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- Click ‘Get Form’ to open the C-4 form in the editor.
- Begin by filling out the employee's personal information, including first name, middle initial, last name, birthdate, and home address. Ensure all fields are completed accurately.
- Next, provide details about the injury. Fill in the date of injury, time of injury (AM/PM), and describe what you were doing at the time of the accident. Be specific and detailed.
- Complete sections regarding your employer’s information and any witnesses to the accident. Include their names and contact details if applicable.
- In the certification section, confirm that all provided information is true by signing and dating the form. This step is crucial for processing your claim.
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