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C139 – Employer’s Information Questionnaire (WCB Alberta), page 1
Moderate · 55/100Form Complexity Index

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What this form asks for

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Form C139 is an employer-completed questionnaire used by WCB Alberta to verify a worker’s employment details and gather workplace exposure information relevant to a claim. It captures employment dates, occupations, and province(s) worked, along with safety precautions such as hearing protection policies. The form also requests supporting documentation like audiograms and noise level readings, or details on where those records can be obtained. This information helps WCB assess workplace noise exposure and determine claim eligibility and benefits.
Fillable fields65
Pages2
Sections17
Tables and lists1
Questions that depend on earlier answers9
Form Complexity IndexModerate, 55/100

The AI checks your answers before you download

15 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Claim Number Presence and Format Validation

Validates that the claim number field is completed and matches the expected WCB claim number format (e.g., allowed length, alphanumeric pattern, no illegal characters). This is critical for correctly associating the questionnaire with the correct claim file and avoiding misfiling. If validation fails, the submission should be rejected or routed to manual review with a request for correction.

Worker Name Completeness (Surname, First Name, Initials)

Ensures the worker’s surname and first name are provided, and that initials (if provided) contain only alphabetic characters and are not used as a substitute for the full first name. Accurate identity information is necessary to match the worker to the claim and employment records. If missing or malformed, the form should be flagged and the employer prompted to correct the worker identification fields.

Worker Date of Birth Format and Plausibility (YYYY/MM/DD)

Checks that the date of birth is present, follows the YYYY/MM/DD format, and represents a valid calendar date. It should also be plausibility-checked (e.g., not in the future and within a reasonable age range for employment). If invalid, the system should block submission or require correction because DOB is commonly used for identity matching and eligibility checks.

Social Insurance Number (SIN) Format and Check-Digit Validation

Validates that the SIN is exactly 9 digits (allowing optional spaces/hyphens for entry) and passes the Luhn check-digit algorithm. This reduces data entry errors and prevents mismatches with government/benefit records. If validation fails, the SIN should be rejected and the user required to re-enter it or leave it blank only if the process explicitly allows missing SIN with an explanation.

Occupation Field Required and Non-Placeholder Validation

Ensures the occupation field is completed and is not a placeholder value (e.g., 'N/A', 'unknown') unless the form rules explicitly allow it with an explanation. Occupation is essential for assessing exposure risk and interpreting hearing/noise information. If missing or non-informative, the submission should be flagged for follow-up because it can materially affect adjudication.

Employer Name Required and Legal-Entity Quality Check

Checks that the employer name is provided and appears to be a business/legal entity name rather than a person’s name or a department only (e.g., 'HR', 'Shop'). Correct employer identification is required for record linkage and potential contact. If validation fails, the form should be returned for correction or routed to manual review to confirm the employer entity.

And 9 more checks
  • Employment Date Range (From/To) Format, Validity, and Order
  • Employment History Table Row Integrity (From/To/Occupation/Province)
  • Employment History vs. Summary Employment Dates Consistency
  • Reason for Unable to Confirm Employment: Single-Selection and Conditional Fields
  • Safety Precautions Yes/No Responses Required and Mutually Exclusive
  • Hearing Assessments Section: Exclusive Option Selection and Attachment/Source Requirements
  • Noise Level Readings Section: Exclusive Option Selection and Attachment/Source Requirements
  • Telephone Number Format Validation (Including Area Code)
  • Employer Contact and Attestation Completeness (Company Name, Contact Name, Title, Signature, Date)

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How to Fill Out C139 Online for Free in 2026

What the AI walks you through.

  1. Enter the claim number and confirm the worker’s identifying details (name, date of birth, SIN, occupation) as shown on the form.
  2. Provide employer details and the worker’s dates of employment (from/to), then complete the Employment History table with dates, occupation(s), and province(s) employed.
  3. If employment cannot be confirmed, select the applicable reason (no files, ownership change with prior owner contact, unable to confirm after search, or other) and add the requested explanation/contact details.
  4. Answer the Safety Precautions questions about whether hearing protection was provided and whether a policy required/enforced its use.
  5. Complete the Hearing Assessments section by indicating whether audiograms exist; attach copies or provide the name and phone number of the source that can supply them, or indicate none were completed.
  6. Complete the Noise Level Readings section by indicating whether readings exist; attach copies or provide the name and phone number of the source, or indicate none were taken, and list equipment/tools/machinery the worker used or worked near.
  7. Add any additional comments, then enter company/contact information, print contact name and title, sign, and date the form before submitting to WCB Alberta via the provided contact method.

