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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
DWC6Supplemental Report of InjurySupervisor/Manager
504 Workers’ Compensation Insurance AcknowledgementEmployee
DWC3Employer's Wage StatementHR Generalist
Leave Authorization FormElection to Use AccrualsEmployee
Bona Fide Job Offer (Exampleacrobat)  WordSupervisor/Manager/HR Generalist