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“NOTICE OF INJURY OR OCCUPATIONAL DISEASE”
(Incident Report)
Pursuant to NRS 616C.015
Name of Employer
Name of Employee
Social Security Number
Date of Accident
Time of Accident
(if applicable)
Telephone
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What is notice of injury form?
The notice of injury form is a document that is used to report an injury or illness that occurred in the workplace.
Who is required to file notice of injury form?
Any employee who suffers from a work-related injury or illness is typically required to file a notice of injury form.
How to fill out notice of injury form?
To fill out a notice of injury form, you will typically need to provide personal information, details about the injury or illness, and any supporting documentation.
What is the purpose of notice of injury form?
The purpose of the notice of injury form is to formally report workplace injuries or illnesses and initiate the claims process for workers' compensation benefits.
What information must be reported on notice of injury form?
The notice of injury form usually requires information such as the employee's name, contact information, details of the injury or illness, date and time of the incident, location, and any witnesses.
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