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Get PH SSS Form B-309 1988

REPORT SS NUMBER SSS FORM B-309 (Revised 06/88) eeg NAME OF EMPLOYEE (Last, First, Middle) NAME OF EMPLOYER SS I.D. NUMBER ADDRESS JOB DESCRIPTION OR OCCUPATION DATE OF ACCIDENT/SICKNESS EXACT TIME PLACE (Check applicable box) REGULAR WORKING HOURS From To DATE LAST REPORTED FOR WORK OVERTIME From To DATE RETURNED TO WORK BRIEF DESCRIPTION OF ACCIDENT/SICKNESS SIGNATURE OF IMMEDIATE SUPERVISOR DATE SIGNATURE OF PERSONNEL MANAGER (Signature above printed name) Internet Edition.

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