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NOTICE TO EMPLOYEESState of Connecticut Workers Compensation CommissionRevised 10012017The Workers Compensation Act (Connecticut General Statutes Chapter 568) requires your employer, Connecticut Institute
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Obtain the form workers compensation act.
02
Read the instructions and requirements outlined on the form.
03
Fill in your personal information accurately, including your full name, address, contact details, and social security number.
04
Provide information about your employer, such as their name, address, and contact details.
05
Specify the date and time of the work-related injury or illness.
06
Describe the details of the incident, including how it happened and what body parts were affected.
07
Attach any supporting documents, such as medical reports or witness statements, if required.
08
Review the completed form for any errors or missing information.
09
Sign and date the form.
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Submit the filled-out form to the relevant authority or your employer's workers compensation insurance provider.

Who needs form workers compensation act?

01
Any individual who has suffered a work-related injury or illness and wishes to file a workers compensation claim needs the form workers compensation act.
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Form workers compensation act is a document that employers use to report any work-related injuries or illnesses to their employees and to their workers' compensation insurance provider.
Employers are required to file form workers compensation act when an employee suffers a work-related injury or illness.
Form workers compensation act can be filled out by providing details of the injured employee, the nature of the injury or illness, and any medical treatment received.
The purpose of form workers compensation act is to ensure that employees receive proper medical treatment and compensation for work-related injuries or illnesses.
Information such as the injured employee's name, date of injury, description of the injury, and details of any medical treatment must be reported on form workers compensation act.
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