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This document presents the decision and order of the Employees’ Compensation Appeals Board regarding the case of Dorothy Callahan, examining her claim for recurrence of disability related to a work

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1. Start by opening the 99-1170doc - dol form on your computer or printing it out if you prefer a hard copy.
2. Begin by entering your personal information, such as your full name, address, and contact details, in the designated fields on the form.
3. Next, provide information about your employer, including their name, address, and contact information. If you are self-employed, you can enter your own details in this section.
4. Moving on, you will need to provide details about your job position or occupation. Include your job title, employment dates, and any relevant job codes or numbers.
5. The next section of the form requires you to provide information about your job duties and responsibilities. Describe your specific tasks and responsibilities in detail, highlighting any important aspects that are relevant to the purpose of the form.
6. If you have experienced any work-related injuries or illnesses, you will need to indicate them in the appropriate section of the form. Provide specific details about the incident, including the date, time, and location of the occurrence.
7. In the following section, you may need to provide additional information if you are applying for certain benefits or compensation related to your work. Consult the instructions or guidelines provided with the form to ensure you accurately complete this section.
8. Finally, review the completed form to ensure all the information is accurate and legible. Make any necessary corrections before submitting it.

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1. Employees who have suffered work-related injuries or illnesses and are seeking compensation or benefits may need to fill out the 99-1170doc - dol form.
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It is important to note that the specific circumstances in which the form is required may vary, so it is advisable to consult with the appropriate authorities or legal experts to determine if this form is necessary in your particular situation.

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