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
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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 Number | Description | File Format |
|---|---|---|
| DWC005 | Employer Notice of No Coverage or Termination of Coverage Rev. 01/13 File Online |
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| DWC007 | Employer’s Report of Non-covered Employee’s Occupational Injury or Disease Rev. 01/13 |
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| DWC205 | Locations of Employer’s Business(es) Addendum to DWC Form-005 or DWC Form-020 - Rev. 11/10 |
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| New Employee Notice English | New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
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| New Employee Notice Vietnamese | New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
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| Notice 5 English | Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
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En Español
| Número del Formulario de TDI | Descripción | Formato del Archivo |
|---|---|---|
| DWC005s | Notificación del Empleador por No Cobertura o Anulación de la Cobertura Rev. 1/13 |
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| DWC205S | Locaciones del Negocio(s) del Empleador Suplemento para el Formulario DWC005 o Formulario DWC020 - Rev. 11/10 |
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| New Employee Notice Spanish | New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
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| Notice 5 Spanish | Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Vietnamese
|
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 Number | Description | File Format |
|---|---|---|
| Notice 5 Vietnamese | Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
|
English
|
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 Number | Description | File Format |
|---|---|---|
| DWC001 | Employer's First Report of Injury or Illness Rev. 10/05. This form is submitted by the carrier to DWC. |
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| DWC001S | Employer's First Report of Injury or Illness (for state employees) Rev. 10/05 |
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| DWC002 | Employer's Report for Reimbursement of Voluntary Payment Rev. 10/05 |
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| DWC003 | Employer's Wage Statement Rev. 10/05 |
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| DWC003ME | Employee's Multiple Employment Wage Statement Rev. 10/05 |
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| DWC003SD | Employer's Wage Statement for School Districts Rev. 10/05 |
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| DWC004 | Employer's Contest of Compensability Rev. 11/08 |
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| DWC006 | Supplemental Report of Injury Rev. 10/05 |
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| DWC008 | Return-to-Work Reimbursement Program for Employers Rev. 04/10 |
WORD |
| DWC008 | Return-to-Work Reimbursement Program for Employers Rev. 04/10 |
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| DWC020SI | Self-Insured Governmental Entity Coverage Information Rev. 08/12 |
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| DWC045 | Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC) Rev. 11/11 |
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| DWC045A | Request for a Medical Contested Case or SOAH Hearing Rev. 09/07 |
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| DWC074 | Description of Injured Employee’s Employment Rev. 9/09 |
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| New Employee Notice English | New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
|
| New Employee Notice Vietnamese | New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
|
| Notice 6 English | Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
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| Notice 8 English | Required Workers' Compensation Coverage (building or construction projects for governmental entities) |
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| 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) |
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En Español
Vietnamese
|
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 Number | Description | File Format |
|---|---|---|
| Notice 6 Vietnamese | Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
|
For more information contact:
