision you are appealing
The WorkSafeBC claim or employer account number for the decision you are appealing

Questions marked (Required) must be filled out so that WCAT can start your application.

Collection and use of personal information: Personal information on this form is collected for the processing and adjudication of a WCAT matter under the Workers Compensation Act and the Freedom of Information and Protection of Privacy Act. Contact the Freedom of Information Coordinator at WCAT if you have questions.

WorkSafeBC file information

Help us to identify the decision(s) you are appealing and applying to stay.

What type of WorkSafeBC or Review Division decision makes an order you are applying to stay? (Required)

Occupational health & safety
Prohibited action
Assessment

WorkSafeBC employer account number (Required)

Please provide the employer account number (firm file number) affected by the decision you are appealing.

Firm or business name (Required)

Please provide the name of the employer firm or business affected by the decision you are appealing.

Review Division decision (Required)

A Review Division decision may cover more than one request for review. List below each Review Reference number that makes an order you are applying to stay.

Reference # (e.g. R0123456)	Decision date (yyyy-mm-dd)

WorkSafeBC prohibited action decision (Required)

List below each prohibited action decision number that makes an order you want WCAT to stay during the course of the appeal.

Prohibited action number (e.g. 2019D999)	Prohibited action decision date (yyyy-mm-dd)

Additional decision information

Provide any additional number(s) related to the order you are applying to stay, such as a request for sanction (RFS) number, administrative penalty order number, or inspection report number.

Tell us about yourself

Your name (as the employer contact) (Required)

First Last

Your pronouns and title

Your pronouns and title will help us to address you respectfully during the appeal process. If you choose “not listed”, a new field will open where you can tell us your pronouns and/or title.

You are free to skip these questions. If there is information about your gender in the WorkSafeBC or Review Division file(s), we will use that when choosing how to address you.

Your pronouns

They/Them
She/Her
He/Him
Pronouns not listed

Your pronouns (Required)

Please tell us your pronouns.

Your title

Your title (Required)

Please tell us how you would like to be addressed.

Your position/job title

Your business/firm mailing address (Required)

Street address Address line 2 City Province / State / Region Postal / Zip code Country

Your phone number (daytime) (Required)

Your phone number (other)

Your fax number

Your phone number (daytime) (Required)

Your phone number (other)

Your fax number

Explain why WCAT should grant your application for a stay

Please complete all of the following sections. This is your submission so you should provide all the information WCAT needs to decide whether to grant your stay.

Explain briefly why your appeal should succeed: (Required)

Explain how you or your business would likely suffer serious harm if WCAT did not grant the stay (e.g. loss of a business): (Required)

It is important that you send any supporting documents, such as financial statements, to WCAT as soon as possible after submitting this form. You can send documents by email, mail, or fax.

Explain which party to the appeal would likely suffer more if the stay were granted or denied, and why: (Required)

Would a stay of the decision being appealed likely endanger worker safety? Please explain: (Required)

List any other factors that you believe support your application for a stay: (Required)

Certification

Full name of the person signing this form: (Required)

Authorization of representative (Required)

This form must be signed by the appellant or an authorized representative. If signed by an authorized representative, we need an authorization less than 2 years old signed by the appellant. Please indicate how authorization has been provided.

I do not have a representative
An authorization of representative form will be submitted online
An authorization of representative should be on the WorkSafeBC or WCAT file

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the following: (Required)

I confirm the information on this form is correct and complete. I will notify WCAT if I change my address or phone number. I understand that WCAT must have my current address to keep my appeal active.

Date signed

Email address for form confirmation

Enter an email address here if you would like to receive confirmation that WCAT received your form. WCAT will send you a copy of the completed form by mail or email (depending on your preferences as shown on the notice of appeal form).

Enter email Confirm email

Phone

This field is for validation purposes and should be left unchanged.