Clark County School District
Skip to main content
Have A Question? Contact Us or 702-799-CCSD
department avatarWorker's Compensation Claims

Worker's Compensation Forms

C-1 -- Notice of Injury or Occupational Disease

CCF-99 -- Supervisor's Accident/Injury/Incident Investigation Report

C-4 -- Employee’s Claim for Compensation

C-4A - Release of Medical and Other Information

Current Form Distribution:

Original kept at work site and a copy given to the employee. Email or fax a copy to Worker's Compensation at 702-799-2995 or

D-1 -- Informational Poster

D-2 -- Brief Description of Your Rights and Benefits

D-12a -- Request for Hearing

D-26 -- Application for Reimbursement of Claim Related Travel Expenses

Provider Map (Rev. 06/20)

Provider Panel List (Rev. 10/20)

Pharmacy Benefits Poster