Resource Browser
| Filename | Description | Updated | |
|---|---|---|---|
| 1E-Take to Doctor | Injured Employee: Take this form to your doctor. It includes instructions and authorization for workers compensation. | ||
| 1S-First Report of Workers Compensation Injured Employee (MAC) | Download the form to your desktop to complete the form. The injury report should be completed by the supervisor or designee within 24 hours of the employee's injury. Workers Compensation First Report Form. MAC Version. |
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| 1S-First Report of Workers Compensation Injured Employee (PC) | Download the form to your desktop to complete the form. The injury report should be completed by the supervisor or designee within 24 hours of the employee's injury. PC version. | ||
| 2E-Doctor Choice Form | Doctor Choice Form 50 - Nebraska. This form is required for workers' compensation injuries fax to 402-715-1097 or e-mail the completed form to fmla-wc@mpsomaha.org. Workers compensation |
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| 2S-MPS Incident Investigation Report | Download the form to your desktop to complete the form. Supervisor Investigation Report for workers compensation - MAC Version. The supervisor should complete within 48 hours of the injury. | ||
| 2S-MPS Incident Investigation Report (PC) | Download the form to your desktop to complete the form. Supervisor Investigation Report for workers compensation. The supervisor should complete within 48 hours of the employee's injury. | ||
| 3E-Employee Work Comp - Follow-up Form | Download the form to your desktop to complete the form. Workers Compensation Forms: Employee Follow-up Form to provide to your supervisor after each doctor visit. | ||
| 3E-Employee Work Comp - Follow-up Form | Workers Compensation Forms: Employee Follow-up Form to provide to your supervisor after each doctor visit. MAC Version |
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| 3S-Supervisor Follow up (PC) | Download the form to your desktop to complete the form. Supervisor Follow-up Injured workers compensation form PC Version | ||
| 4E - First Fill Prescription Form | Injured Employee: Get your workers' compensation prescriptions filled. English & Spanish Version |
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| Employee Flow Chart for Workers Compensation Injuries | Step by step Instructions if you are injured at work | ||
| Rights & Obligations | Workers Compensation Information Sheet | ||
| Rights & Obligations (Spanish) | Workers Compensation Information Sheet (Spanish) | ||
| S-Supervisor flow chart for workers compensation employee injuries | Instructions for supervisors if an employee is injured at work |