Revised Forms


TO: Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, Legal Advisory Panel Members, Medical Advisory Panel Members, and Advisory Board Members
FROM: John A. Mastropietro, Chairman
DATE: October 29, 2001
RE: Revised Forms


I am pleased to announce that the Commission has recently revised and redesigned four of its most-often used forms: (1) the 30C "Notice of Claim for Compensation" form, (2) the "Hearing Request" form, (3) the "Petition for Review" form, and (4) the "Notification of Appearance" form.

You can print and fill out the newly-revised forms online at:

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

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.