Employer Resource Library

Nevada Employer Resource Guide

Cover Sheet and Welcome Letter

Table of Contents

Instructions for Posters

D-1 – Informational Poster

D-2 – Brief Description of Rights and Benefits

D-22 – Notice to Employees – Tip Information

Fraud Prevention Poster (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 Form (Español)

Supervisor’s Report of Employee Incident (Español)

Witness Statement of Injury or Incident (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 (Español)

Request for Medical History (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