Employer Participation Form | Pdf Fpdf Doc Docx | Connecticut

 Connecticut   Workers Compensation 
Employer Participation Form | Pdf Fpdf Doc Docx | Connecticut

Last updated: 12/23/2014

Employer Participation Form

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Description

EMPLOYER PARTICIPATION FORM. This form is used to document an employer's participation in a workers' compensation medical care plan. It collects information about the employer, including their business details, representative, workers’ compensation carrier, and policy information. It also inquires about collective bargaining agreements, adherence to plan obligations, and requires attachments such as a health and safety committee certificate, financial arrangements, a plain language explanation for employees, and a description of the modified/light duty work program. www.FormsWorkflow.com

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