Get 16026 Whscc Form 67 - Worksafenb - Worksafenb

Filling out the 16026 WHSCC Form 67 is an essential step in reporting workplace accidents or occupational diseases. This guide provides detailed, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the form properly.

1. Press the ‘Get Form’ button to acquire the form and access it in your digital workspace.
2. Begin by entering the claim number at the top of the form. Ensure that all pertinent details regarding the incident are prepared for completion.
3. In the personal information section, fill in the last name, given name, street address or PO Box, postal code, apartment number, city, telephone number, social insurance number, date of birth, and Medicare number.
4. Provide the company name and its corresponding address along with the employer number.
5. Proceed to Part I, where you will enter the date and time of the accident, the date reported to the employer, and who the accident was reported to.
6. Record the occupation and contact information of the reporting person, along with the sex of the worker.
7. Specify the parts of the body injured and give a detailed account of the accident. Use additional sheets if necessary.
8. List witness names if there are any, and provide the name of the first doctor seen after the incident, along with the date of the visit and the healthcare facility.
9. Indicate whether the worker has missed any work due to the injury. If 'Yes', complete Parts II and III; if 'No', proceed to only Part III.
10. For Part II, if applicable, fill in the dates of last worked, hire date, whether the worker is a subcontractor, and the type of employment.
11. Enter gross earnings for the previous 12 months, or for the appropriate period if the worker was employed for less time.
12. Complete any additional fields regarding gross weekly earnings, hours worked, and marital exemption related to taxation.
13. In Part III, both the worker and the employer must sign the form, verifying the accuracy of the information provided.
14. Once all sections are completed, ensure that all necessary signatures are obtained. You may then save the form, download it, print it, or share it as required.

Complete the 16026 WHSCC Form 67 online today to ensure timely reporting of workplace incidents.