Get and Sign Online Forms State of Connecticut Workers

Pain with anyone at work If yes with whom and when Yes No Have you had any recent non-work-related injuries/illnesses If yes please list Yes If the above answer is yes what was the problem when did it occur and what if any medical treatment did you receive Show part s of the body injured noting the longevity type and degree of pain. On the diagram below indicate the location description and level of pain you are experiencing at this time. Example A-6 Ache- Severe pain Note type of pain P Pins...