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0006A (1).pdf

Mail To:

Workplace Safety and Insurance Board 200 Front Street West Toronto ON M5V 3J1

OR Fax To:

416-344-4684 OR 1-888-313-7373

Worker's Report of Injury/Disease (Form 6)

Claim Number6 Please PRINT in black ink

A. Worker Information

Social Insurance NumberFirst NameLast Name

TelephoneAddress (number, street, apt., suite, unit)

City/Town Province Postal Code Alternate/Cell Phone

How long have you been doing this job for this employer?

Date you started with employer

dd mm yyJob Title/Occupation (at the time you were hurt)

dd mm yyOnly check if you

are one of the following:

Date of

Birth executive elected official owner spouse or relative of the employer

Your Preferred LanguageSex Would an interpreter

be helpful? yes noOtherF English FrenchM

If yes, do you consent to the disclosure of verbal claim file status information to your union representative?

Are you a member of a union? Do you authorize your union to represent you in this claim? yes no

yes no yes no

Provide your Union Name and Local

B. Employer Information

Company/Employer Name

Address

Postal CodeCity/Town Province

Company TelephoneYour Immediate Supervisor's Name

C. Accident/Illness Dates & Details

2. Who did you report this accident/illness to? (Name & Position) 1. Date and hour of accident/Awareness of illness

dd mm yy AM

PM

Telephone Date and hour reported to employer

dd mm yy AM

PM

3. Area of Injury (Body Part) - (Please check all that apply)

Right Right Left Right RightLeft Left LeftUpper backHead Teeth Shoulder Wrist Hip AnkleLower backFace Neck

HandArm FootThighEye(s) Chest Abdomen Elbow Finger(s) Toe(s)KneePelvis Ear(s)

Forearm Lower Leg

Are you: Other: Left Handed Right handed

Specify where it happened (shop floor, warehouse, client/customer site, parking lot, etc.):4. Did the accident/illness happen on

the employer's property or work site? yes no

If yes, indicate where

(city, province/state, country): 5. Did it happen outside the Province

of Ontario? yes no

7. Do you have any prior

related WSIB/WCB claims?

6. Have you hurt this area(s) of your

body before? yes no no yes - In Ontario yes - Outside Ontario

A guide to complete this form is available at www.wsib.on.ca

0006A (02/13) Page 1 of 3

Worker's Report of Injury/Disease (Form 6)

Claim Number6 Please PRINT in black ink

Social Insurance NumberWorker Name - Last Name First Name

C. Accident/Illness Dates & Details (continued)

8. If you had a sudden type of accident/illness, describe your injury and what happened to cause it (e.g. hurt lower back while lifting a 50 pound box, sprained

left ankle when I slipped on a wet floor, used a new cleaner and immediately got a rash). Please indicate the size, weights and names of any objects involved.

or

If you had a gradual onset type of injury, describe your injury, the work that you do and what you believe caused your injury/condition.

9. When did you first start to have problems with this injury/condition?

10. If you did not report this to your employer right away, please tell us the reason why.

11. If there were any witnesses to your accident, or if you mentioned your pain or problems to your supervisor or any of your co-workers,

give us their names & positions.

Name Position

1.

2.

12. The Workplace Safety and Insurance Act requires your employer to give you a copy of the Employer's Report of Injury/Disease (Form 7).

Did you receive a copy of the Form 7? yes no

The Workplace Safety and Insurance Act requires you to give a copy of this report

(Worker's Report of Injury/Disease - Form 6) to your employer.

Give your Health Professional your WSIB Claim number.D. Health Care Information

dd mm yy and by whom (Name):1. Did you get first aid or care at work

If yes, when yes no

2. Where did you go for health care, for your injury, outside of work? (Check all that apply)

Facility/Hospital (Name & Address) Date of Visit (dd/mm/yy)

Nursing Station

Date of Visit (dd/mm/yy) Ambulance

Emergency Department

Health Professional Office

Admitted to Hospital

Clinic

4. Were you referred for any other treatment or tests?3. Were you prescribed any medications/drugs? yes no yes no

If yes, were you given

any work limitations? 5. Did you talk to your health professional about going back to

regular or modified work? yes no yes no

If no, please tell your employer right away.6. Did you tell your employer you went for medical treatment? yes no

dd mm yy Name

If yes, when? and to whom? Position

0006A2 (02/13) Page 2 of 3

Worker's Report of Injury/Disease (Form 6)

Claim Number6 Please PRINT in black ink

Social Insurance NumberWorker Name - Last Name First Name

E. Lost Time & Return to Work

1. After the day of accident/illness:

I returned to work to my regular job and did not lose any time or pay.

