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C504 2026
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- Click ‘Get Form’ to open the c504 in the editor.
- Begin by entering your Claim Number and Worker’s Name, including surname, first name, and initial. Ensure accuracy for proper identification.
- Indicate whether you will be off work due to the injury by selecting 'Yes' or 'No'.
- Fill in your Personal Health Number and Date of Birth in the specified format (Year/Month/Day).
- Answer the questions regarding your job title and describe a typical workday. Be specific about any changes that may have contributed to your symptoms.
- Check all applicable symptoms from the list provided, such as pain or numbness, and specify when these symptoms were first noticed.
- Detail tasks performed at work that may cause or increase symptoms, including how often you perform these tasks each day.
- List any medical treatments received for this condition along with your doctor's information.
- Complete any additional sections regarding past injuries, medications, and activities affected by your injury.
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