Workers' Compensation Health & Safety Forms
Division of Workers Compensation Main Forms page
English
| TDI Form Number | Description | File Format |
|---|---|---|
| DWC101 | Program Review Report (Rev. 08/06) |
|
| DWC101 | Program Review Report (Rev. 08/06) |
WORD |
| DWC102 | Accident Prevention Plan Cover Sheet (Rev. 08/06) |
|
| DWC102 | Accident Prevention Plan Cover Sheet (Rev. 08/06) |
WORD |
| DWC103 | Approved Professional Source Safety Consultant Application (Rev. 12/06) Note: The Approved Professional Source designation applies only to Loss Control Representatives of Texas Mutual Insurance Company as of September 1, 2005. |
WORD |
| DWC104 | Employer Request for DWC Safety Consultation (Rev. 08/06) |
WORD |
| DWC104 | Employer Request for DWC Safety Consultation (Rev. 08/06) |
|
| DWC105 | Accident Prevention Services Worksheet (Rev. 04/09) |
|
| DWC109 | Accident Prevention Services Annual Report (Rev. 12/05) |
WORD |
| DWC109 | Accident Prevention Services Annual Report (Rev. 12/05) |
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