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Employer Resource Library

You have the option to download the full Omaha National Employer Resource Guide or just the sections that you are interested in. Choose the materials from the state where you are located as they may vary.

Arizona Employer Resource Guide

Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Notice to Employees: Arizona Workers’ Compensation Law
Notice to Employees: Work Exposure to Bodily Fluids (HIV, AIDS, Hepatitis C)    (Versión en Español)
Notice to Employees: Work Exposure to MRSA, Spinal Meningitis, or Tuberculosis (TB)
2021 Minimum Wage Poster    (Versión en Español)
Earned Paid Sick Time Poster    (Versión en Español)
Employee Safety and Health Protection Poster    (Versión en Español)
Fraud Prevention Poster    (Versión en Español)
Instructions for Injury Report Forms
ICA 04‐0101 ‐ Employer's Report of Industrial Injury
ICA 2212 - Serious Event Reporting Form
Incident Investigation Form    (Versión en Español)
Supervisor's Report of Employee Incident    (Versión en Español)
Witness Statement of Injury or Incident    (Versión en Español)
15-IN-Instructions-for-Informational-Documents-2-11-2020
Instructions for Injured Worker Handouts
ICA 0407 ‐ Workers' Report of Injury
ICA 0124 - Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material
Consent and Authorization for Release of Information Form    (Versión en Español)
18-IN-Instructions-for-General-Forms-2-11-2020
Request for Medical History Form    (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
Significant Exposure Under the Arizona Workers’ Compensation Act
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 - Confidential Request for Ownership Information
Company Contacts Verification
Instructions for State-Specific Forms & Documents
ICA 0113 - Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law
ICA 0114 - Employee’s Notice to Revoke Rejection of Terms of the Arizona Workers’ Compensation Law

California Employer Resource Guide

Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Utilization Review Plan
DWC-7 – Notice to Employees – Injuries Caused by Work    (Versión en Español)
Fraud Prevention Poster    (Versión en Español)
Instructions for Injury Report Forms
DLSR-5020 - Employer's Report of Occupational Injury or Illness
DIA-510 – Notice of Employee Death
Incident Investigation Report    (Versión en Español)
Supervisor’s Report of Employee Incident    (Versión en Español)
Witness Statement of Injury or Incident    (Versión en Español)
Instructions for Injured Worker Handouts
DWC-1 – Claim Form & Notice of Potential Eligibility    (Versión en Español)
Employee Medical Provider Network Notice    (Versión en Español)
Notice to Victims of Workplace Crimes    (Versión en Español)
Employee Acknowledgement Form    (Versión en Español)
Consent & Authorization for Release of Information Form    (Versión en Español)
Request for Medical History Form    (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Medical Provider Network (MPN) Information for Employers
Reduce Your Workers Compensation Costs
Instructions for General Forms
Request for Subrogation Waiver
Notice of Ownership Change
Company Contacts Verification
Instructions for State-Specific Forms & Documents
DWC Time of Hire Pamphlet    (Versión en Español)
Employee Acknowledgement Form    (Versión en Español)

Nevada Employer Resource Guide

Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Worker's Compensation Notice
D-1 - Informational Poster
D-2 - Brief Description of Rights and Benefits
D-22 - Notice to Employees - Tip Information
Fraud Prevention Poster    (Versión en Español)
Instructions for Injury Reports
C-3 – Employer’s Report of Industrial Injury or Occupational Disease
D-8 – Employer’s Wage Verification Form
Incident Investigation Report    (Versión en Español)
Supervisor’s Report of Employee Incident    (Versión en Español)
Witness Statement of Injury or Incident    (Versión en Español)
Instructions for Injured Worker Handouts
C-1 - Notice of Injury or Occupational Disease
D-2 - Brief Description of Rights and Benefits
D-53 - Alternative Choice of Physician or Chiropractor
D-36 - Request for Additional Medical Information and Medical Release
Consent and Authorization for Release of Information    (Versión en Español)
Request for Medical History Form    (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 - Confidential Request for Ownership Information Company Contacts Verification
Instructions for State-Specific Forms & Documents
D-25 - Affirmation of Compliance with Mandatory Industrial Insurance Requirements
D-43 - Employee’s Election to Reject Coverage and Election to Waive the Rejection of Coverage for Excluded Persons
D-44 - Election of Coverage by Employer; Employer Withdrawal of Election of Coverage
D-23 – Employee’s Declaration of Election to Report Tips