Search results
C-1 Fillable Form with Signature (2/2020) C-3 Employer's Report of Industrial Injury or Occupational Disease (2/2020) C-3 Fillable Form (2/2020) C-4 Employee's Claim for Compensation - Report of Initial Treatment - Fillable (8/23) C-4A Release of Medical and Other Information For Nevada Workers’ Compensation Claims 8/21 - Discontinued eff 9 ...
- NOTICE OF INJURY OR OCCUPATIONAL DISEASE
compensation (form c-4). For assistance with Workers’...
- Forms for Download
Employee's Claim for Compensation/Report of Initial...
- Compensation Forms
Forms To Provide and Review With Injured Employees. C-1...
- Injured
The C-1 form is titled the “Notice of Injury or Occupational...
- NOTICE OF INJURY OR OCCUPATIONAL DISEASE
Notice of Injury or Occupational Disease (Incident Report Form C-1): If an injury or occupational disease (OD) arises out of and in the course of employment, you must provide written notice to your employer as soon as practicable, but no later than 7 days after the accident or OD.
compensation (form c-4). For assistance with Workers’ Compensation Issues you may contact the State of Nevada Office for Consumer Health Assistance Toll Free: 1-888-333-1597 Web site:
C1 fillable form. "NOTICE OF INJURY OR OCCUPATIONAL DISEASE" (Incident Report) Pursuant to NRS 616C.015. Name of Employer. MY EMPLOYER/INSURER MAY HAVE MADE ARRANGEMENTS TO DIRECT ME TO A HEALTH CARE PROVIDER FOR MEDICAL TREATMENT OF MY INDUSTRIAL INJURY OR OCCUPATIONAL DISEASE. I HAVE BEEN NOTIFIED OF THESE ARRANGEMENTS.
Employee's Claim for Compensation/Report of Initial Treatment [C-4 form]
Forms To Provide and Review With Injured Employees. C-1 Fillable Form - Notice Of Injury Form; C-1 Form - Notice Of Injury Form; Employee Responsibility Form; Leave Choice Option Form; Physical Assessment Form
The C-1 form is titled the “Notice of Injury or Occupational Disease – Incident Report”. It creates a record of your injury, and it is proof that you informed your employer about the injury. The C-1 form is simply a report.
