WORK BC

Application for Compensation and
Report of Injury or Occupational Disease

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:
MARK

Worker last name:
HOLAND

PHN:
9128-549-738

SIN:
730-742-368

Claim number:
42647461

Wage information: Summary - BRITISH COLUMBIA RAPID TRANSIT COMPANY LTD.

Missed work after injury date?
Yes

Full or part time?
Full time

Permanent or temporary?
Permanent

Employed less than 12
months?

No

more?

Duration of three months or

Start date?

Relative of employer?

No

Wage information: Time loss - BRITISH COLUMBIA RAPID TRANSIT COMPANY LTD.

Last day worked:
January 22, 2026

Worked past injury date?
Yes

First shift missed:
January 26, 2026

Hours worked on last day:

10.00 10.00

Hours scheduled on last day:

0.00

Hours paid for last day:

Amount paid for last day:
$0.00

Work schedule: Variable - BRITISH COLUMBIA RAPID TRANSIT COMPANY LTD.

Variable shifts?
Yes

Days never scheduled to work?

Work schedule details

During training, the worker is scheduled Monday-Thursday, paid for 40 hours per week. Once training is
completed, worker will be 3-on, 3-off, paid for 12 hours per shift.

6T

(22/03) Page 5 of 7