Follow the steps to properly complete your claim form.

1. Press the ‘Get Form’ button to access the Making A Claim For Noise-induced Hearing Loss WSIB form and open it in the editor.
2. Begin by filling in the 'Worker Information' section. Provide your last name, first name, address (including number, street, apartment, suite, unit), city or town, province, postal code, telephone number, email address, date of birth, social insurance number, and miner’s certificate number or payroll number. Indicate your language preference.
3. In the hearing information section, specify when you first noticed a loss of hearing by entering the date. Indicate whether the change in hearing was gradual or sudden, and when you first sought medical attention, including the date.
4. Respond to the questions regarding ringing in your ears, including whether you are affected and how long you have experienced this condition. Indicate if the ringing is constant or severe.
5. Answer whether you use a hearing aid and if you have been assessed by an Ear, Nose and Throat (ENT) specialist. If applicable, provide the contact details for the specialist.
6. Include details about your current employment status. If employed, provide your employer's name, address, and phone number along with years worked and decibel levels experienced.
7. Fill out your prior work history, starting with the most recent employer and including details such as the employer’s name, address, job title, employment dates, equipment used, and whether ear protection was utilized.
8. Complete the declaration and consent section by confirming the accuracy of the information provided. Sign, date, and upload the form accordingly.
9. Finally, review all the information for completeness and accuracy before saving the changes. You can download, print, or share the completed form as needed.

Complete your claim form online today to ensure a thorough and timely submission.