I returned to modified duties and did not lose any time or pay.

I lost time and/or pay (e.g. regular pay, shift differential, bonuses, premiums, etc.).

dd mm yy Date you first lost time and/or pay υ

2. If you lost time, have you returned to work? yes no

dd mm yy Date of your return to workIf yes regular work modified workυ

Does your employer have modified work?Did you discuss return to work with

your employer? If no υ yes noyes no

F. Earnings (Do not include overtime here)

1. Rate of pay: per hour week other:$

2. Usual number of pay hours: per week other:

3. If you lost time from work after the day of accident/illness, did your employer continue to pay you? yes no

4. Have you applied for, or did you receive, any other benefits (money) while off work

(e.g. EI benefits, sick benefits, social services, insurance, etc.). yes no

5. At the time of the accident/illness did you work for more than one employer? noyes

G. Declarations and Signature

By signing below, I am claiming benefits under the Workplace Safety and Insurance Act, 1997, for a work-related injury or disease. I am also authorizing any health

professional who treats me to provide me, my employer and the Workplace Safety and Insurance Board with information about my functional abilities on the WSIB's

"Functional Abilities Form for Planning Early and Safe Return to Work".

It is an offence to deliberately make false statements to the Workplace Safety and Insurance Board. I declare that all of the information provided on pages 1, 2, and 3 is true.

Signature Date (dd/mm/yy)

If you are under the age of 16, your parent or guardian, must authorize the release of the functional abilities information.

Date (dd/mm/yy) TelephoneSignature Relationship:

( )

Personal information about you will be collected throughout your claim under the authority of the Freedom of Information and Protection of Privacy Act and will

be used to administer the Workplace Safety and Insurance Act, 1997, your claim(s) and programs of the Board. Medical and non-medical information is collected

from health care providers, vocational agencies, labour market service providers, employers, witnesses, Canada Revenue Agency (CRA), and others as required.

Your Social Insurance Number is used to register claims, identify workers and to issue income tax receipts and is collected under the authority of the Income Tax

Act. Information may only be disclosed to the employer, external medical, vocational, and safety agencies, external payment and service providers, researchers,

and others as authorized by the Workplace Safety and Insurance Act and the Freedom of Information and Protection of Privacy Act. Your name and telephone

number may be disclosed to third party researchers conducting satisfaction surveys and focus groups. Incoming and outgoing calls may be recorded for quality

assurance purposes. Questions should be directed to the decision maker responsible for your file or toll free at 1-800-387-0750.

A more detailed PRIVACY STATEMENT for workers may be found at www.wsib.on.ca or by calling toll free at 1-800-387-0750.

0006A3 (02/13) Page 3 of 3

Worker's Report of Injury/Disease (Form 6)

Claim Number6 Please PRINT in black ink

Social Insurance NumberWorker Name - Last Name First Name

K. Additional Information

The Workplace Safety & Insurance Act requires you to give a copy of this report

(Worker's Report of Injury/Disease - Form 6) to your employer

0006A4 (02/13)

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Form7.pdf

Did you know that you can securely file form 7 online with our eServices?

eForm7 offers a fast, effective solution for managing your Form 7 reports with the WSIB.

New features to our eForm 7 makes reporting online even quicker and easier. Take our new and improved eForm 7 video tour.

To submit an eForm 7, visit our eServices site. It only takes a few minutes to subscribe and you can start filing your reports right away.

Please note: Submitting a No Lost Time claim? Only complete sections A to D, E (#1) and J.

Mail To: 200 Front Street West Toronto ON M5V 3J1

OR Fax To: 416-344-4684 OR 1-888-313-7373

Employer's Report of Injury/Disease (Form 7)

Claim Number7Please PRINT in black ink A. Worker Information Job Title/Occupation (at the time of accident/illness - do not use abbreviations) Length of time in this position

while working for you Social Insurance Number

Please check if this worker is a: spouse or relative of the employerexecutive elected official owner Is the worker covered by a Union/Collective Agreement?

