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Workers' Compensation Employer Forms and Notices

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

Non-Covered Employer Forms and Notices - English | En Español | Vietnamese
Covered Employer Forms and Notices - English | En Español | Vietnamese

   

English


Non-Covered Employer Forms and Notices

Employers in the State of Texas are required to post notices to their employees as to whether they do or do not carry workers' compensation insurance. Below you will find the required notice packages which contain the forms and notices you will need (coverage package documents in PDF format only).

TDI Form NumberDescriptionFile Format
DWC005 Employer Notice of No Coverage or Termination of Coverage
Rev. 01/13 File Online
PDF
DWC007 Employer’s Report of Non-covered Employee’s Occupational Injury or Disease
Rev. 01/13
PDF
DWC205 Locations of Employer’s Business(es)
Addendum to DWC Form-005 or DWC Form-020 - Rev. 11/10
PDF
New Employee Notice English New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDF
Notice 5 English Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDF

En Español

Formularios y Avisos para Empleadores sin Cobertura
Número del Formulario de TDIDescripciónFormato del Archivo
DWC005s Notificación del Empleador por No Cobertura o Anulación de la Cobertura
Rev. 1/13
PDF
DWC205S Locaciones del Negocio(s) del Empleador
Suplemento para el Formulario DWC005 o Formulario DWC020 - Rev. 11/10
PDF
New Employee Notice Spanish New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDF
Notice 5 Spanish Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDF

Vietnamese


Non-Covered Employer Forms and Notices

Employers in the State of Texas are required to post notices to their employees as to whether they do or do not carry workers' compensation insurance. Below you will find the required notice packages which contain the forms and notices you will need (coverage package documents in PDF format only).

TDI Form NumberDescriptionFile Format
New Employee Notice Vietnamese New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDF
Notice 5 Vietnamese Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDF

   

English


Covered Employer Forms and Notices

Employers in the State of Texas are required to post notices to their employees as to whether they do or do not carry workers' compensation insurance. Below you will find the required notice packages which contain the forms and notices you will need (coverage package documents in PDF format only).

Please see the OIEC website to obtain the The Employer's Notification of the Ombudsman Program to Employees.

TDI Form NumberDescriptionFile Format
DWC001 Employer's First Report of Injury or Illness
Rev. 10/05. This form is submitted by the carrier to DWC.
PDF
DWC001S Employer's First Report of Injury or Illness (for state employees)
Rev. 10/05
PDF
DWC002 Employer's Report for Reimbursement of Voluntary Payment
Rev. 10/05
PDF
DWC003 Employer's Wage Statement
Rev. 10/05
PDF
DWC003ME Employee's Multiple Employment Wage Statement
Rev. 10/05
PDF
DWC003SD Employer's Wage Statement for School Districts
Rev. 10/05
PDF
DWC004 Employer's Contest of Compensability
Rev. 11/08
PDF
DWC006 Supplemental Report of Injury
Rev. 10/05
PDF
DWC008 Return-to-Work Reimbursement Program for Employers
Rev. 04/10
WORD
DWC008 Return-to-Work Reimbursement Program for Employers
Rev. 04/10
PDF
DWC020SI Self-Insured Governmental Entity Coverage Information
Rev. 08/12
PDF
DWC045 Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC)
Rev. 11/11
PDF
DWC045A Request for a Medical Contested Case or SOAH Hearing
Rev. 09/07
PDF
DWC074 Description of Injured Employee’s Employment
Rev. 9/09
PDF
New Employee Notice English New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDF
Notice 6 English Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDF
Notice 8 English Required Workers' Compensation Coverage
(building or construction projects for governmental entities)
PDF
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)
PDF

En Español

Formularios y Avisos para Empleadores con Cobertura
Número del Formulario de TDIDescripciónFormato del Archivo
DWC003MES Declaración de Salario de Múltiples Trabajos del Empleado
Rev. 10/05
PDF
DWC003SDS Declaración de Salario Para Escuelas de Distrito
Rev. 10/05
PDF
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
PDF
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
PDF
New Employee Notice Spanish New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDF
Notice 6 Spanish Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDF
Notice 8 Spanish Required Workers' Compensation Coverage
(building or construction projects for governmental entities)
PDF
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)
PDF

Vietnamese


Covered Employer Forms and Notices

Employers in the State of Texas are required to post notices to their employees as to whether they do or do not carry workers' compensation insurance. Below you will find the required notice packages which contain the forms and notices you will need (coverage package documents in PDF format only).

Please see the OIEC website to obtain the The Employer's Notification of the Ombudsman Program to Employees.

TDI Form NumberDescriptionFile Format
New Employee Notice Vietnamese New Employee Notice
covered and non-covered employers shall notify their employees of coverage status, in writing
PDF
Notice 6 Vietnamese Notice to Employees Concerning Workers' Compensation in Texas
must be posted for employees to read
PDF

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Translation by WorldLingo