Common Mistakes in Completing C139

The ones the AI is built to catch.

Using the wrong date format (not YYYY/MM/DD)
People often enter dates in their usual local format (e.g., DD/MM/YYYY or MM/DD/YYYY) or write them in words, which can cause the claim to be interpreted incorrectly. This can lead to delays while WCB confirms timelines or requests clarification. Always enter dates exactly as YYYY/MM/DD for date of birth, employment dates, and signature date, and double-check that month/day are not swapped.
Leaving employment dates incomplete or inconsistent
A common error is providing only a start date, using vague ranges (e.g., “2019–2021”), or listing dates that don’t match the “Employer name / Date of employment from/to” section and the Employment History table. Inconsistent timelines can prevent WCB from confirming exposure duration and may trigger follow-up requests. Ensure the “from” and “to” dates are complete, consistent across the form, and reflect any breaks in employment in separate lines.
Not listing all occupations and provinces in the Employment History table
Employers sometimes enter only one job title or omit the province, especially if the worker had multiple roles or worked at different sites. Missing occupation/province details can weaken the exposure assessment and slow adjudication. List each distinct role and location/province on separate lines with the correct date ranges, even if the worker stayed with the same company.
Checking a reason for “unable to confirm employment” without completing the required details
When selecting options like “no personnel files beyond this date” or “company changed ownership,” people often forget to fill in the date, former owner contact information, or the “beyond this date” cutoff. This leaves WCB without a path to verify employment and can stall the claim. If you check any of these boxes, complete every related blank (dates, names, phone numbers, addresses) and add a brief explanation under “Other” when needed.
Contradictory answers about hearing protection and enforcement policy
It’s common to answer “Yes” to hearing protection being provided but “No” to having/enforcing a policy (or vice versa) without explanation. Contradictions raise questions about actual usage and workplace controls, often prompting follow-up. Answer both questions carefully and, if the situation changed over time, clarify in the comments (e.g., policy introduced in a certain year or enforced only in specific areas).
Selecting “audiograms attached” but not actually attaching them (or attaching incomplete records)
Employers frequently check that audiograms are attached but forget to include them, include only a summary, or omit key pages/dates. Missing audiograms can delay medical review and exposure correlation. Attach complete copies (all pages, dates, and identifiers) or, if obtaining from a provider, choose the “copies can be obtained from” option and provide the provider’s full name and phone number.
Providing incomplete third-party contact details for audiograms/noise readings
When indicating records can be obtained elsewhere, people often provide only a company name without a contact person, or omit the area code/phone number. Incomplete contact details prevent WCB from retrieving records efficiently and can lead to repeated requests. Provide a specific contact name (if available), full telephone number including area code, and ensure the organization name is spelled correctly.
Not completing the noise level readings section correctly (box checked but no supporting info)
A frequent mistake is checking that noise readings exist but not attaching copies or not identifying where they can be obtained. This can delay assessment of workplace noise exposure and may require WCB to request additional documentation. If readings exist, either attach them or provide a clear source contact; if they do not exist, check “not been taken” and use the equipment list and comments to describe noise sources.
Listing equipment/tools too vaguely or omitting key noise sources
People often write generic terms like “machinery” or “tools” without specifying types, models, or the worker’s proximity, or they forget intermittent but loud equipment (e.g., grinders, impact tools, compressors). Vague equipment lists make it harder to evaluate exposure and may lead to follow-up questions. List specific equipment (type/model if known), typical tasks, and whether the worker operated it or worked nearby.
Missing or illegible employer identification and sign-off details
Common omissions include leaving out company name, contact name (printed), position/title, telephone number, signature, or the signature date. Without a clear authorized sign-off, WCB may treat the submission as incomplete and request resubmission. Print the contact name clearly, include a direct phone number, provide the signer’s title, sign the form, and date it in YYYY/MM/DD.
Employer form completed by the worker or someone without authority
Despite the instruction that the form is to be completed by the employer only (if the worker is currently employed), workers or unauthorized staff sometimes fill it out, leading to credibility and verification issues. This can result in WCB rejecting the information or requesting an authorized employer representative to redo it. Ensure an appropriate employer representative (HR, safety officer, or manager with access to records) completes and signs the form, and use company records rather than memory where possible.