Worker Reference Number Last Name First Name

yes no Worker's preferred language dd mm yyDate of

Birth Address (number, street, apt., suite, unit)

English French Other Telephone

ProvinceCity/Town Postal Code

dd mm yySex Date of Hire FM

Fold here for #10 envelopeB. Employer Information

?Trade and Legal Name (if different provide both) Check one:

Provide NumberFirm Number

Account Number

OR

Rate Group Number Classification Unit CodeMailing Address

TelephoneCity/Town Postal CodeProvince

FAX NumberDescription of Business Activity Does your firm have 20 or more workers? yes no

Branch Address where worker is based (if different from mailing address - no abbreviations)

City/Town Province Alternate TelephonePostal Code

C. Accident/Illness Dates and Details dd mm yy1. Date and hour of

accident/Awareness of illness

2. Who was the accident/illness reported to? (Name & Position)AM PM

dd mm yy Telephone Ext.Date and hour reported to employer

AM PM

3. Was the accident/illness: 4. Type of accident/illness: (Please check all that apply) Sudden Specific Event/Occurrence Fall Slip/TripStruck/Caught Gradually Occurring Over Time Overexertion Harmful Substances/Environmental Motor Vehicle Incident Occupational Disease Repetition Assault Fatality Fire/Explosion Other

5. Area of Injury (Body Part) - (Please check all that apply) Right Right Left Right RightLeft Left LeftUpper backHead Teeth

Face Lower backNeck Shoulder Wrist Hip Ankle HandArm FootThighEye(s) Chest Abdomen

Elbow Finger(s)Ear(s) Pelvis Toe(s)Knee Forearm Lower LegOther

6. Describe what happened to cause the accident/illness and what the worker was doing at the time (lifting a 50 lb. box, slipped on wet floor, repetitive movements, etc. . .). Include what the injury is and any details of equipment, materials, environmental conditions (work area, temperature, noise, chemical, gas, fumes, other person) that may have contributed. For a condition that occurred gradually over time, please attach a description of the physical activity required to do the work.

A guide to complete this form is available at www.wsib.on.ca Page 1 of 30007A (01/11)

Employer's Report of Injury/Disease (Form 7)

Claim Number7 Please PRINT in black ink

Social Insurance NumberWorker Name

C. Accident/Illness Dates and Details (Continued) Specify where (shop floor, warehouse, client/customer site, parking lot, etc..).7. Did the accident/illness happen on the employer's

premises (owned, leased or maintained)? yes no

If yes, where (city, province/state, country).8. Did the accident/illness happen outside the Province of Ontario?

yes no

If yes, provide name(s), position(s), and work phone number(s).9. Are you aware of any witnesses or other employees involved in this accident/illness?

1.yes no

2.

If yes, please provide name and work phone number10. Was any individual, who does not work for your firm, partially or totally responsible for this accident/illness? yes no

If yes, please explain11. Are you aware of any prior similar or related problem, injury or condition?

yes no

12. If you have concerns about this claim, attach a written submission to this form. submission attached

D. Health Care dd yy dd yymm mm2. When did the employer learn that the worker

received health care? 1. Did the worker receive health care for this injury?

yes no If yes, when :

3. Where was the worker treated for this injury? (Please check all that apply) On-site health care Ambulance Emergency department Admitted to hospital Health professional office Clinic

Other:

Name, address and phone number of health professional or facility who treated this worker (if known)

E. Lost Time - No Lost Time 1. Please choose one of the following indicators. After the day of accident/awareness of illness, this worker:

Returned to his/her regular job and has not lost any time and/or earnings. (Complete sections G and J). Returned to modified work and has not lost any time and/or earnings. (Complete sections F, G, and J). Has lost time and/or earnings. (Complete ALL remaining sections).

dd yy dd yymm mm regular work Provide date worker first lost time Date worker returned to work (if known)υυ modified work

2. This Lost Time - No Lost Time - Modified Work information was confirmed by: Telephone Ext. Myself Other

Name

F. Return To Work 2. Has modified work been discussed with this worker?

3. Has modified work been offered to this worker?

If yes, was it1. Have you been provided with work limitations for this worker's injury?

