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1E-Take to Doctor Injured Employee: Take this form to your doctor. It includes instructions and authorization for workers compensation.
1S-First Report of Injury The injury report should be completed by the supervisor or designee within 24 hours of the employee's injury.
1S-First Report of Injury (MAC) The injury report should be completed by the supervisor or designee within 24 hours of the employee's injury. MAC version.
2E-Doctor Choice Form Doctor Choice Form 50 - Nebraska
2S-MPS Incident Investigation Report Supervisor Investigation Report MAC Version. The supervisor should complete within 48 hours of the injury.
2S-MPS Incident Investigation Report Supervisor Investigation Report. The supervisor should complete within 48 hours of the injury.
3E-Employee Follow-up Form
3E-Employee Follow-up Form MAC Version
3S-Supervisor Follow up Supervisor Follow-up Form MAC Version
3S-Supervisor Follow up Form
4E - First Fill Prescription Form Injured Employee: Get your workers' compensation prescriptions filled.
Employee Flow Chart for Injuries 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 Injuries Instructions for supervisors if an employee is injured at work