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 Wcb C040 Fillable  Form 2006

Wcb C040 Fillable Form 2006

Create a custom Wcb C040 Fillable Form 2006 that meets your industry’s specifications.

Number: Industry: Address: Does injured worker have personal coverage? Yes No City: Is injured worker a partner or director in this business? Yes No Province: Postal Code: Employer / Supervisor Contact Name: Telephone: Fax: Telephone: Injury or Occupational Disease Information 1 Date and time of injury: Y M Hours of employment on the day of accident: 2 Did injury occur on employer’s premises? am Time: From Yes pm OR Did this condition develop over a period of...
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