Accepted Declined

If Declined please attach a copy of the written offer given to the worker.yes no yes no yes no

4. Who is responsible for arranging worker's return to work Telephone Ext.

OtherMyself Name

Page 2 of 30007A (01/11)

Employer's Report of Injury/Disease (Form 7)

Claim Number7 Please PRINT in black ink

Worker Name Social Insurance Number

G. Base Wage/Employment Information - (Do not include overtime here)

1. Is this worker (Please check all that apply) Owner Operator or (Sub) ContractorCasual/Irregular Registered ApprenticePermanent Full Time Student

Permanent Part Time Seasonal Unpaid/Trainee Optional Insurance Temporary Full Time Contract

OtherTemporary Part Time

2. Regular rate of pay $ per hour day week other

H. Additional Wage Information Provide percentage

1. Net Claim Code or Amount

2. Vacation pay - on each cheque? %Federal Provincial yes no

3. Date and hour last worked 4. Normal working hours on last day worked

5. Actual earnings for last day worked

6. Normal earnings for last day worked

dd mm yy From To AM AM AM

$ $PM PM PM 7. Advances on wages: Is the worker being paid while he/she recovers? yes no Full/Regular OtherIf yes, indicate:

8. Other Earnings (Not Regular Wages): Provide the total of additional earnings for each week for the 4 weeks before the accident/illness.

* For Rotational Shift workers - If the shift cycle exceeds 4 weeks, please attach the earnings information for the last complete shift cycle prior to the date of accident/illness.

Use these spaces for any other earnings (indicate Commission, Differentials, Premiums, Bonus, Tips, In Lieu %, etc..).θ

Mandatory Overtime Pay

Voluntary Overtime Pay

From Date (dd/mm/yy)

To Date (dd/mm/yy)Period

$ $ $ $ $ $Week 1 Week 2 $ $ $ $ $ $

$ $ $ $ $ $Week 3 Week 4 $ $ $ $ $ $

I. Work Schedule (Complete either A, B or C. Do not include overtime shifts)

Example: Monday to Friday, 40 hours(A.) Regular Schedule - Indicate normal work days and hours. υ S M T W T F SSunday Monday Tuesday Wednesday Thursday Friday Saturday

8 8 8 8 8 or,

(B.) Repeating Rotational Shift Worker - Provide

NUMBER OF DAYS ON

NUMBER OF DAYS OFF

HOURS PER SHIFT(s)

NUMBER OF WEEKS IN CYCLE

Example: 4 days on, 4 days off, 12 hours per shift, 8 weeks in cycle.υor, - Provide the total number of regular hours and shifts for each week for the 4 weeks prior to the accident/illness. (Do not include overtime hours or shifts here).

(C.) Varied or Irregular Work Schedule

Week 3 Week 4Week 1 Week 2 From/To Dates (dd/mm/yy) Total Hours Worked Total Shifts Worked

J. It is an offence to deliberately make false statements to the Workplace Safety and Insurance Board. I declare that all of the information provided on pages 1, 2, and 3 is true. Name of person completing this report (please print) Official title

dd yymmSignature Telephone Ext. Date

THE WORKPLACE SAFETY AND INSURANCE ACT REQUIRES YOU GIVE A COPY OF THIS FORM TO YOUR WORKER Page 3 of 30007A (01/11)

Employer's Report of Injury/Disease (Form 7)

