Workers' Compensation is an insurance program which covers injuries and diseases that are work related. Fault or negligence by the employer or the employee is not considered in the injured employee’s claim for benefits. The primary objective of the program is to return the injured employee to gainful employment as quickly as possible.

In order to receive benefits for a covered injury or disease, a claim must be initiated by the injured employee by completing the following workers compensation forms as required by law.

Workers' Compensation Introduction Video

• Notice of Injury or Occupational Disease (Form C-1)  *Revised 10/29/2020

• Informational Poster (D-1) * Revised 06/11/2025

• Brief Description of Rights and Benefits (Form D-2)  *Form Revision 07/01/2025

• Claim for Compensation (Form C-4) *Revised 02/2025

• Initial Treatment Map *Revised 03/2025

• Release of Medical and Other Information for Worker's Compensation Claim (Form C4-A)

*Recycle old forms and posters! Each work location will receive new D-1 posters and C-1 forms. Discard the old D-1 poster and C-1 forms and replace with D-1 poster revised in June 2025 and the C-1 form with the second page update July 2025, as soon as you receive them in school mail. 

These documents are controlled by the Division of Industrial Relations (DIR) for the State of Nevada. Any modifications or additions to them must be approved by the DIR. The CCSD Workers' Compensation office has no control over the timing of these revisions but we are required to start using the updated form immediately.

Current Form Distribution:

Once filled out the original is kept at work site and a copy given to the employee. Scan a copy to workcomp@nv.ccsd.net or Fax a copy to Workers' Compensation at 702-799-2995 or mail to 4828 S. Pearl Street, Las Vegas, NV 89121.

CCSD is self-insured for all workers' compensation claims.

• Certificate of Self Insurance - Nevada

If an injury or occupational disease (OD) arises out of and in the course of employment, the injured employee must provide written notice to his/her supervising administrator by completing a Form C-1 as soon as practicable, but no later than 7 days after the accident or OD. C-1 Forms are available at the job site.

1. The C-1 Form must be fully completed by the injured employee, including a signature and a date as required by the Form.

2. Upon receipt of the injured employee’s fully completed C-1 Form, the site administrator or immediate supervisor is mandated by law to sign and date it. The signature of the supervisor is an acknowledgment of the receipt of the C-1 form and is not deemed to be admission of liability on the part of the District, site administrator, or immediate supervisor.

3. The site administrator or immediate supervisor must also complete the CCF-99, Supervisor's Accident/Injury/Incident Investigation Report. The CCF-99 should be completed and provided to Risk Management as soon as possible, but no later than 7 days after the incident.

There may also be incidents that a supervisor wants to record as being a "near miss" for injury. In those instances, the supervisor would still complete the CCF-99 form but the employee doesn't need to complete a C-1 Form, if no injury resulted. This will allow the Safety office in our department to review situations that could have caused injury and adjust procedures or develop training to prevent future accidents. 

Current Form Distribution:

Original kept at work site and a copy given to the employee. Fax a copy to Worker's Compensation at 702-799-2995, email to workcomp@nv.ccsd.net or mail to 4828 S. Pearl Street, Las Vegas, NV 89121.

If medical treatment is sought, the Form C-4 is available at the place of initial treatment. The injured employee must file a completed C-4 Form within 90 days after an accident or occupational disease.

Worker's Compensation benefits may include:

• Medical Treatment

• Temporary Total Disability Compensation

• Vocational Rehabilitation

• Death Benefits

Medical Treatment

Treatment Locations

Provider Panel 2024

State law allows the school district to establish a network of preferred providers for the purpose of treating employees that are injured on the job or have an occupational disease. With the exception of life-threatening conditions, injured employees can obtain medical care only from providers who are listed on the school district-approved network of worker's compensation providers.

Temporary Total Disability Compensation

If the authorized treating or attending doctor has certified the injured employee unable to work for a period of at least 5 consecutive days, or 5 cumulative days in a 20-day period, or places temporary work restrictions that the school district does not accommodate, the injured employee may be entitled to temporary total disability (TTD) compensation. TTD compensation is 66 2/3 percent of the injured employee’s average monthly wage at the time of the injury, subject to a maximum limit set by the state. School district employees have the option to continue to receive their normal salary in lieu of TTD by using part of their accrued sick leave as income continuation supplement.

Vocational Rehabilitation

Injured employees who are unable to return to their usual and customary occupation due to permanent work restrictions established by a physician may be eligible for vocational rehabilitation services. The injured employee’s right to such services depends on the employee’s place of residence. Furthermore, a lump sum buyout in lieu of vocational services may be an option.

Death Benefits

In the event a work-related injury or accident results in the death of the employee, workers compensation will cover burial expenses and survivor’s and/or dependent’s compensation subject to a maximum limit set by the state.