FORM: Notice of Participation – occupational health & safety interested parties | Workers' Compensation Appeal Tribunal (WCAT)

This form will be your formal notice of participation in an appeal. Submit this form to WCAT within 14 days of our invitation letter. If we do not receive a response from you within 14 days, the appeal will proceed without your participation.

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

The WCAT appeal number for the appeal you are participating in
The WorkSafeBC employer account number associated with the appeal you are participating in

Questions marked (Required) must be filled in so that WCAT can update your participation in the appeal.

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 appeal have you been invited to participate in?

You have received a letter from WCAT inviting you to participate in an appeal or application. Please provide some details about the appeal or application to help us identify it.

Appeal number (Required)

Name of the appellant (Required)

Please give us the name of the person or business/firm that began the appeal.

WorkSafeBC employer account number (Required)

Please provide the WorkSafeBC employer account number (also called a firm file number) for the employer affected by the decision being appealed. This information is in the “Re:” line of the letter from WCAT.

Review Division decision number

If known, please provide us with the Review Division decision number that is being appealed (these start with the letter R). This information is in the “Re:” line of the letter from WCAT.

Review Division decision date

What date did the Review Division make the decision being appealed?

Participation

Will you participate in the appeal? (Required)

If you participate, you will be sent a copy of any written submissions and new evidence. You will have an opportunity to provide written submissions and evidence and we will invite you to attend an oral hearing if one is held.

Yes, I will participate
No, I do not want to participate

Tell us about yourself

You must tell us about any changes in this information, or the appeal may proceed without your participation.

What is your role in the occupational health and safety decision? (Required)

I am the Worker Representative on the Inspection Report
I am on the employer’s Joint Health and Safety Committee
I am the Worker Representative on the employer’s Safety Committee

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/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 job title/position

Employer's business/firm name (Required)

Your work address (Required)

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

Your work phone number (Required)

Your work fax number

Your personal phone number

Your work phone number (Required)

Your work fax number

Your personal phone number

Can WCAT send you email related to the appeal(s) or application(s) you are participating in? (Required)

If you select yes, WCAT will send all letters and decisions about appeals and applications by email instead of mail.

Please note: WCAT Online Services is not available for interested parties in appeals of Occupational Health and Safety matters

Yes, please send me email
No, I prefer mail

Email address for correspondence (Required)

Enter email Confirm email

If an oral hearing is held, do you need an interpreter? (Required)

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)

Certification

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 contact information. I understand that WCAT must be able to contact me or the appeal will proceed without my participation.

Date signed

Email address for form receipt only (Required)

If you would like to receive an email confirming that WCAT has received this form, enter an email address here. WCAT will not send you any further emails.

Enter email Confirm email

Comments

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