C3 form 2026

1. Click ‘Get Form’ to open the c3 form in the editor.
2. Begin with Section A, 'Your Information.' Enter your full name, date of birth, mailing address, Social Security Number, phone number, and gender. Ensure all details are accurate for a smooth claims process.
3. Move to Section B, 'Your Employer(s).' Fill in the employer's name at the time of injury, their contact number, work address, hire date, and supervisor's name. If applicable, list any other employers.
4. In Section C, 'Your Job on the Date of Injury or Illness,' provide your job title and describe your typical activities. Indicate your employment type and gross pay per pay period.
5. Proceed to Section D for 'Your Injury or Illness.' Document the date and time of injury, location details, and a thorough description of how the injury occurred.
6. Complete Sections E and F regarding return to work status and medical treatment received. Be specific about dates and treatment locations.

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