Free OD-7 Form - Nevada

Important Information Regarding Physical Examinations for Police Officers and Firemen
Industrial insurance benefits are available to all qualified police officers and firemen who acquire lung and heart diseases. To qualify, certain minimum employment requirements must be met and firemen and police officers are required to submit to physical examinations. The implementation of these benefits requires the involvement and cooperation of the employers, the police officers, firemen and volunteer firemen, the insurer (SIIS), and the medical examiners. Nevada Revised Statutes, NRS 617.455 and 617.457, provide that, under certain circumstances, all lung and heart diseases for police officers and firemen, and lung diseases for volunteer firemen, are conclusively presumed to have arisen out of and in the course of employment. The Nevada Administrative Code (NAC), Chapter 617, provides the administrative requirements for all police officers and firemen who are required to submit to physical examinations in order to receive industrial insurance benefits pursuant to NRS 617.455 and 617.457. These requirements detail the frequency of examinations, the minimum requirements of the exams, the duties of the employer, and the duties of the employee. A copy of Chapter 617 of the Nevada Administrative Code is attached. Also attached are copies of the necessary forms; please copy them for your own use. These forms are: Firemen and Police Officers' Medical History Form (OD-1) Firemen and Police Officers' Lung Examination Form (OD-2) Firemen and Police Officers' Extensive Heart Examination Form (OD-3) Firemen and Police Officers' Limited Heart Examination Form (OD-4) Hearing Examination Form (OD-5) Receipt of Forms From the Examiner (sample letter)

OD-7 (rev. 7/99)