Division of Workers Compensation main forms page
Electronic Filing: Forms available for electronic filing are indicated by 
. See Electronic filing - online forms for more information about filing your PDF form online. See Electronic filing – XML format for more information about files with multiple submissions.
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| 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. |
English | |
| DWC001S |
Employer's First Report of Injury or Illness (for state employees) Rev. 10/05 |
English | |
| DWC002 |
Employer's Report for Reimbursement of Voluntary Payment Rev. 02/17 |
English | |
| DWC003 |
Employer’s wage statement Rev. 10/22 |
English | |
| DWC003ME |
Employee’s multiple employment wage statement Rev. 07/22 |
English | |
| DWC003MES |
Declaración de salario de múltiples trabajos del empleado Rev. 07/22 |
Spanish | |
| DWC003S |
Declaración de salarios del empleador Rev. 10/22 |
Spanish | |
| DWC003SD |
Employer’s wage statement for school districts Rev. 07/22 |
English | |
| DWC003SDS |
Declaración de salario del empleador para distritos escolares Rev. 07/22 |
Spanish | |
| DWC004 |
Employer's Contest of Compensability Rev. 11/08 |
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” above. |
English | |
| DWC005 |
Employer Notice of No Coverage or Termination of Coverage Rev. 02/18 - static version for mailing and faxing |
English | |
| DWC005s |
Aviso del Empleador de No Cobertura o de Cancelación de la Cobertura Rev. 02/18 |
Spanish | |
| DWC006 |
Supplemental Report of Injury Rev. 10/05 |
English | |
| DWC007 |
Employer’s report of noncovered employee’s work-related injury or illness Rev. 02/22 |
English | |
| DWC007S |
Reporte del empleador para lesiones o enfermedades relacionadas con el trabajo de los empleados sin cobertura Rev. 02/22 |
Spanish | |
| DWC008 |
Return-to-Work Reimbursement Program for Employers Rev. 04/10 |
English | |
| DWC020SI |
Self-Insured Governmental Entity Coverage Information Rev. 08/12 - Using Google Chrome or Mozilla Firefox to file electronically? See more at “Electronic Filing - Online Forms” above. |
English | |
| DWC045 |
Request to schedule, reschedule, or cancel a benefit review conference (BRC) Rev. 07/21 |
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 |
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 |
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 |
Spanish | |
| DWC074 |
Description of Injured Employee’s Employment Rev. 9/09 |
English | |
| DWC154 |
Workers' Compensation Complaint Form Rev. 03/16 |
English | |
| DWC154S |
Quejas de Compensación para Trabajadores Rev. 03/16 |
Spanish | |
| DWC156 |
Prospective employment authorization and certification Rev. 08/21 |
English | |
| DWC156S |
Certificación y autorización de un posible empleo Rev. 08/21 |
Spanish | |
| DWC205 |
Locations of Employer’s Business(es) Addendum to DWC Form-005 or DWC Form-020 - Rev. 11/10 |
English | |
| DWC205S |
Locaciones del Negocio(s) del Empleador Suplemento para el Formulario DWC005 o Formulario DWC020 - Rev. 11/10 |
Spanish | |
| New Employee Notice Vietnamese |
New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
Vietnamese | |
| New Employee Notice English |
New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing |
English | |
| New Employee Notice Spanish |
New Employee Notice Covered and non-covered employers shall notify their employees of coverage status in writing. |
Spanish | |
| Notice 5 English |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
English | |
| Notice 5 Spanish |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Spanish | |
| Notice 5 Vietnamese |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Vietnamese | |
| Notice 6 English |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
English | |
| Notice 6 Spanish |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Spanish | |
| Notice 6 Vietnamese |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Vietnamese | |
| Notice 7 English |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
English | |
| Notice 7 Spanish |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Spanish | |
| Notice 7 Vietnamese |
Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read |
Vietnamese | |
| Notice 8 English |
Required Workers’ Compensation Coverage (building or construction projects for governmental entities) |
English | |
| Notice 8 Spanish |
Required Workers’ Compensation Coverage (building or construction projects for governmental entities) |
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) |
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) |
Spanish |
For more information, contact: WebStaff@tdi.texas.gov
