Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
ERD-800 – Employee Notice Poster (Versión en Español)
ERD-801 – Employee Warning – Cancellation Pending
ERD-802 – Employee Warning – Cancellation Requested
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Report Forms
Instructions for First Report of Injury or Occupational Disease (Versión en Español)
ERD-991 – First Report (Versión en Español)
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)
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form, (Versión en Español)
Mileage Reimbursement Form (Versión en Español)
Workers’ Compensation Benefits Summary
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
