In the event of a workplace related employee Injury or Illness

1. Employees must immediately report any workplace related injury/illness to a supervisor.
2. In the event of an emergency, call 911 immediately
3. For non-emergencies, supervisors should direct the employee to the nearest urgent care or emergency room for an initial evaluation.

Employees may visit any walk-in urgent care, such as Concentra, or any emergency department for initial treatment prior to receiving a workers compensation claim number.

After the above steps are taken, the injured employee and their supervisor will be responsible for reporting the injury or illness to both the DEEP health & safety office as well as DAS workers compensation office. All incidents must be reported to the health & safety office and workers compensation regardless of whether or not medical attention was sought.

Please note: the DEEP Health & Safety Office cannot answer questions related to or assist with workers compensation forms and procedures. Please reach out to DAS Workers Compensation office at DAS_RfaxWCGG@ct.gov for any questions related to workers compensation.

For workers compensation,

1. Supervisors should complete WC-207 and 207-1 before the end of the shift.
2. Employees should complete the DAS acknowledgment letter, WC-715, WCC-1A, and WC-211 forms.
3. Supervisors or employees should report workers compensation claims to Gallagher Basset Services by the end of the shift by calling 1-800-828-2717. If the injury is a recurrence, please call 1-866-220-6534.
4. All workers compensation forms should be sent by email or fax to DAS_RfaxWCGG@ct.gov.

For health & safety,

1. Supervisors should work with injured/ill employees, if the employee is able, to complete the OSHA 301 form.
2. Supervisors should submit the OSHA 301 form within 7 days from the date of the incident to DEEP.SafetyOffice@ct.gov. Any questions regarding OSHA 301 forms can be directed to this email as well.
3. Supervisors or injured/ill employees should continue to update the reported information to the safety office, such as the total number of days missed or on restricted work or if medical attention is sought after the report is submitted.

Please see below for links to related documentation.

Health & Safety Forms

DEEP 301