Prescriber's request for an exemption from WCB's mandatory generic drug policy.
- Completed by
- Prescriber
- Issued by
- WCB Nova Scotia
- Format
- Fillable PDF
- Language
- English
WCB Nova Scotia Form E: Physical Abilities Report
Form E is WCB Nova Scotia's physical abilities report, tracking a worker's measured abilities against pre-injury job demands over up to four assessment periods. It records lifting, carrying, pushing and pulling at frequent or occasional rates, standing, sitting and walking tolerances, grip strength, and capability for pre-injury or transitional duties. On discharge it captures the final return-to-work outcome.
Who completes it
The treating health care provider completes the form and initials each test period, noting whether pre-injury job demands were reported by the worker, the employer or another source. Copies go to the worker's physician, the employer and WCB.
Submitting and payment
- How to submit it
- Complete, print and sign it, write the worker's claim number on every page, and fax it to WCB. Forms B and C both ask whether a Form E is attached.
- Who pays
- WCB guarantees payment only for pre-authorized services, and out-of-province providers fax a separate invoice for each worker listing the claim number, dates of service and services.
Good to know
- Frequency is coded F for frequent (66%) and O for occasional (33%), and weights can be recorded in pounds or kilograms.
- Standing, sitting and walking tolerances are marked as reported by the worker or observed during assessment, and grip strength is recorded for the right and left hand.
- Work capability is coded P for pre-injury job duties and T for transitional duties, and overall progress as I for improving, N for no change or D for declining.
- The final outcome, completed on discharge, records no time lost, return to pre-injury work, return to suitable work, or did not return with a reason, plus the discharge date.
Get the official form
Download the current version from the source each time; forms change without notice.
Physical Abilities Report – Form E (For out of province providers)
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Frequently asked questions
What does WCB Nova Scotia's Form E measure?
Lifting above shoulder, horizontally and floor to waist, carrying with the right, left or both hands, pushing and pulling, standing, sitting and walking tolerances, grip strength and other essential or critical job tasks. Each is recorded against pre-injury job demands across up to four test periods, using WCB's Work Capabilities definitions.
Who receives a copy of Form E?
The form is marked as copied to the physician, the employer and WCB. It also asks for the employer's name and contact person, and whether the pre-injury job demands came from the worker, the employer or another source, which supports return-to-work planning with the workplace.
When is the final return-to-work outcome completed on Form E?
On discharge. The final outcome section records whether the worker had no time lost, returned to pre-injury work, returned to suitable work or did not return, with the relevant date and, if they did not return, the reason. A return to work or stay at work plan applies when transitional duties are selected.