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 73 State Forms found

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EMPLOYEE'S DECLARATION OF ELECTION TO REPORT TIPS For the Purpose of Workers' Compensation

 D-23 rev. 7/99

Employee’s Election to Reject Coverage; and Election to Waive the Rejection of Coverage for Excluded Persons

 D-43 Rev. 02/04

EMPLOYER'S WAGE VERIFICATION FORM

 D-8 (rev 11/23)

EXPLANATION OF WAGE CALCULATION

 D-7 rev. 7/99

FATALITY REPORT

 D-21 (rev 9/23)

Firefighters and Police Officers Extensive Heart Examination Form

 OD-3 rev. 11/22

Firemen and Police Officers' Hearing Examination Form

 OD-5 rev. 06/14

Firefighters and Police Officers Limited Heart Examination Form

 OD-4 rev. 11/22

Firefighters and Police Officers' Lung Examination Form

 OD-2 rev. 11/22

Firefighters and Police Officers' Medical History Form

 OD-1 Rev. 11/22

Firefighters and Police Officers Sample Letter

 OD-6 rev. 11/22

INFORMATION PAGE

 D-49 (Rev 7/99)

Brief Description of Your Rights and Benefits If You Are Injured on the Job or have an Occupational Disease - Information Poster

 D-1 rev. 02/24

INJURED EMPLOYEE'S REQUEST FOR COMPENSATION

 D-6 Rev. 7/99

INJURED EMPLOYEE'S RIGHT TO REOPEN A CLAIM WHICH HAS BEEN CLOSED

 D-13 rev. 7/99
Disclaimer: These forms may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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