First Report of Alleged Occupational Injury or Illness - EDI SUBMISSION Forms
| Form Name | First Report of Alleged Occupational Injury or Illness - EDI SUBMISSION |
| Form # | NWCC Form 1 |
| Form Revision | Revised 12/2011 |
| Category | Forms » First Report |
| Downloads | |
| Form State | Nebraska |
| Language | English |
| State Description | Note: Companies that have signed a Trading Partner Agreement with the Nebraska Workers' Compensation Court may use this form only with the court's permission. |
| Claimwire Description | n/a |