State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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WCC New and Revised Forms Memorandum - July 26, 2002


MEMORANDUM NO. 2002-04

TO: Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Legal Advisory Panel Members, and Advisory Board Members
FROM: John A. Mastropietro, Chairman
DATE: July 26, 2002
RE: NEW and REVISED FORMS

I am pleased to announce that the Commission has recently revised and redesigned four of its most-often used forms: (1) the "Voluntary Agreement" form, (2) the "43" form, (3) the "Employer's First Report of Occupational Injury or Illness" form, and (4) the "Notification of Appearance" form. Each of these forms now carries a revision date of 7-22-2002.

It is hoped that those of you receiving this memorandum will use the newly-revised forms beginning immediately to assist the Commission in providing its services as efficiently and effectively as possible. Thank you for your anticipated cooperation.

 

DIRECTIONS FOR USE OF THE NEW VOLUNTARY AGREEMENT FORM:

 

You can print and fill out the newly-revised forms online at: http://wcc.state.ct.us/download/forms.htm

PLEASE NOTE:

 

For hard copies of the new forms, please contact:

Workers' Compensation Commission
Education Services
21 Oak Street, 4th Floor
Hartford, CT 06106-8011

Phone: (860) 493-1500
Fax: (860) 247-1361
E-Mail: wcc.chairmansoffice@po.state.ct.us


State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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State of Connecticut
Workers' Compensation Commission
Page last revised: July 26, 2002
Page URL: http://wcc.state.ct.us/memos/2002/2002-04.htm

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