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You are here: www.tdi.texas.gov . forms . form20employer

Workers' Compensation Employer Forms and Notices

This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Type links on the Forms Home Page or scan through our form listings.

Division of Workers Compensation Main Forms page
Self-Insured Employer Forms and Required Coverage Notices

Workers' Compensation Employer Forms and Notices
TDI Form Number Description File FormatLanguage
DWC001
Employer's First Report of Injury or Illness
Rev. 10/05. This form is submitted by the carrier to DWC.
PDFEnglish
DWC001S
Employer's First Report of Injury or Illness (for state employees)
Rev. 10/05
PDFEnglish
DWC002
Employer's Report for Reimbursement of Voluntary Payment
Rev. 10/05
PDFEnglish
DWC003
Employer's Wage Statement
Rev. 10/05
PDFEnglish
DWC003ME
Employee's Multiple Employment Wage Statement
Rev. 10/05
PDFEnglish
DWC003MES
Declaración de Salario de Múltiples Trabajos del Empleado
Rev. 10/05
PDFSpanish
DWC003SD
Employer's Wage Statement for School Districts
Rev. 10/05
PDFEnglish
DWC003SDS
Declaración de Salario Para Escuelas de Distrito
Rev. 10/05
PDFSpanish
DWC004
Employer's Contest of Compensability
Rev. 11/08
PDFEnglish
DWC006
Supplemental Report of Injury
Rev. 10/05
PDFEnglish
DWC008
Return-to-Work Reimbursement Program for Employers
Rev. 04/10
WORDEnglish
DWC008
Return-to-Work Reimbursement Program for Employers
Rev. 04/10
PDFEnglish
DWC020SI
Self-Insured Governmental Entity Coverage Information
Rev. 08/12
PDFEnglish
DWC045
Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC)
Rev. 11/11
PDFEnglish
DWC045A
Request for a Medical Contested Case or SOAH Hearing
Rev. 09/07
PDFEnglish
DWC045AS
Solicitud para una Audiencia para Disputar Beneficios Médicos o Audiencia en la Oficina Estatal de Audiencias Administrativas (SOAH, por sus Siglas en Inglés)
Rev. 10/07
PDFSpanish
DWC045S
Solicitud para Programar, Reprogramar, o Cancelar una Conferencia para Revisión de Beneficios (Benefit Review Conference -BRC, por su nombre y siglas en inglés)
Rev. 11/11
PDFSpanish
DWC074
Description of Injured Employee’s Employment
Rev. 9/09
PDFEnglish
New Employee Notice Vietnamese
New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDFVietnamese
New Employee Notice English
New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDFEnglish
New Employee Notice Spanish
New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDFSpanish
Notice 5 English
Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDFEnglish
Notice 5 Spanish
Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDFSpanish
Notice 5 Vietnamese
Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDFVietnamese
Notice 6 English
Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDFEnglish
Notice 6 Spanish
Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDFSpanish
Notice 6 Vietnamese
Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDFVietnamese
Notice 8 English
Required Workers' Compensation Coverage
(building or construction projects for governmental entities)
PDFEnglish
Notice 8 Spanish
Required Workers' Compensation Coverage
(building or construction projects for governmental entities)
PDFSpanish
Notice 9 English
Notice Regarding Certain Work-Related Communicable Diseases and Eligibility for Workers' Compensation Benefits
(law enforcement officers, fire fighters, emergency medical service employees, paramedics, and correctional officers)
PDFEnglish
Notice 9 Spanish
Notice Regarding Certain Work-Related Communicable Diseases and Eligibility for Workers' Compensation Benefits
(law enforcement officers, fire fighters, emergency medical service employees, paramedics, and correctional officers)
PDFSpanish


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Last updated: 09/17/2014

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Translation by WorldLingo


Translation by WorldLingo


Translation by WorldLingo