Name: BRITISH COLUMBIA RAPID TRANSIT COMPANY LTD. WorkSafeBC account number: 333926

Review Report

Please review the Incident/Injury Report below. Ensure that required information must be entered before submitting.

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Report type:

~~ Operating Location ~~

Operating location number:
Operating location description:
Operating location address:

6800 14TH AVE BURNABY BC V3N 487

~ Classification Unit~

Classification unit number:
Classification unit description:

Comm Bus, Shuttle, or Public Transit nes

Employer Contact
Last name:
First name:

Phone number:
Fax number:

Payroll Contact
Last name:
First name:
Phone number:
Fax number:

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Worker Details

Last name:

Middle initial:

First name:

Gender:

Date of birth:

Social insurance number:
Claim number (if known):

Worker Address

Country:
Mailing address
City:

Province:
Postal code:

Worker Contact Information

Home phone number:
Work number:

Worker Employment Details

What's the worker's occupation?

Did the worker's injury occur while performing
volunteer activities?

Did the worker deduct business or equipment
expenses from the employment income?

Is the worker a relative of an employer?

An occupational disease

001
OMC

732046

PRIER
CONNIE
(604) 653-8439 Ext:

JINAHBAI
ARTI
(672) 335-4657 Ext:

HOLAND
MARK

1978/09/04
730742368
42647461

Canada
UNIT 311 318 AGNES ST

NEW WESTMINSTER
British Columbia
V3L 0J3

Ext:

Relief Control Operator
NO

NO
NO

000236