• Increase Text Icon
  • Decrease Text Icon
  • Email Icon
  • Print this page
You are here: Home . forms . form20health

Workers' Compensation Health and Safety Forms

Division of Workers Compensation Main Forms page
Workers' Compensation Health and Safety Forms
TDI Form Number Description File FormatLanguage
DWC101
Program Review Report
Rev. 08/06
WORD English
DWC101
Program Review Report
Rev. 08/06
PDF English
DWC102
Accident Prevention Plan Cover Sheet
Rev. 08/06
WORD English
DWC102
Accident Prevention Plan Cover Sheet
Rev. 08/06
PDF English
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 English
DWC104
Employer Request for DWC Safety Consultation
Rev. 08/06
WORD English
DWC104
Employer Request for DWC Safety Consultation
Rev. 08/06
PDF English
DWC105
Accident Prevention Services Worksheet
Rev. 10/13
WORD English
DWC105
Accident Prevention Services Worksheet
Rev. 10/13
PDF English
DWC109
Accident Prevention Services Annual Report
Rev. 10/13
WORD English
DWC109
Accident Prevention Services Annual Report
Rev. 10/13
PDF English

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.


For more information, contact:

Contact Information and Other Helpful Links