City of Henderson C1 FormHad an on-the-job injury and need to fill out a C1 Form?
Follow the link below to open the PDF fillable form. Instructions can be found to the right.
Refer to your "wallet card" for treatment locations or contact your supervisor.
You may also contact Amy Wong (ext. 1921) or Mary Sexton (ext. 1922) if you have any questions.
First Notice of Injury/C1 Submittal ProcessThis form only applies to City employees and volunteers