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Workers’ Compensation Section

Worker’ Compensation Forms

Click on the form to download.

Form Description Completed By
DWCC73 Texas Workers’ Compensation Work Status Report Treating Physician
DWCC6 Supplemental Report of Injury Supervisor/Manager
504 Workers’ Compensation Insurance Acknowledgement Employee
DWCC3 Employer's Wage Statement HR Generalist
Leave Authorization Form Election to Use Accruals Employee
Bona Fide Job Offer Supervisor/Manager/HR Generalist