Connecticut Injury Absence Report

State:
Multi-State
Control #:
US-AHI-276
Format:
Word; 
Rich Text
Instant download
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Public form

Description

This AHI form is used to document an absence due to work-related injury. The form also includes the number of hours lost due to the injury. This form must be submitted prior to the close each pay period.

How to fill out Injury Absence Report?

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FAQ

28) What does Coding CTPL in Box 14 on the employee W-2 represent? Coding CTPL in Box 14 on the employee W-2 represents funding to support the CT Paid Leave program. Employee payroll deductions beginning January 1, 2021 are capped at 0.5% of the employee's wages up to the Social Security contribution base.

Care for a family member with a serious health condition; Because of an employee's own serious health condition; To serve as an organ or bone marrow donor; To address qualifying exigencies arising from a spouse, son, daughter or parent's active-duty service in the armed forces; and.

Family and Medical Leave Obligations Generally, the FMLA allows employees that are eligible to take leave up to 12 weeks in any 12-month period (Connecticut allows 16 weeks in any 24-month period) for situations that include the serious health condition of the employee.

The state of Connecticut FMLA allows up to 16 weeks of unpaid leave in a 24-month period (or up to 24 weeks if you are a state of Connecticut employee). Pregnancy: The Connecticut FMLA allows up to 12 weeks of unpaid leave in a 12-month period.

If the employee suffers an accidental injury during the course of their employment, then he or she has a time period of up to one year to file an official claim for workers' compensation.

If the employee suffers an accidental injury during the course of their employment, then he or she has a time period of up to one year to file an official claim for workers' compensation.

Workers' CompensationFor Assistance: 860-807-6932.DAS Public Safety Fax Number: 1-860-707-1846.Email: DASRfaxWCPS@ct.gov.Medical Claim Contact: 860-256-3409.Denise Miller 860-256-3453.

The State of Connecticut Workers' Compensation Program requires that an employee report a work-related injury or illness to his/her employer immediately. For injuries prohibiting the employee from immediately notifying his/her supervisor, the supervisor, on behalf of the injured employee, can directly report the claim.

This law provides eligible employees with up to 12 weeks of unpaid leave during a 12-month period for qualifying family or medical reasons. Employees are entitled to return to their same or, if not available, an equivalent job at the end of their leave.

In order to be eligible for FMLA leave, an employee: (1) must have worked at least 12 months (need not be consecutive) for the employer; (2) must have worked at least 1,250 hours during the 12 months immediately preceding the date of commencement of FMLA leave; and (3) must work at a location where the employer has at

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Connecticut Injury Absence Report