FORM: Notice of Appeal – WorkSafeBC prohibited action decision | Workers' Compensation Appeal Tribunal (WCAT)

This form will be your formal notice of appeal. Submit it within 90 days of your WorkSafeBC prohibited action decision. If it’s been more than 90 days, also submit a request for an extension of time.

Appealing a WorkSafeBC decision does not delay it taking effect. If the WorkSafeBC 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 WorkSafeBC prohibited action decision number for the decision you are appealing
- The WorkSafeBC employer account number for the employer affected by the prohibited action decision
- The contact information for your representative (if you have one)
Questions marked (Required) must be filled out so that WCAT can register 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 WorkSafeBC prohibited action decision.
WorkSafeBC prohibited action complaint number (Required)
WorkSafeBC prohibited action decision date (Required)
YYYY dash MM dash DD
Previous grievance(s) (Required)
Has a grievance under a collective agreement been filed regarding this prohibited action decision?
- Yes
- No
- I don’t know
Tell us about yourself
What is your role in the WorkSafeBC prohibited action decision? (Required)
- I am the worker
- I am the employer
- I am the dependant of a deceased worker
- I represent the union
WorkSafeBC employer account number
If you know it, please give us the three- to nine-digit WorkSafeBC employer account number (sometimes called a firm file number) of the employer affected by the prohibited action decision. This helps us to identify the correct prohibited action decision.
Employer firm/business name
If you know it, please give us the name of the employer firm/business affected by the prohibited action decision to help us identify the correct WorkSafeBC decision.
WorkSafeBC employer account number (Required)
Please give us your three- to nine-digit WorkSafeBC employer account number (sometimes called a firm file number).
Your firm/business name (Required)
Your union name (Required)
Your name (Required)
First Last
Your Date of Birth or Social Insurance Number
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 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
- Mx.
- Ms.
- Mr.
- Mrs.
- Dr.
- Title not listed
Your title (Required)
Please tell us how you would like to be addressed.
WCAT will send you information about your application(s) and appeal(s) by encrypted email.

Please note: WCAT Online Services is not available for appeals of Prohibited Action decisions.
Can WCAT send you email related to your appeals and applications? (Required)
If you select yes, WCAT will send all letters and decisions about your appeals and applications by email instead of mail. WCAT will also use this address to provide you disclosure, which is a copy of the prohibited action file(s).
- Yes, please send me email
- No, I prefer mail
Your email address (Required)
Enter Email Confirm Email
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. 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 to have made to the prohibited action decision. 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 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
Your representative’s email address is used by WCAT to correspond with them about your appeal(s) or application(s). Find out how information is shared by email.
Representative's email for disclosure
Representatives must provide an email address so WorkSafeBC can send them a copy of the prohibited action file(s).
Enter Email Confirm Email
Can WCAT use this email address to send you information about this appeal? (Required)
WCAT Online Services is not available for prohibited action appeals
- Yes, please send email to my representative
- No, please send correspondence to a different email address
- No, my representative prefers correspondence by mail
Representative's email for appeal information (Required)
WCAT will send appeal information to your representative at this email address.
Enter Email Confirm Email
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
Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?
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.
- Yes
- No
Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?
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.
- Yes
- No
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 form less than 2 years old that is signed by the appellant.
Authorization of Representative (Required)
- 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
Email address for form receipt only
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
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. WCAT will not send your representative any further emails.
Enter Email Confirm Email

If you’d prefer to mail or fax a printed copy, use this version: Notice of Appeal – WorkSafeBC prohibited action decision (PDF, 105KB).

First Name	Last Name

FORM: Notice of Appeal – WorkSafeBC prohibited action decision

What would you like to appeal?

Tell us about yourself

Reason for appeal

Change requested from appeal

Method of appeal

Representation

Certification and authorization