Complete and submit this form to request a review of an assessment penalty. Before completing it, please review Assessment Policy 5-261-1 to see circumstances in which a penalty may be reduced or cancelled.

You can print this form, complete and sign it by hand, then scan it and email it to ASSESSREQCLASSREV@worksafebc.com with the subject line "Request for Penalty Review returned from…" Alternatively, you can complete it digitally in Adobe Acrobat. If you don’t already have Acrobat on your computer, you can download Adobe Acrobat Reader, a free app, from get.adobe.com/reader.

Please note the form's functionality will not work properly if the form is opened in an internet browser such as Microsoft Edge or Google Chrome.

To submit the form digitally:

1. Click the Download PDF button. The form will be copied to the Downloads folder on your computer hard drive.
2. Open the form in Acrobat by going to your Downloads folder and right-clicking on the PDF file. Select Open with > Adobe Acrobat Reader.
3. Type your information in the form and add your electronic signature.
4. Save your form, then click the Submit button.
5. An email to ASSESSREQCLASSREV@worksafebc.com will pop up. Ensure your completed form is attached, then click Send.