City of Henderson C1 Form
Had an on-the-job injury and need to fill out a C1 form?
Refer to your "wallet card" for treatment locations or contact your supervisor.
You may also contact Mary Sexton (ext. 1922) if you have any questions.
First Notice of Injury/C1 Submittal Process
This form only applies to city employees and volunteers
- Complete the pdf-fillable C1 form (left). All fields must be completed.
- Print a copy of the form for signature. Save a copy for your records if you wish. Bring the hard copy to your supervisor for additional processing.
- Obtain supervisor signature on the hardcopy of the completed C1 form (and any other forms, if appropriate) and interoffice it to Human Resources, MSC 122.
- Human Resources and/or safety representatives will be in touch for further information and instruction.