Worker's Compensation (CIRMA)

Workers Compensation

Please note that incidents should be reported no more than 24-48 hours after an occurrence.

MPS Workers Compensation Procedures for ALL Incidents: 

The  Employee Accident/Injury Report  form Download form, fill in, save/print, also known as the First Report of Injury, is the document that initiates workers’ compensation benefits to the injured employee.  Any delay involving the submission of this form is delaying an injured employee’s receipt of benefits to which he or she may be entitled.  The  Employee Accident/Injury Report must be completed in its entirety, in detail, and signed by a supervisor. Once completed, it should be faxed to the attention of  Kathy Famiglietti, Insurance & Benefits Coordinator, Board of Education  (Fax # 860 638-1457).  Please keep a copy for your records.

The  Witness Statement   Download form, fill in, save/print  should be filled out only if there are any witnesses to the incident.

The   Supervisor’s Accident Investigative Report   Download form, fill in, save/print should be filled out by the employee’s immediate supervisor.  The purpose is to find out how a similar incident can be prevented in the future.

Workers' Compensation Procedure

(It is important that this office receives the accident/injury form a.s.a.p. even without the other two forms initially, if there is delay in completion.)


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