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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 Workers Compensation Injured Employee (PC/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.
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
2S-MPS Incident Investigation Report (PC/MAC) 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
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
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