Form 30C – Notice of Claim for Workers’ Compensation

The Form 30C is the official "Notice of Claim for Compensation" used in Connecticut workers’ compensation cases. It must be filed promptly after a work‑related injury or occupational disease to protect your right to benefits.

What Is Form 30C and When Is It Required?

Form 30C is required whenever an employee suffers an injury or illness that is believed to be job‑related. Connecticut law sets a filing deadline of one year from the date of injury (or three years from the first manifestation of a disease). Submitting this form starts the claims process with the Workers’ Compensation Commission (WCC).

How to Complete the Fillable Form 30C Online

Instead of downloading a static PDF, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load the fillable version of Form 30C, allowing you to type directly into each field, add dates, and sign electronically.

• Step 1: Click the blue "Fill out this form" button.
• Step 2: Wait a few seconds while the Formize PDF Filler loads.
• Step 3: Complete every required field – the app highlights missing information.
• Step 4: Save your progress or submit the form directly to the WCC district office and your employer.

Common Mistakes to Avoid When Filing Form 30C

Even a small error can delay your claim. Keep these tips in mind:

• Missing signatures: Both the employee and employer must sign.
• Incorrect dates: Verify the injury date and the date you are filing.
• Incomplete contact info: Provide a current phone number and mailing address.
• Failing to attach supporting documents: Include medical reports or accident reports when required.

Using the online fillable version reduces these errors because required fields are flagged in real time.

Need a printable copy? You can still download the original PDF below, but we highly recommend the online filler for a faster, error‑free experience.