Skip to form

Risk Management

WCinjuryreport@stamfordct.gov

Stamford Government Center 888 Washington Boulevard 10th Floor Stamford, CT 06901

(203) 977-4083

SeamlessDocs

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

x

Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

x

Additional Signatures Required