S REVIEW DIVISION
WORKING TO MAKE A DIFFERENCE

installation of the industrial server racks in.an occupied room, and the severe, asymmetric
medical deterioration that fractured a long-standing, stable medication baseline. These
layered issues of employer conduct, evidence tampering, and clinical mischaracterization
cannot be adequately resolved through a simple file review alone

Preferred Phone Number: (236) 991-3373

Would you like advance notice that the Review Yes
Officer would like to speak with you?

Interpreter Needed? No

| acknowledge that the information given on this form or in any documents attached is to my knowledge correct and complete. | understand itis |
a serious offence to knowingly provide false information in order to induce WorkSafeBC to make a particular decision.

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Personal information an this form is collected for lhe purposes of administering a worker's compensation claim by WorkGafeBC in accordance with the Workers
Compensation Act and the Freedom of Information and Protection of Privacy Act. For further information about the collection of personal information. please
contact WorkSafeBC's Freedam of information Coordinator at PO Box 2310 Stn Terminal, Vancouver BC, V6B 3W5, or telephone 604 279-8171.

63M5-P if you have questions, please call 604-214-5411 or 1-888-922-8804 Page 2 of 2

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