NOTICE OF APPEAL FROM WORKSAFEBC: Discriminatory Action Decision

You must complete, sign and return this form to WCAT within 90 days of the Discriminatory Action decision being appealed. Make sure that you answer every question. We only require the basic information on this form to start your appeal. You will have an opportunity later on to provide more information to support your appeal.

If you are sending this form after the 90 day time limit you also need to apply for an extension of time to appeal. You can find the Application for an Extension of Time to Appeal on our website (www.wcat.bc.ca) under the Forms tab, or call us and we will send you the form.

Appealing a WorkSafeBC decision does not delay its implementation. A "stay" is when we order WorkSafeBC to delay its implementation of a decision (such as an order that you pay a penalty) while we are considering the appeal. If you want to apply for a stay you must file an Application for a Stay with WCAT within 7 days of the date we receive this Notice of Appeal. You can find this form on our website (www.wcat.bc.ca) under the Forms tab, or call us and we will send you the form.

IMPORTANT NOTICE!
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IMPORTANT NOTICE!

1. DISCRIMINATORY ACTION COMPLAINT INFORMATION

2. INFORMATION ABOUT YOU (APPELLANT)

To keep your appeal active you must tell us about changes in this information.

3. REASON FOR APPEAL

Provide a brief answer for each Discriminatory Action decision you wish to appeal.

4. RESULT/BENEFIT REQUESTED FROM APPEAL

Provide a brief answer for each Discriminatory Action decision you wish to appeal.

5. PREVIOUS GRIEVANCE

6. METHOD OF APPEAL

WCAT will decide how your appeal will proceed. Please indicate your preference: *

7. REPRESENTATION

You may appoint one person or an organization to represent you or choose to represent yourself. Please indicate your choice below.

8. CERTIFICATION AND AUTHORIZATION

9. FORM CHECK-LIST

4, continued:

5, continued:

7, continued: