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department avatarWorker's Compensation Claims

Worker's Compensation Forms

C-1 -- Notice of Injury or Occupational Disease

CCF-99 -- Supervisor's Accident/Injury/Incident Investigation Report

C-4 -- Employee’s Claim for Compensation

Current Form Distribution:

Original kept at work site and a copy given to the employee. Email or fax a copy to Worker's Compensation at 702-799-2995 or workcomp@nv.ccsd.net.

D-1 -- Informational Poster

D-2 -- Brief Description of Your Rights and Benefits

D-12a -- Request for Hearing

D-26 -- Application for Reimbursement of Claim Related Travel Expenses

CCSD Leave Choice Option Form

Provider Map

Pharmacy Benefits Poster