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Worker's Authorization for Release of Personal Information (form 69W1)

By completing this form, you authorize WorkSafeBC to access your personal information relevant to injury/disease and pertaining to examination, treatment, history, and employment.

Submit your form online

You can complete, sign, and upload your form directly to your claim file, making it easier for you to provide authorization to WorkSafeBC.

How do I complete and submit the form online?

  1. Download the form and open it in Acrobat Reader.
    Using a mobile device? Please download the Adobe Acrobat Reader app for iOS or Android.
  2. Complete all fields on the form.
  3. Draw and add your electronic signature (please note: we cannot accept typed signatures or digital IDs).
  4. Save the form.
  5. Submit your form to WorkSafeBC by returning to this page and clicking the "Upload form" button.

Creating your electronic signature (video)

To learn more about how to create your electronic signature and place it on your form, watch this short video.

Questions?

For more information, please refer to our Q & A.

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Publication Date: Oct 2021 File type: PDF (337 KB) Asset type: Form Form: 69W1