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Worker Information Worker s Report of Injury/Disease Form 6 Claim Number ase PRINT in black ink Social Insurance Number First Name Last Name Telephone Address number street apt. Did it happen outside the Province If yes indicate where city province/state country 6. Have you hurt this area s of your 7. Do you have any prior the employer s property or work site of Ontario body before related WSIB/WCB claims yes - In...
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6 worker
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