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Workers' compensation employer forms and notices

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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.
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. 07/22
PDF English
DWC003MES Declaración de salario de múltiples trabajos del empleado
Rev. 07/22
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” above.
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 - Using Google Chrome or Mozilla Firefox to file electronically? See more at “Electronic Filing - Online Forms” above.
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

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