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Workers’ Comp Forms

Renaissance Tower - 1201 Elm Street, 23rd Floor, Suite 2300-B, Dallas, TX 75270
Telephone: (214) 653-7638 • Fax: (214) 653-7608


Worker’ Compensation Forms

Click on the form to download.

FormDescriptionCompleted By
DWCC73Texas Workers’ Compensation Work Status ReportTreating Physician
DWCC6Supplemental Report of InjurySupervisor/Manager
504 Workers’ Compensation Insurance AcknowledgementEmployee
DWCC3Employer's Wage StatementHR Generalist
Leave Authorization FormElection to Use AccrualsEmployee
Bona Fide Job OfferSupervisor/Manager/HR Generalist