C1 fillable form 2025

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The document is a 'Notice of Injury or Occupational Disease' incident report, required under NRS 616C.015, for employees to report workplace injuries or diseases. It includes sections for employee and employer information, details about the accident, nature of the injury, witnesses, medical treatment arrangements, and claim filing instructions.

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Click ‘Get Form’ to open the C1 fillable form in the editor.
Begin by entering the 'Name of Employer' and 'Name of Employee' in the designated fields. Ensure accuracy as this information is crucial for processing.
Fill in the 'Social Security Number', 'Date of Accident', and 'Time of Accident' if applicable. These details help establish the timeline of the incident.
Provide a contact number in the 'Telephone Number' field and describe where the accident occurred under 'Place where accident occurred'.
Detail the nature of the injury or occupational disease, listing any body parts involved. Use clear language to describe what happened.
Indicate whether first aid was provided and include relevant dates and times if applicable. This information is vital for claims processing.
Complete sections regarding witness names, return to work status, and treating physician details as necessary.
Finally, ensure both the supervisor's signature and your own are included along with dates before submitting your form.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (27 Votes)
2005	4 Satisfied (37 Votes)
1999	4 Satisfied (22 Votes)

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What is a C1 form in Scotland?

What is confirmation (Scottish probate) and the C1 form? A Grant of Confirmation is a legal document issued by a Local Sheriff Court in Scotland that states which assets make up the deceaseds estate. In addition, it also establishes who is authorised to deal with them - these people are called the executor(s).