Claims Forms,
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To be completed by Supervisor

Nebraska Workers Compensation Court NWCC Form 1 - First Report of Alleged Occupational Injury or Illness. To be completed by supervisor. This is an official public document.

To be completed by Employee

Nebraska Workers Compensation Court NWCC Form 50 Employees Choice of Doctor. To be completed by employee.

To be completed by Employee

ALICAP Incident Report - a suggested form. School could use their own internal form. To be completed by employee. Report to be used by supervisor to assist in completing Nebraska Workers Compensation Courts Form 1.

To be completed by Supervisor

ALICAP Accident Investigation Report. Form to be completed by supervisor. Requested for all indemnity claims (claims involving loss of wages) although useful if completed on all claims, even those which are medical only.

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