C 4 forms 2003-2026

1. Click ‘Get Form’ to open the C-4 form in the editor.
2. 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.
3. 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.
4. Complete sections regarding your employer’s information and any witnesses to the accident. Include their names and contact details if applicable.
5. 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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