DWC001
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Employer's First Report of Injury or Illness Rev. 10/05. This form is submitted by the carrier to DWC.
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PDF |
English |
DWC001S
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Employer's First Report of Injury or Illness (for state employees) Rev. 10/05
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PDF |
English |
DWC002
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Employer's Report for Reimbursement of Voluntary Payment Rev. 02/17
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PDF |
English |
DWC003
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Employer’s wage statement Rev. 10/22
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PDF |
English |
DWC003ME
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Employee’s multiple employment wage statement Rev. 05/23
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PDF |
English |
DWC003MES
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Declaración de salario de múltiples trabajos del empleado Rev. 05/23
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PDF |
Spanish |
DWC003S
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Declaración de salarios del empleador Rev. 10/22
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PDF |
Spanish |
DWC003SD
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Employer’s wage statement for school districts Rev. 07/22
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PDF |
English |
DWC003SDS
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Declaración de salario del empleador para distritos escolares Rev. 07/22
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PDF |
Spanish |
DWC004
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Employer's Contest of Compensability Rev. 11/08
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PDF |
English |
DWC005
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Employer Notice of No Coverage or Termination of Coverage Rev. 02/18 - For help and an instructional video see “Electronic Filing - Online Forms” page.
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PDF |
English |
DWC005
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Employer Notice of No Coverage or Termination of Coverage Rev. 02/18 - static version for mailing and faxing
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PDF |
English |
DWC005s
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Aviso del Empleador de No Cobertura o de Cancelación de la Cobertura Rev. 02/18
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PDF |
Spanish |
DWC006
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Supplemental Report of Injury Rev. 10/05
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PDF |
English |
DWC007
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Employer’s report of noncovered employee’s work-related injury or illness Rev. 02/22
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PDF |
English |
DWC007S
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Reporte del empleador para lesiones o enfermedades relacionadas con el trabajo de los empleados sin cobertura Rev. 02/22
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PDF |
Spanish |
DWC008
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Return-to-Work Reimbursement Program for Employers Rev. 04/10
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PDF |
English |
DWC020SI
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Self-Insured Governmental Entity Coverage Information Rev. 08/12 - For help and an instructional video see “Electronic Filing - Online Forms” page.
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PDF |
English |
DWC045
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Request to schedule, reschedule, or cancel a benefit review conference (BRC) Rev. 07/21
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PDF |
English |
DWC045A
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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
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PDF |
English |
DWC045AS
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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
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PDF |
Spanish |
DWC045S
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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
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PDF |
Spanish |
DWC074
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Description of Injured Employee’s Employment Rev. 9/09
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PDF |
English |
DWC154
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Workers' Compensation Complaint Form Rev. 03/16
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PDF |
English |
DWC154S
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Quejas de Compensación para Trabajadores Rev. 03/16
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PDF |
Spanish |
DWC156
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Prospective employment authorization and certification Rev. 08/21
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PDF |
English |
DWC156S
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Certificación y autorización de un posible empleo Rev. 08/21
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PDF |
Spanish |
DWC205
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Locations of Employer’s Business(es) Addendum to DWC Form-005 or DWC Form-020 - Rev. 11/10
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PDF |
English |
DWC205S
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Locaciones del Negocio(s) del Empleador Suplemento para el Formulario DWC005 o Formulario DWC020 - Rev. 11/10
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PDF |
Spanish |
New Employee Notice Vietnamese
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New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing
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PDF |
Vietnamese |
New Employee Notice English
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New Employee Notice covered and non-covered employers shall notify their employees of coverage status, in writing
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PDF |
English |
New Employee Notice Spanish
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New Employee Notice Covered and non-covered employers shall notify their employees of coverage status in writing.
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PDF |
Spanish |
Notice 5 English
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
English |
Notice 5 Spanish
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Spanish |
Notice 5 Vietnamese
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Vietnamese |
Notice 6 English
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
English |
Notice 6 Spanish
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Spanish |
Notice 6 Vietnamese
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Vietnamese |
Notice 7 English
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
English |
Notice 7 Spanish
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Spanish |
Notice 7 Vietnamese
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Vietnamese |
Notice 8 English
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Required Workers’ Compensation Coverage (building or construction projects for governmental entities)
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PDF |
English |
Notice 8 Spanish
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Required Workers’ Compensation Coverage (building or construction projects for governmental entities)
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PDF |
Spanish |
Notice 9 English
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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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PDF |
English |
Notice 9 Spanish
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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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PDF |
Spanish |
Notice 10 English
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
English |
Notice 10 Spanish
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Spanish |
Notice 10 Vietnamese
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Notice to Employees Concerning Workers' Compensation in Texas must be posted for employees to read
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PDF |
Vietnamese |