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Texas Department of Insurance
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Workers' compensation health and safety forms

If the form is a fillable PDF, learn how to enable all fillable form features.

TDI Form Number Description File Format Language
DWC101

Program review report for rejected risk employers

Rev. 11/21

PDF English
DWC101

Program review report for rejected risk employers

Rev. 11/21

WORD English
DWC102

Accident prevention plan cover sheet for rejected risk employer

Rev. 11/21

PDF English
DWC102

Accident prevention plan cover sheet for rejected risk employer

Rev. 11/21

WORD English
DWC104

Employer request for DWC safety consultation

Rev. 11/21

PDF English
DWC104

Employer request for DWC safety consultation

Rev. 11/21

WORD English
DWC105

Accident prevention services worksheet

Rev. 11/21

PDF English
DWC105

Accident prevention services worksheet

Rev. 11/21

WORD English
DWC109

Accident prevention services annual report

Rev. 11/21

PDF English
DWC109

Accident prevention services annual report

Rev. 11/21

WORD English

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