|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 firstname.lastname@example.org.
|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.
|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|