Skip to Top Main Navigation Skip to Left Navigation Skip to Content Area Skip to Footer
Texas Department of Insurance
Topics:   A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All

Workers' compensation employer forms and notices

If the form is a fillable PDF, learn how to enable all fillable form features.

TDI Form Number Description File Format Language
DWC001

Employer's First Report of Injury or Illness

Rev. 10/05. This form is submitted by the carrier to DWC.

PDF English
DWC001S

Employer's First Report of Injury or Illness (for state employees)

Rev. 10/05

PDF English
DWC002

Employer's Report for Reimbursement of Voluntary Payment

Rev. 02/17

PDF English
DWC003

Employer’s wage statement

Rev. 10/22

PDF English
DWC003ME

Employee’s multiple employment wage statement

Rev. 05/23

PDF English
DWC003MES

Declaración de salario de múltiples trabajos del empleado

Rev. 05/23

PDF Spanish
DWC003S

Declaración de salarios del empleador

Rev. 10/22

PDF Spanish
DWC003SD

Employer’s wage statement for school districts

Rev. 07/22

PDF English
DWC003SDS

Declaración de salario del empleador para distritos escolares

Rev. 07/22

PDF Spanish
DWC004

Employer's Contest of Compensability

Rev. 11/08

PDF English
DWC005

Employer Notice of No Coverage or Termination of Coverage

Rev. 02/18 - For help and an instructional video see “Electronic Filing - Online Forms” page.

PDF English
DWC005

Employer Notice of No Coverage or Termination of Coverage

Rev. 02/18 - static version for mailing and faxing

PDF English
DWC005s

Aviso del Empleador de No Cobertura o de Cancelación de la Cobertura

Rev. 02/18

PDF Spanish
DWC006

Supplemental Report of Injury

Rev. 10/05

PDF English
DWC007

Employer’s report of noncovered employee’s work-related injury or illness

Rev. 02/22

PDF English
DWC007S

Reporte del empleador para lesiones o enfermedades relacionadas con el trabajo de los empleados sin cobertura

Rev. 02/22

PDF Spanish
DWC008

Return-to-Work Reimbursement Program for Employers

Rev. 04/10

PDF English
DWC020SI

Self-Insured Governmental Entity Coverage Information

Rev. 08/12 - For help and an instructional video see “Electronic Filing - Online Forms” page.

PDF English
DWC045

Request to schedule, reschedule, or cancel a benefit review conference (BRC)

Rev. 07/21

PDF English
DWC045A

Request for a Medical Contested Case or SOAH Hearing

Rev. 09/07, applicable only to medical disputes that were filed prior to June 1, 2012

PDF English
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, aplicable solamente para las disputas médicas que fueron presentadas antes del 1º de junio del 2012

PDF Spanish
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. 07/21

PDF Spanish
DWC074

Description of Injured Employee’s Employment

Rev. 9/09

PDF English
DWC154

Workers' Compensation Complaint Form

Rev. 03/16

PDF English
DWC154S

Quejas de Compensación para Trabajadores

Rev. 03/16

PDF Spanish
DWC156

Prospective employment authorization and certification

Rev. 08/21

PDF English
DWC156S

Certificación y autorización de un posible empleo

Rev. 08/21

PDF Spanish
DWC205

Locations of Employer’s Business(es)

Addendum to DWC Form-005 or DWC Form-020 - Rev. 11/10

PDF English
DWC205S

Locaciones del Negocio(s) del Empleador

Suplemento para el Formulario DWC005 o Formulario DWC020 - Rev. 11/10

PDF Spanish
New Employee Notice Vietnamese

New Employee Notice

covered and non-covered employers shall notify their employees of coverage status, in writing

PDF Vietnamese
New Employee Notice English

New Employee Notice

covered and non-covered employers shall notify their employees of coverage status, in writing

PDF English
New Employee Notice Spanish

New Employee Notice

Covered and non-covered employers shall notify their employees of coverage status in writing.

PDF Spanish
Notice 5 English

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF English
Notice 5 Spanish

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Spanish
Notice 5 Vietnamese

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Vietnamese
Notice 6 English

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF English
Notice 6 Spanish

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Spanish
Notice 6 Vietnamese

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Vietnamese
Notice 7 English

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF English
Notice 7 Spanish

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Spanish
Notice 7 Vietnamese

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Vietnamese
Notice 8 English

Required Workers’ Compensation Coverage

(building or construction projects for governmental entities)

PDF English
Notice 8 Spanish

Required Workers’ Compensation Coverage

(building or construction projects for governmental entities)

PDF Spanish
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 English
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 Spanish
Notice 10 English

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF English
Notice 10 Spanish

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Spanish
Notice 10 Vietnamese

Notice to Employees Concerning Workers' Compensation in Texas

must be posted for employees to read

PDF Vietnamese

For more information, contact: WebStaff@tdi.texas.gov