The Connecticut Employer’s First Report of Occupational Injury or Illness is a form used to report workplace injuries and illnesses that occur in Connecticut. This form is required to be completed and filed with the Connecticut Department of Labor for any workplace injury or illness, regardless of whether the employee seeks medical attention or misses work due to the injury or illness. The form must be completed within 24 hours of the employer being notified of the incident. The Connecticut Employer’s First Report of Occupational Injury or Illness has two parts. The first part is the general information section, which includes information about the employer, the injured or ill employee, and details of the incident. The second part is the medical section, which includes the medical diagnosis of the injury or illness, the medical provider, and any medical treatment that was provided. The two types of Connecticut Employer’s First Report of Occupational Injury or Illness are the Initial Report of Injury or Illness and the Follow-up Report of Injury or Illness. The Initial Report of Injury or Illness must be completed within 24 hours of the employer being notified of the incident. The Follow-up Report of Injury or Illness must be filled out within seven days of the initial report or when the employee returns to work, whichever comes first.
Connecticut Employer's First Report of Occupational Injury or Illness
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How to fill out Connecticut Employer's First Report Of Occupational Injury Or Illness?
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FAQ
The Employer's First Report of Occupational Injury or Illness form is to be completed by an employer or its workers' compensation insurance carrier to notify the Workers' Compensation Commission of occupational injuries or illnesses that result in incapacity for one day or more.
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.
The employer is required to file an Employer's First Report of Injury or Illness DWC FORM-001 Rev. 10/05 with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.
Report the injury or illness to your employer If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits.
The statute of limitations for filing a compensation claim for an accidental injury is one year from the date of the injury, while for an occupational disease or illness it is three years from the first manifestation of a symptom...so be sure to file in time!