Follow the steps to successfully fill out the form

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the WCB claim number at the top of the form. This is a unique identifier for your case and is essential for tracking purposes.
3. In the 'Worker’s Surname' and 'First Name' fields, type the full name of the individual for whom the assessment is being conducted.
4. Complete the address section by filling in the street address, city/town, province, and postal code of the worker.
5. Enter the personal health number, date of accident, and date of birth in the specified formats (yyyy/mm/dd).
6. Provide the worker's telephone number and referral source details, including the referral source name and contact number.
7. Fill in the provider contact name, date of referral, and their telephone number as well.
8. Record the assessment date in the specified format (yyyy/mm/dd).
9. In the general section, answer the referral questions, provide background information, and a brief work history.
10. Indicate the worker's height and weight in inches and pounds respectively.
11. Detail the ergonomics participants involved in the assessment.
12. In the job description section, outline an overview of the job along with the essential job functions and critical job demands.
13. List the tools used to perform the job and include any necessary work station measurements.
14. In the recommendations section, ensure that all suggestions relate directly to the injury accepted under the claim.
15. Finally, provide the provider's name, telephone number, and the date of filling out the form. Review all entries for accuracy.
16. Once completed, save your changes, and you can either download, print, or share the filled-out form as needed.

Take action now by completing your Occupational Therapy Ergonomic Assessment Form online.