Get Workers Report Occupational Noise Induced Hearing Loss Od - Wsib - Drwerger

This guide provides clear and supportive instructions for completing the Workers Report Occupational Noise Induced Hearing Loss form online. It aims to assist users in effectively navigating each section of the form to ensure accurate and comprehensive submissions.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to request the form and access it for completion.
2. Begin by filling out the 'A. Worker Information' section with your details, including first name, last name, address, city, province, telephone number, postal code, date of birth, miner's certificate number or payroll number, and social insurance number.
3. In section '1', indicate when you first noticed your hearing loss and when you sought medical attention by providing the appropriate dates.
4. Section '2' requires you to answer questions about your current hearing aid usage, employment in hazardous noise conditions, past assessments by an Ear, Nose and Throat specialist, and whether you've experienced sudden or gradual hearing loss. Fill in the information as it applies to you.
5. Proceed to section '3', confirming your current employment status. If employed, include details about your employer and any noise exposure from equipment or machinery.
6. If you are retired, detail your retirement date in section '4' and provide information about any noisy machinery you have used.
7. In section 'B', list two co-workers who can verify your noise exposure in employment along with their positions.
8. Section 'C' requires you to document your entire work history, including employer names, addresses, dates of employment, occupation, equipment used, exposure hours per day, and if ear protection was utilized.
9. In section 'D', read and acknowledge the declaration and consent statements. Sign and date the form to confirm the accuracy of your information.
10. Finally, ensure that you provide a copy of this form to your last employer and review the form for completeness before submission. You can then save changes, download, print, or share the completed form as needed.

Complete the Workers Report Occupational Noise Induced Hearing Loss form online today and ensure your submission is accurate and thorough.