BC Application for Compensation and
Report of Injury or Occupational Disease

WORK

If you have any questions, please call our Contact Centre at 604.231.8888 or toll-free at 1.888.967.5377.

Worker first name: Worker last name: PHN: SIN: Claim number:
MARK HOLAND 9128-549-738 730-742-368 42647461

Medical clinic treatment information

Medical clinic visit? Date: Physician or clinic:
Yes January 30, 2026 Amplifon Clinic Surrey - (604) 580-0055
Treatment:

The worker went to have their hearing tested. Worker noted mild changes in the left ear.
Dr. Gbogboade Ademiluyi - (604) 522-2206

Medication: Sumatriptan, Nurtec.
Imaging: No.

Healthcare treatments: No.
Specialist Referral: No.

Time-off: One week off work.
Follow-up: TBD.

Practitioner number:

Next appointment information

Next appointment: Physician or clinic

Employer information - BRITISH COLUMBIA RAPID TRANSIT COMPANY LTD. (Accident Employer)

WorkSafeBC account number: Employer operating location number: Incident at this location number?
333926 001 Yes
Employer/ organization: Contact: Phone:

BRITISH COLUMBIA RAPID
TRANSIT COMPANY LTD.

Address: City:
6800 14TH AVE Burnaby
Province/state: Postal/zip code: Country:
British Columbia V3N4S7 Canada

Employment type: Regular - BRITISH COLUMBIA RAPID TRANSIT COMPANY LTD.
Is regular employment?
Yes

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