Bridgewater, CT · Litchfield County
7C Proof of Workers’ Compensation Coverage
This form documents a general contractor’s or principal employer’s workers’ compensation exclusion and is used when applying for a building permit for a construction project.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
A general contractor or principal employer who has properly excluded themselves from workers’ compensation coverage completes this form and identifies the certificate filed with the Workers’ Compensation Commission. The affidavit states that they will require proof of workers’ compensation insurance from every contractor, subcontractor, or other worker before work begins at the property. The form is for use with a building permit application and requires an oath when the affidavit applies.
Who needs it
A general contractor or principal employer who has excluded themselves from workers’ compensation coverage and is applying for a building permit for the project needs this form.
Why it needs a notary
The affidavit has a jurat stating it was subscribed and sworn to before a notary public or Commissioner of the Superior Court; the general contractor or principal employer signs before the notary.
How to get this notarized
- 1
Download the Form
Get the 7C Proof of Workers’ Compensation Coverage form for your building permit application.
- 2
Complete the Form
Select your role and the certificate filed, then fill in the requested applicant, business, and property details.
- 3
Book an Online Notary
Schedule a remote appointment with a commissioned online notary if you need to complete the affidavit.
- 4
- 5
Submit With Your Application
Submit the completed form with your building permit application as directed by the town.
Preview the form
The blank PDF straight from Bridgewater. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the 7C workers’ compensation form?
- Select your business role and the certificate filed with the Workers’ Compensation Commission, enter the requested details, and sign the affidavit before a notary if applicable.
- Do I need to sign the affidavit before a notary?
- The form says to sign the affidavit in the presence of a notary public or Commissioner of the Superior Court when applicable. Do not sign it before your notary appointment.
- Can I use an online notary for this form?
- Connecticut authorizes its notaries to perform remote online notarizations under Public Act 23-28, codified at Conn. Gen. Stat. §3-95b. A commissioned online notary can notarize an eligible affidavit by video.
- Where do I submit the completed form?
- The form is for a building permit application, but it does not name a submission office. Ask the building permit office where to submit it; confirm with the town clerk if unsure.
7C Proof of Workers’ Compensation Coverage in other Connecticut cities
Each city publishes its own version of this form. Pick the city where you’re filing.