Frequently Asked Questions About C139

 

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How complex is C139 to fill out?
C139 has a Form Complexity Index of 55 out of 100, in the moderate tier: 65 fillable fields across 2 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is Form C139 (Employer’s Information Questionnaire) used for?
Form C139 is used by WCB-Alberta to collect employer information about a worker’s employment history and workplace noise exposure, often in support of a hearing-related claim. It helps WCB confirm job dates, duties, and whether hearing protection, audiograms, and noise readings exist.
Who is supposed to complete Form C139?
If the worker is currently employed, the form must be completed by the employer only. The employer should have someone with access to HR/safety records complete and sign it.
What claim and worker details are required at the top of the form?
You must provide the WCB claim number and the worker’s surname, first name, initials, date of birth, Social Insurance Number, occupation, employer name, and dates of employment. Use the date format shown on the form (YYYY/MM/DD).
How do we fill out the Employment History section if the worker had multiple roles or worked in different provinces?
List each period separately with the “From” and “To” dates, the occupation for that period, and the province where the work was performed. Add additional lines or attach a separate page if needed, and reference the claim number on any attachment.
What if we can’t confirm the worker’s employment dates or details?
Check the box that best explains why you cannot confirm the employment (e.g., records don’t go back that far, ownership changed, or records/long-time employees can’t confirm). Provide the requested details such as the date records begin, former owner contact information, or an explanation under “Other.”
What should we answer for the hearing protection questions?
Indicate whether hearing protection was provided and whether there was a policy requiring or enforcing its use. Answer based on the period(s) the worker was employed and your documented safety practices.
What are “audiograms” and what do we need to submit about them?
Audiograms are hearing test results (hearing assessments). If audiograms were taken, check the appropriate box and either attach copies or provide the name and phone number of the provider who can supply them.
What if our company has never done hearing assessments for employees?
Check the box stating that hearing assessments have not been completed for your employees. You can still add helpful context in the comments section about noise exposure controls or any relevant history you are aware of.
What are “noise level readings,” and do we have to attach them?
Noise level readings are measurements of workplace noise exposure. If readings exist, check the box and attach copies, or provide the contact name and phone number for where WCB can obtain them.
What if we have never taken noise level readings at our worksite?
Check the box indicating noise level readings have not been taken. Then complete the equipment/tools/machinery list to help WCB understand potential noise sources in the worker’s work area.
How detailed should the list of equipment, tools, and machinery be?
List the main noise-producing equipment the worker used or worked near (e.g., compressors, grinders, saws, heavy equipment, stamping presses). Include enough detail to identify the type of equipment and the work area, and add extra pages if necessary.
What should we include in the “additional comments” section?
Use this section to share relevant information such as known pre-existing hearing issues, any traumatic injury events, changes in job duties, or hearing protection practices. Keep comments factual and based on records or direct knowledge.
Where do we send the completed Form C139 and any attachments?
Submit the form to WCB-Alberta using the contact details shown on the form: fax to 780-427-5863 or 1-800-661-1993, or email to [email protected]. Include the claim number on the form and on any attachments.
Who should sign the form, and what contact information is required at the end?
An authorized employer representative should print their name, provide their position/title, sign, and date the form (YYYY/MM/DD). The company name, telephone number, and a contact name are also required so WCB can follow up if needed.
How long does it take to process after we submit the form?
The form itself does not list a specific processing time, and timelines can vary depending on the claim and whether records (audiograms/noise readings) are complete. Submitting the form promptly and attaching available documents can help avoid delays.
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