Worker's Compensation Forms
Worker's Compensation Forms
C-1 -- Notice of Injury or Occupational Disease (Revised 10/2020)
CCF-99 -- Supervisor's Accident/Injury/Incident Investigation Report
C-3: Employer’s Report of Industrial Injury or Occupational Disease
C-4 -- Employee’s Claim for Compensation
C-4A - Release of Medical and Other Information
Current Form Distribution:
Original kept at work site and a copy given to the employee. Email or fax a copy to Worker's Compensation at 702-799-2995 or workcomp@nv.ccsd.net.
D-2 -- Brief Description of Your Rights and Benefits (Revised 07/2025 - on back of C-1 Form)
D-26 -- Application for Reimbursement of Claim Related Travel Expenses
Preferred Initial Treatment Locations