Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
What to Do if You’re Injured at Work Poster
Form NOA-1 – Notice of Accident or Occupational Disease Disablement
Workers’ Compensation Fraud is a Crime Poster
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Report Forms
Form E1.2 – IA-1 – Employers’ 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
Form NOA-1 – Notice of Accident or Occupational Disease Disablement
Injured Workers First Fill Prescription Form (Versión en Español)
Workers’ Authorization for Use & Disclosure of Health Records (Versión en Español)
Request for Medical History 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
Instructions for State-Specific Forms & Documents
Executive Employee Affirmative Election
Revocation of Prior Election
