Get C504 Worker's Progressive Injury Questionnaire - Workers ... - Wcb Ab

Filling out the C504 Worker's Progressive Injury Questionnaire is an essential step in documenting your injury for workers' compensation purposes. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the questionnaire online

1. Use the ‘Get Form’ button to obtain the questionnaire, making it accessible in your preferred format for completion.
2. Begin by entering your personal information at the top of the form. This includes your name, personal health number, and date of birth.
3. Provide your claim number and indicate if you will be off work due to your injury by selecting 'Yes' or 'No'.
4. Describe your job title and outline your typical work day, providing details on tasks and responsibilities.
5. Answer how long this work day has been typical for you, along with any changes that may have contributed to your symptoms.
6. Indicate any symptoms you are experiencing by checking the appropriate boxes for aching, weakness, pain, and other sensations.
7. Describe where the symptoms are located by selecting the appropriate body parts on the form.
8. Indicate your hand dominance (right or left) and list all tasks you perform that relate to your symptoms.
9. Detail the frequency and duration of each task you perform during your work day, indicating whether these tasks are continuous.
10. List any tools or equipment that you use which may exacerbate your symptoms, and specify if you take scheduled breaks and their frequency.
11. Document any medical treatments received for the injury, including the name of your doctor and address.
12. Answer questions regarding any previous medical conditions or past injuries that could be relevant.
13. Provide information about any medications you are currently taking.
14. Indicate any activities you can no longer perform due to your injury and provide any additional relevant information.
15. Finally, date and sign the form, ensuring that all information is completed accurately.
16. Save your changes, and then download, print, or share the completed form as necessary.

Complete your C504 Worker's Progressive Injury Questionnaire online today to facilitate your claim process.