C-1 Notice of Injury or Occupational Disease Incident Report - unr 2026

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  1. Click ‘Get Form’ to open the C-1 Notice of Injury or Occupational Disease Incident Report in the editor.
  2. Begin by entering the 'Name of Employer' and 'Name of Employee' at the top of the form. Ensure accuracy as this information is crucial for processing.
  3. Fill in the 'Social Security Number', 'Date of Accident', and 'Time of Accident' if applicable. This data helps establish a timeline for the incident.
  4. Provide a detailed description of the injury or occupational disease, including any body parts involved. Use clear language to describe what occurred.
  5. List any witnesses present during the incident. Their accounts may be important for claims processing.
  6. Indicate whether first aid was provided and if so, note when it occurred. This information can impact compensation claims.
  7. Complete sections regarding return to work status and treating physician details, ensuring all fields are filled accurately.
  8. Finally, have both the supervisor and injured employee sign and date the form before submitting it as instructed.

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The Employers First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimants employment and circumstances surrounding the injury or illness are also requested.
A certificate of exemption is a document that exempts a business from obtaining a Nevada state business license. This exemption applies to specific types of businesses or organizations that meet certain criteria outlined by the state.
EMPLOYERS REPORT OF INDUSTRIAL INJURY OR OCCUPATIONAL DISEASE.
Notice of Injury or Occupational Disease (Incident Report Form C-1): If an injury or occupational disease (OD) arises out of and in the course of employment, you must provide written notice to your employer as soon as practicable, but no later than 7 days after the accident or OD.
You must seek medical treatment and complete the Claim for Compensation/Physicians Report of Initial Injury, Form C-4, within 90 days from the date of injury. The C-4 form is the legal document for filing a claim in Nevada.

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Occupational Safety and Health Administration (OSHA) Form 301, Injury and Illness Incident Report, is used by employers to keep a record of a single injury, illness, or death in a workplace. This form is found within OSHA Form 300, which is used to log and classify all such incidents for a workplace.
NOTICE OF INJURY OR OCCUPATIONAL DISEASE (Incident Report)

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