Claim Number7 Please PRINT in black ink

Worker Name Social Insurance Number

K. Additional Information

THE WORKPLACE SAFETY AND INSURANCE ACT REQUIRES YOU GIVE A COPY OF THIS FORM TO YOUR WORKER 0007A (01/11) Page 4 of 4

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  88. cbareaofinjury hip left: Off
  89. cbareaofinjury hip right: Off
  90. cbareaofinjury thigh left: Off
  91. cbareaofinjury thigh right: Off
  92. cbareaofinjury knee left: Off
  93. cbareaofinjury knee right: Off
  94. cbareaofinjury lower leg left: Off
  95. cbareaofinjury lower leg right: Off
  96. cbareaofinjury ankle left: Off
  97. cbareaofinjury ankle right: Off
  98. cbareaofinjury foot left: Off
  99. cbareaofinjury foot right: Off
  100. cbareaofinjury toes left: Off
  101. cbareaofinjury toes right: Off
  102. txt6describewhathappened:
  103. pge 1: Page 1 of 4
  104. LBLweb notice2: When PRINTING make sure you print the document FULL SIZE - In the "PRINT WINDOW" Clear all "tick boxes" that "REDUCE" or "SHRINK"
  105. cb7accidenthappen: Off
  106. txt7accidenthappen:
  107. cb8accidenthappenoop: Off
  108. txt8accidenthappenoop:
  109. cb9witness: Off
  110. txt9witnessnamepos1:
  111. txt9witnessnamepos2:
  112. cb10individualrespons: Off
  113. txt10individualresponsnameaddetc:
  114. cb11similarincident: Off
  115. txt11similarincident:
  116. cb12submission: Off
  117. txtworkersurname:
  118. txtworkerfirstname:
  119. cbD1workerreceivehealthcare: Off
  120. txtD1workerreceivehealthcarewhenDay:
  121. txtD2employerlearnedofworkerreceivehealthcarewhenDay:
  122. cbD3workerreceivehealthcarewhere on site: Off
  123. cbD3workerreceivehealthcarewhere ambulance: Off
  124. cbD3workerreceivehealthcarewhere emergency dept: Off
  125. cbD3workerreceivehealthcarewhere hospital: Off
  126. cbD3workerreceivehealthcarewhere HP office: Off
  127. cbD3workerreceivehealthcarewhere clinic: Off
  128. cbD3workerreceivehealthcarewhere other: Off
  129. cbtxtD3workerreceivehealthcarewhere other description:
  130. cbtxtD3workerreceivehealthcarewhere namelocation1:
  131. cbtxtD3workerreceivehealthcarewhere namelocation2:
  132. cbE1: Off
  133. txtE1workerdatelosttimeDay:
  134. txtE1DatertwDay:
  135. cbE1rtwtypeofwork: Off
  136. cbE2Modworkconfirmby: Off
  137. txtE2Modworkconfirmbyname:
  138. txtE2Modworkconfirmbytelephone:
  139. txtE2ModworkconfirmbytelephoneEXT:
  140. CBF1providedwithlimitations: Off
  141. CBF2modifiedworkdiscussed: Off
  142. CBF3modifiedworkoffered: Off
  143. CBF3modifiedworkofferedwasit: Off
  144. CBF3modifiedworkdeclinedattachcopy: Off
  145. cbF4whoarrangedrtw: Off
  146. txtF4whoarrangedrtwname:
  147. txtF4whoarrangedrtwtelephone:
  148. txtF4whoarrangedrtwtelephoneext:
  149. lblgoto: next page
  150. pge 2: Page 2 of 4
  151. cbG1is this worker pft: Off
  152. cbG1is this worker ppt: Off
  153. cbG1is this worker tft: Off
  154. cbG1is this worker tpt: Off
  155. cbG1is this worker ci: Off
  156. cbG1is this worker seas: Off
  157. cbG1is this worker contract: Off
  158. cbG1is this worker student: Off
  159. cbG1is this worker ut: Off
  160. cbG1is this worker ra: Off
  161. cbG1is this worker oi: Off
  162. cbG1is this worker oosc: Off
  163. cbG1is this worker other: Off
  164. txtG1is this worker other desc:
  165. txtG2regrateof pay:
  166. cbG2rateofpayper: Off
  167. txtG2rateofpayperotherdesc:
  168. txtH8otherearningNRWWeek1fromDAY:
  169. txtH8otherearningNRWWeek1toDAY:
  170. txtH8otherearningNRWWeek1toMONTH:
  171. txtH8otherearningNRWWeek1toYEAR:
  172. txtH8Week1mopay:
  173. txtH8Week1vopay:
  174. HEADINGS1: [Commission]
  175. HEADINGS2: [Commission]
  176. HEADINGS3: [Commission]
  177. HEADINGS4: [Commission]
  178. txtH8Week1other1:
  179. txtH8Week1other2:
