Get Worker Hearing Loss Report - Workers Compensation Board Of ...

This guide provides a comprehensive overview for users on how to complete the Worker Hearing Loss Report online. By following these steps, you will be equipped to accurately fill out the form and submit it for processing.

Follow the steps to effectively complete the report.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by entering your personal information in the 'Worker Information' section. Fill in your last name, first name, address, telephone number, city, social insurance number, and province. Ensure all details are accurate.
3. In the 'Employer Information' section, provide your job title, business name, and the employer's address, including city, province, and postal code. Include the employer's telephone number as well.
4. Describe the details of your injury in the 'Injury Details' section. Indicate when you first became aware of your hearing problem and note whether you reported this to your employer, including the name and title of the person you reported to.
5. Specify whether your hearing loss was sudden or gradual. If it was sudden, provide a brief explanation.
6. Complete the illnesses/conditions section by checking the applicable boxes for any conditions you have experienced. Include any physician attendance and relevant dates.
7. Indicate if there is a family history of deafness or hearing impairment, and provide an explanation if applicable.
8. If you take any regular medication, indicate this and list the medications used.
9. Describe the noise level at your workplace. Specify any ear protection used, including the make and model, and the duration of use.
10. If you have had your hearing checked, include the details of the individual performing the tests, their address, and the dates of the tests.
11. Indicate whether you have filed or intend to file a claim for hearing loss with another Workers Compensation Board. Provide the name of the Board and if the claim was accepted.
12. Complete the section regarding participation in activities that may contribute to hearing loss.
13. If applicable, provide details about any service in the Armed Forces, including service number and trades, and whether you were exposed to gunfire.
14. Finally, save your changes, and if you wish, download, print, or share the completed form.

Begin completing your Worker Hearing Loss Report online today for efficient processing.