Free Connecticut Workers Compensation Forms

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40 Forms found in Connecticut — Workers Compensation — Page 1 of 1
Title Last Updated
Coverage Election By Sole Proprietor Or Single Member LLC August 27, 2015
Coverage Election By Employees Who Are Members Of Partnership August 27, 2015
Coverage Election By Employee Who Is An Officer Or Member August 27, 2015
Voluntary Agreement April 17, 2015
Inspection Form December 23, 2014
Employer Participation Form December 23, 2014
Education Services Order Form December 23, 2014
Utilization Review Company Minimum Standards December 23, 2014
Authorization For Release Of Medical Records July 19, 2013
Employer Medical Care Plans Information Packet And Forms April 5, 2013
Physicians Permanent Impairment Evaluation November 10, 2010
Employee Medical And Work Status Form November 10, 2010
Notice Of Claim For Compensation (Employee To Commissioner And To Employer) November 10, 2010
Notice Of Intention To Reduce Or Discontinue Payments November 4, 2009
Dependents Notice Of Claim June 9, 2009
Stipulation Questionnaire March 18, 2009
Application For Certificate Of Self Insurance December 3, 2008
Notice To Dependents June 2, 2008
Form Notice To Compensation Commissioner And Employee Of Intention To Discontinue Or Reduce Payment June 2, 2008
Rehabilitation Request April 1, 2008
Hearing Request April 1, 2008
Hearing Cancellation Request April 18, 2007
Mileage Worksheet For Medical Treatment December 1, 2006
Notice To Employees December 1, 2006
Order To Second Injury Fund In Cases Of Concurrent Employment December 1, 2006
Notice To Compensation Commissioner And Employee Of Intention To Contest Employees Right To Compensation Benefits December 1, 2006
Physicians Report Of Medical Evaluation Permanent Medical Impairment December 1, 2006
Petition For Review December 1, 2006
Notification Of Appearance December 1, 2006
Filing Status And Exemption Form December 1, 2006
Employers First Report Of Occupational Injury Or Illness December 1, 2006
Coverage Election By Employee Who Is Officer Of Corporation Manager Of LLC Or Member Of Multiple Member LLC December 1, 2006
Building Permit For The Sole Proprietor Or Property Owner December 1, 2006
Building Permit For The General Contractor Or Principal Employer December 1, 2006
Building Permit Affidavit For Property Owners Or Sole Proprietors December 1, 2006
Record Of Employment Contacts May 25, 2006
Self Insurer Surety Bond July 14, 2004
Self Insurance Guarantee Agreement July 14, 2004
Guarantee Resolution July 14, 2004
Employer Safety And Health Committee Information Packet And Inspection Form July 14, 2004