Follow the steps to successfully complete the CT 30C form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the 'INJURED WORKER' box, type or neatly print the name of the injured worker, including their date of birth and contact details. Check the box if the worker is a minor.
3. In the 'EMPLOYER' box, provide the employer's name and address. Indicate whether the injury occurred at this location or another, providing specifics if applicable.
4. In the 'INJURY' box, fill out the date of the injury and the location. Describe the injury succinctly, specifying the affected body parts and how the injury happened.
5. Sign the form in the 'SIGNATURE OF INJURED WORKER OR REPRESENTATIVE' box and date it. Ensure correct representation if signed by someone other than the injured worker.
6. Make two copies of the completed form. Send the original to the employer and to the appropriate Workers’ Compensation Commission District Office, using certified or registered mail.
7. Keep the final copy of the CT 30C form for your records.

Complete your CT 30C form online today to ensure your workers' compensation claim is submitted promptly.