Claim Forms

Workers' Compensation Incident Reporting Forms

• 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.
• Nebraska Workers Compensation Court NWCC Form 50 Employees Choice of Doctor. 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.
• 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.

Property and Liability Incident Reporting Forms

• ALICAP property liability incident report.