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Get Worksafe Bc Form S30

Te of injury/disability (yyyy-mm-dd) Middle initial WorkSafeBC claim number Date of request (yyyy-mm-dd) Earnings submitted regarding (select one) Modified return-to-work program Start date (yyyy-mm-dd) Vocational rehabilitation program Start date (yyyy-mm-dd) OR Is the worker being maintained (select one) On full payroll Only for hours worked Week one (indicate by x below; then provide details in table below) Week two (indicate by x below; then provide details in table.

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