Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
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
Injured Workers First Fill Prescription Form (Versión en Español)
DWC-1 – Claim Form & Notice of Potential Eligibility
Employee Medical Provider Network Notice (Versión en Español)
Notice to Victims of Workplace Crimes (Versión en Español)
Employee Acknowledgement Form – Part Two (Versión en Español)
Consent and 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 – Part One (Versión en Español)
Utilization Review Plan
