Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
DWC Form 14-0001 – First Report of Injury or Illness
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 Form 14-0043 – Authorization to Release Information Regarding Claimants Seeking WC Benefits
DWC Form 14-0196 – Authorization for the Iowa DWC to Release Information
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
Direct Deposit Authorization 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
