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.
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.
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 email address is used by WCAT to correspond with you about your appeal(s) or application(s). Find out how information is shared by email.
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.
If you’d prefer to mail or fax a printed copy, use this version: Notice of Appeal – WorkSafeBC prohibited action decision (PDF, 105KB).