Employee Accident/ Incident Investigation Forms

Nye County Staff

If you are injured or in an accident while working, here is what to do:

All accidents or incidents (injury, car accident, property damage) must be completed before an employee’s work shift ends.  

Risk Management Forms

Pre-step: If you have an acute or traumatic injury, call 911 for immediate assistance; otherwise…

Step 1: Tell your supervisor

Step 2: Supervisor tell Risk Management by email (riskmanagement@nyecountynv.gov) or phone (775-751-6329)

Step 3: Fill out the papers and send to Risk Management (riskmanagement@nyecountynv.gov):

  1. Notice of Loss/Accident Report
  2. Employee Incident Report
  3. C-1, Employee Report of Injury
  4. C-3, Employers First Report of Injury Form

Step 4: The supervisor is to fill out the accident investigation form and send it to Risk Management (riskmanagement@nyecountynv.gov).

Step 5: The Safety Officer fills out an independent accident investigation form and creates a safety training action plan.

Step 6: Drug/Alcohol Testing – From 9 am to 5 pm, this is carried out by HR (775-751-6303). After hours, it is carried out by Risk Management (775-293-3201). Drug and alcohol testing will be carried out if an accident involves the following: death, medical treatment other than first-aid, loss of consciousness, or property damage estimated to be valued at or in excess of $500.00 (PPM 2.10.9 Post-Accident Testing).

Supervisors will ensure that any employee requiring prompt medical attention visits one of the following places (otherwise, reimbursement for medical attention is not guaranteed):

Amargosa Valley
Amargosa Valley Medical Clinic
845 E. Farm Road
775-372-5432

Beatty
Beatty Medical Clinic
250 S. Irving St.
775-553-9111

Gabbs
Mount Grant General Hospital
200 South A Street
Hawthorne, NV
775-945-2461

Banner Churchill Community Hospital
801 E. Williams
Fallon, NV
775-423-3151

 

Tonopah

Frontier Medical Group 775-382-2000

825 S. Main Street

Tonopah, NV

 

Beatty Medical Clinic 775-553-9111

250 S. Irving

Beatty, NV

 

Pahrump

Intermountain Healthcare 775-727-5500

1397 S. Loop Road

Pahrump, NV

 

*After hours and emergency cases:

Desert View Hospital 775-751-7500

360 S. Lola Lane

Pahrump, NV

 

Physical Therapy Providers

Affiliated Physical Therapy 775-727-8900

2250 E. Postal Driver Ste. 4

Pahrump, NV

 

Affiliated Physical Therapy 775-727-3838

921 South Highway 160

Pahrump, NV

 

*In the event of an acute serious traumatic injury the employee may seek medical treatment from the nearest emergency medical facility.