Worker's Compensation Forms
Worker's Compensation Forms
C-1 -- Notice of Injury or Occupational Disease (Revised 2/2020)
CCF-99 -- Supervisor's Accident/Injury/Incident Investigation Report
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-1 -- Informational Poster (Revised 10/2020 Orange poster replaces yellow poster)
D-2 -- Brief Description of Your Rights and Benefits (Revised 10/2020 - on back of C-1 Form)
D-26 -- Application for Reimbursement of Claim Related Travel Expenses
Preferred Medical Clinics Map (Rev. 03/23)