Forms and Applications

The following forms are available in PDF fill-in-the blank format. It is recommended that you use Acrobat® Reader to complete the form(s). Using Acrobat® Reader will ensure that the information you enter on the form(s) is saved in the correct format.

You can complete these forms electronically and print them, or you can save them to your computer so that you can return to them later. Follow the steps below to save, fill out, print and return your form(s).

  1. Right-click on the link to one of the forms below and select “Save target as” or “Save link as” (wording may be different depending on the browser being used).
  2. Select a location on your computer to save the file.
  3. Open the file from the saved location using Acrobat® Reader. If you cannot open the file, or you require a newer version of Acrobat® Reader you can Download Acrobat® Reader for free.
  4. Fill out the form.
  5. Click the Save button at the top of the Acrobat® Reader window or choose File – Save As.
  6. Print the form, then sign and date it.
  7. Return the form by one of the following methods:
    • Mail or Deliver to:
      Workplace Health, Safety and Compensation Review Division
      2nd Floor, Dorset Building, 6 Mount Carson Avenue
      Mount Pearl, NL A1N 3K4
    • Fax: (709) 729—6956
    • Scan the signed form and email it to
  • Request for Review  (100 KB)
    • This form, along with a copy of the final decision of WorkplaceNL, must be sent to the WHSCRD office within 30-days from the date of WorkplaceNL’s decision.
  • Authorized Representative Consent  (117 KB)
    • If you plan to have another party represent you during the review process, then you will need to submit this form consenting to the release of information to your representative.
  • Employer’s Notice of Intention to Participate  (64 KB)
    • As an employer, if you require access to documents in an application filed by one of your employees, you must fill out this form which will be sent to you and return it to the WHSCRD office within 14 days of receipt of correspondence.
  • Extension of Time Application  (58 KB)
    • The Chief Review Commissioner upon receipt of this form may provide an extension of time.