Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
WC-PUB-005 – Employees – Know Your Rights Poster
WC-PUB-006 – Rights and Responsibilities Poster
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
WC-100 – Employer’s Basic Report of Injury
WC-106 – Supplemental Report of Fatal Injury
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
WC-PUB-001 – Summary of Your Rights and Responsibilities under Workers’ Compensation (Versión en Español)
Injured Workers First Fill Prescription Form (Versión en Español)
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
WC-155 – Authorization for Release of Records
Direct Deposit Authorization (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
Specific Person Exclusion Form
Certified Resolution-Consent Form