  180. txtH8Week1other3:
  181. txtH8Week1other4:
  182. txtH8otherearningNRWWeek2fromDAY:
  183. txtH8otherearningNRWWeek2fromMONTH:
  184. txtH8otherearningNRWWeek2fromYEAR:
  185. txtH8otherearningNRWWeek2toDAY:
  186. txtH8otherearningNRWWeek2toMONTH:
  187. txtH8otherearningNRWWeek2toYEAR:
  188. txtH8Week2mopay:
  189. txtH8Week2vopay:
  190. txtH8Week2other1:
  191. txtH8Week2other2:
  192. txtH8Week2other3:
  193. txtH8Week2other4:
  194. txtH8otherearningNRWWeek3fromDAY:
  195. txtH8otherearningNRWWeek3fromMONTH:
  196. txtH8otherearningNRWWeek3fromYEAR:
  197. txtH8otherearningNRWWeek3toDAY:
  198. txtH8otherearningNRWWeek3toMONTH:
  199. txtH8otherearningNRWWeek3toYEAR:
  200. txtH8Week3mopay:
  201. txtH8Week3vopay:
  202. txtH8Week3other1:
  203. txtH8Week3other2:
  204. txtH8Week3other3:
  205. txtH8Week3other4:
  206. txtH8otherearningNRWWeek4fromDAY:
  207. txtH8otherearningNRWWeek4fromMONTH:
  208. txtH8otherearningNRWWeek4fromYEAR:
  209. txtH8otherearningNRWWeek4toDAY:
  210. txtH8otherearningNRWWeek4toMONTH:
  211. txtH8otherearningNRWWeek4toYEAR:
  212. txtH8Week4mopay:
  213. txtH8Week4vopay:
  214. txtH8Week4other1:
  215. txtH8Week4other2:
  216. txtH8Week4other3:
  217. txtH8Week4other4:
  218. txtH1nextclaimcodefederal:
  219. txtH1nextclaimcodeprovincial:
  220. cbH2vacationpaypercheque: Off
  221. txtH2vacationpayperchequepercent:
  222. txtH3datelastworkedDay:
  223. txtH3timelastworkedAM:
  224. txtH3timelastworkedPM:
  225. cbtimelastworked: Off
  226. txtH4timelastworkedfromAM:
  227. txtH4timelastworkedfromPM:
  228. cbh4timelastworkedfrom: Off
  229. txtH4timelastworkedtoAM:
  230. txtH4timelastworkedtoPM:
  231. cbh4timelastworkedto: Off
  232. txtH5actualearninglastday:
  233. txtH5normalearninglastday:
  234. cbH7advanceearnings: Off
  235. cbH7advanceearningsamount: Off
  236. txtH7advanceearningsamount other desc:
  237. txtIAsunday:
  238. txtIAmonday:
  239. txtIAtuesday:
  240. txtIAwednesday:
  241. txtIAthursday:
  242. txtIAfriday:
  243. txtIAsaturday:
  244. cbIschedule: Off
  245. txtIBnoofdayson:
  246. txtIBnoofdaysoff:
  247. txtIBhourspershiftnoofdayson:
  248. txtIBnoofweeksincycle:
  249. txtICtotalhoursworkedWeek1:
  250. txtICtotalshiftsworkedWeek1:
  251. txtICtotalhoursworkedWeek2:
  252. txtICtotalshiftsworkedWeek2:
  253. txtICtotalhoursworkedWeek3:
  254. txtICtotalshiftsworkedWeek3:
  255. txtICtotalhoursworkedWeek4:
  256. txtICtotalshiftsworkedWeek4:
  257. LBL/: /
  258. txtIjname:
  259. txtJtitle:
  260. txtJtelephoneareacode:
  261. txtJtelephoneextension:
  262. txtJdatesignedDay:
  263. Signature: Please print form & sign before returning to the WSIB
  264. pge 3: Page 3 of 4
  265. Help: Use this button to clear the data fields
  266. lblgotohome: home
  267. pge 4: Page 4 of 4
  268. TXTKADDITIONAL TEXT:
  269. txtaccidentreportedto1:
  270. txtH8otherearningNRWWeek1fromYEAR:
  271. txtH8otherearningNRWWeek1fromMONTH:
  272. print oval:
  273. Start herenew:
  274. reset oval:
  275. txtICvwsWeek1FROM day:
  276. txtICvwsWeek1FROM month:
  277. txtICvwsWeek1FROM year:
  278. txtICvwsWeek1TO day:
  279. txtICvwsWeek1TO month:
  280. txtICvwsWeek1TO year:
  281. txtICvwsWeek2FROM day:
  282. txtICvwsWeek2FROM month:
  283. txtICvwsWeek2FROM year:
  284. txtICvwsWeek2TO day:
  285. txtICvwsWeek2TO month:
  286. txtICvwsWeek2TO year:
  287. txtICvwsWeek3FROM day:
  288. txtICvwsWeek3FROM month:
  289. txtICvwsWeek3FROM year:
  290. txtICvwsWeek3TO day:
  291. txtICvwsWeek3TO month:
  292. txtICvwsWeek3TO year:
  293. txtICvwsWeek4FROM day:
  294. txtICvwsWeek4FROM month:
  295. txtICvwsWeek4FROM year:
  296. txtICvwsWeek4TO day:
  297. txtICvwsWeek4TO month:
  298. txtICvwsWeek4TO year:
  299. Button3: