FORM: Notice of Appeal – Review Division assessment or occupational health & safety decision | Workers' Compensation Appeal Tribunal (WCAT)

If you’d prefer to mail or fax a printed copy, use this version: Notice of Appeal – Review Division assessment or occupational health & safety decision (PDF, 105KB).

Notice of Appeal – Review Division assessment or occupational health & safety decision

This form will be your formal notice of appeal. Submit it within 30 days of your Review Division decision. If it’s been more than 30 days, also submit a request for an extension of time.
Appealing a Review Division decision does not delay it taking effect. If the Review Division decision makes any orders (such as an order to pay a penalty) then you may request a “stay” (pause) of that order while WCAT is considering your appeal. If you want to apply for a stay you must submit an Application for a Stay to WCAT within 7 days of the date we receive this Notice of Appeal.
It takes about 10 to 15 minutes to complete this form. Make sure you have the following information ready:
- The Review Division decision number for the decision you are appealing
- The WorkSafeBC employer account number for the decision you are appealing
- The contact information for your representative (if you have one)
Questions marked (Required) must be filled out for WCAT to start your appeal. You don’t need to argue your appeal at this time. Only basic information is required to start your appeal. You can provide more details later.

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.
What would you like to appeal?
Tell us about your Review Division decision. If you don’t have a Review Division decision, find out what you need to do before you can start an appeal.
What type of decision are you appealing? (Required)
- An assessment decision by the Review Division
- An occupational health and safety (prevention) decision by the Review Division
Review Division decision date (Required)
What date was the Review Division decision made?
YYYY dash MM dash DD
Review Division decision number (Required)
What is the Review Reference number for the decision you are appealing? Review Reference numbers begin with the letter R.
Additional Review Reference numbers
A Review Division decision may cover more than one request for review. List each other Review Reference number you are appealing. Use the plus sign to add another row.
Additional information
If applicable, please provide the request for sanction (RFS) number, administrative penalty number, and/or inspection report number(s).
Workplace posting requirement
In some cases, an employer who is party to an appeal of an administrative penalty for an occupational health and safety matter will post a notice to employees of the appeal in one or more conspicuous places at the workplace.
Has the employer posted the Notice to Employees in the workplace? (Required)
- Yes, the employer has posted a Notice to Employees. (Please provide a copy of the completed notice to WCAT)
- No, the employer has NOT posted a Notice to Employees
- I don’t know
The employer has not posted a Notice to Employees because… (Required)
Tell us about yourself
WCAT needs information about you as the appellant (the person starting the appeal) in order to get the appeal registered.
What is your role in relation to the decision you are appealing? (Required)
- I am the employer
- I am the worker
- I am the owner
- I am the dependant of a deceased worker
- I represent the union
- I am a supplier
- I am an independent operator
Employer firm/business name (Required)
WCAT needs to know which employer was affected by the Review Division decision.
WorkSafeBC employer account number (Required)
This is also called a firm file number and is a 6 to 9 digit number issued to an employer by WorkSafeBC. WCAT needs to know which employer was affected by the Review Division decision. Enter “Not Applicable” if not registered with WorkSafeBC.
Your name (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/Hers
- He/His
- Pronouns not listed
Your pronouns (Required)
Please tell us your pronouns.
Your title
- Mx.
- Ms.
- Mr.
- Mrs.
- Dr.
- Title not listed
Your title (Required)
Please tell us how you would like to be addressed.
Your job title or position
How WCAT can send you information
To get appeal information by email, please sign up for WCAT Online Services. Otherwise, WCAT will send you appeal information by mail to the address you provided.
Your email address for form confirmation and disclosure (Required)
WCAT will use this email address to confirm that we have received this form.

WorkSafeBC will also use this address to provide you a copy of the assessment or occupational health and safety file(s). If you are represented, the file(s) will be sent to your representative. You can enter your representative’s email address later.
Enter Email Confirm Email
Worker or dependant email for disclosure
Workers and dependants of deceased workers may opt out of receiving the assessment or occupational health and safety file(s) by email. Can WorkSafeBC use the email address you entered to send you a copy of the file(s)?
- Yes, send the file(s) to the email I entered above.
- No, send the file(s) to the address I enter below.
Dependant email for appeal information
WCAT Online Services is not available for dependants of a deceased worker at this time. Can WCAT use the email you entered above to send you appeal information by encrypted email?
- Yes, send appeal information to the email address I entered above
- No, send appeal information to the mailing address I enter below
Your mailing address (Required)
Please provide a mailing address even if you have provided an email address above.

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
Are you an Indigenous person (includes a person of Indigenous ancestry: Inuit, Metis, First Nations, non-status, status, and anyone with First Nations ancestry)?
- Yes
- No
- I prefer not to answer
If you self-identify, you can work with a WCAT Navigator to tell your story. These experienced staff members can offer neutral support and make sure that cultural sensitivities are respected. This service is part of implementing the Truth and Reconciliation Commission’s Calls to Action. Learn more about self-identifying as Indigenous.
Reason for appeal
Briefly tell us why the decision is wrong for each Review Reference number you wish to appeal. You will have a chance to provide more information later.
The decision is wrong or should be changed because: (Required)
Change requested from appeal
Briefly tell us about the change you would like for each Review Reference number you wish to appeal. You will have a chance to provide more information later.
This is what I would like to have happen: (Required)
Method of appeal
WCAT will decide how your appeal will proceed. Tell us what your preference is: (Required)
- In writing (through written submissions)
- Verbally (by oral hearing)
Please tell us why an oral hearing is necessary: (Required)
Oral hearing method (Required)
An oral hearing can be held by videoconference on Microsoft Teams or in person in one of twelve cities in BC. If you select “in person,” you can then tell us your location preference.
- By videoconference
- In person
Oral hearing location (Required)
- Richmond (at WCAT)
- Castlegar
- Courtenay
- Cranbrook
- Fort St. John
- Kamloops
- Kelowna
- Nanaimo
- Prince George
- Terrace
- Victoria
- Williams Lake
If an oral hearing is held, do you need an interpreter?
WCAT provides professional interpreters for oral hearings. Family and friends may not interpret for you.
- Yes
- No
The language (and dialect) I speak is: (Required)
If an oral hearing is held, will you bring witnesses?
- Yes
- No
- Unsure
List of witnesses
If you are ready, please provide the name of each witness you plan to bring to an oral hearing, if one is held. Use the “plus sign” icon to add another witness. This is just an early list. You will be able to change it later.
First Name Last Name
Representation
You may appoint a person or an organization (with or without a specific contact) to represent you, or you may represent yourself.
Do you have a representative? (Required)
- No, I will be representing myself
- Yes, I have a professional representative
- Yes, I have a friend/family member representing me
Name of representative's organization/firm (Required)
Representative's name (Required)
First Last
Representative’s pronouns and title
Your representative’s pronouns and title will help us to address them 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 representative’s gender or title in the WorkSafeBC or Review Division file(s), we will use that when choosing how to address them.
Representative's pronouns
- They/Them
- She/Her
- He/Him
- Pronouns not listed
Representative's pronouns (Required)
Please tell us your representative’s pronouns.
Representative's title
- Mx.
- Ms.
- Mr.
- Mrs.
- Dr.
- Title not listed
Representative's title (Required)
Please tell us how to address your representative.
Representative's relationship to me (Required)
Representative's email for appeal information and disclosure (Required)
Representatives must provide an email address so WorkSafeBC can send them a copy of the assessment or occupational health and safety file(s).

To get appeal information by email, your representative should sign up for WCAT Online Services. Otherwise, WCAT will send them appeal information by mail.
Enter Email Confirm Email
Representative email for appeal information (Required)
WCAT Online Services is not available for dfriends and family representatives at this time. Can WCAT send emails to your friend or family representative about appeals they are participating in?
- Yes, please send appeal information to my representative by email
- No, my representative prefers to receive appeal information by mail
Representative's email address for appeal information (Required)
WCAT will send appeal information to your friend or family representative at this email address.
Enter Email Confirm Email
WCAT will send appeal information to your friend or family representative to the mailing address entered below.
Representative's mailing address (Required)
Street address Address line 2 City Province / State / Region Postal / Zip code Country
Representative's phone number (daytime) (Required)
Representative's phone number (other)
Representative's fax number
Certification and authorization
Hidden
Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?
- Yes
- No
Operating independently of WorkSafeBC, the Workers’ Advisers Office provides free advice and assistance to workers and their dependants on disagreements they may have with WorkSafeBC decisions.
Hidden
Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?
- Yes
- No
Operating independently of WorkSafeBC, the Workers’ Advisers Office provides free advice and assistance to workers and their dependants on disagreements they may have with WorkSafeBC decisions.
Hidden
Adviser's name
First Last
This form must be signed by the appellant or by their authorized representative. If signed by an authorized representative, WCAT requires an authorization less than 2 years old that is signed by the appellant.
Authorization of Representative
- I will fill out an Authorization of Representative form and submit it online.
- An Authorization of Representative should be on file with WorkSafeBC.
- This form authorizes the person/firm named above as my representative (appellant must sign the form below)
Full name of person signing this form (Required)
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. I authorize my representative named above to act on my behalf in this appeal. For workers: I authorize disclosure of my claim file(s) and information relating to this appeal to WCAT, my representative, and other parties to this appeal for the purposes of this appeal and as allowed under section 314 of the Workers Compensation Act. I also authorize WCAT to obtain or view from any source a copy of my employment or medical records or any other documents that may relate to this appeal or the decision(s) being appealed.
Date signed
YYYY dash MM dash DD

You will receive a confirmation of this form at the email address you provided above.
Representative's email address for form receipt only
If your representative would like to receive an email confirming that WCAT has received this form, enter an email address here. It does not have to be the same representative’s email address as provided above.
Enter Email Confirm Email
Email
This field is for validation purposes and should be left unchanged.

First Name	Last Name

FORM: Notice of Appeal – Review Division assessment or occupational health & safety decision

Notice of Appeal – Review Division assessment or occupational health & safety decision

What would you like to appeal?

Workplace posting requirement

Tell us about yourself

How WCAT can send you information

Reason for appeal

Change requested from appeal

Method of appeal

Representation

Certification and authorization