| work Eat 1 Memo

WORKING TO MAKE A DIFFERENCE (continued)

Worker last name First name Middle initial WorkSafeBC claim number

HOLAND 42647461

CONFIDENTIALITY DISCLAIMER

The information contained in this transmission may contain privileged and
confidential information of WorkSafeBC - the Workers' Compensation Board. It is
intended for review only by the person(s) named above. Dissemination, distribution
or duplication of this communication is strictly prohibited by all recipients unless
expressly authorized otherwise. If you are not the intended recipient, please contact
the sender by reply email and destroy all copies of the original message. Thank
you.

Ms Jaylin Cassady

Sr Adjudicator

Claims Intake & Adjudication Services

Personal information on this form is collected for the purposes of administering a worker's compensation claim by WorkSafeBC 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 Freedom of
Information Coordinator at PO Box 2310 Stn Terminal, Vancouver BC, V6B 3W5, or telephone 604 279-8171.

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