Resource Browser
| Filename | Description | Updated | |
|---|---|---|---|
| 1E-Take to Doctor | Injured Employee: Take this form to your doctor. It includes instructions and authorization for workers compensation. | ||
| 1S-First Report of Workers Compensation Injured Employee (PC/MAC) | Download the form to your desktop to complete the form. The injury report should be completed by the supervisor or designee within 24 hours of the employee's injury. | ||
| Doctor Choice Form 50 - Nebraska. This form is required for workers' compensation injuries fax to 402-715-1097 or e-mail the completed form to fmla-wc@mpsomaha.org. Workers compensation |
|||
| 2S-MPS Incident Investigation Report (PC/MAC) | Download the form to your desktop to complete the form. Supervisor Investigation Report for workers compensation. The supervisor should complete within 48 hours of the employee's injury. | ||
| 3E-Employee Work Comp - Follow-up Form | Download the form to your desktop to complete the form. Workers Compensation Forms: Employee Follow-up Form to provide to your supervisor after each doctor visit. | ||
| 3E-Employee Work Comp - Follow-up Form | Workers Compensation Forms: Employee Follow-up Form to provide to your supervisor after each doctor visit. MAC Version |
||
| 3S-Supervisor Follow up (PC) | Download the form to your desktop to complete the form. Supervisor Follow-up Injured workers compensation form PC Version | ||
| 4E - First Fill Prescription Form | Injured Employee: Get your workers' compensation prescriptions filled. English & Spanish Version |
||
| Employee Flow Chart for Workers Compensation Injuries | Step by step Instructions if you are injured at work | ||
| Rights & Obligations | Workers Compensation Information Sheet | ||
| Rights & Obligations (Spanish) | Workers Compensation Information Sheet (Spanish) | ||
| S-Supervisor flow chart for workers compensation employee injuries | Instructions for supervisors if an employee is injured at work |