Workers' Compensation Forms
Supervisor's Report of Injury
1. Download form to computer
2. Fill out form in Adobe
3. Print Form
4. Supervisor signature is required
5. Supervisor send form to ehs@txstate.edu & kb1569@txstate.edu
For questions please call Katherine Beamer at 512-245-3616
Claims Procedure Checklists
WC Policies & Procedure
: Claims Procedure Checklist
(PDF, 183 KB)
Authorization for Release of Information
SORM16_InfoRelease[2]
: Inormation Release Form
(PDF, 46 KB)
Employee's Report of Injury
SORM-29_EmployeesReportOfInjury[2]
: Employee Report of Injury
(PDF, 500 KB)
Request for Travel Reimbursement
dwc048_trvlreim
(PDF, 168 KB)
Witness Statement
SORM74_WitnessStatement[2]
: Witness Statement English
(PDF, 686 KB)
SORM74_WitnessStatement[3]
: Witness Statement Spanish
(PDF, 198 KB)
Employees Election Regarding Utilization of Sick and Annual Leave
SORM-80_SickAnnualleave[2]
: Sick & Annual Leave Usage Election English
(PDF, 182 KB)
SORM-80_SickAnnualleave [3]
: Sick & Annual Leave Usage Election Spanish
(PDF, 246 KB)
Medical Reimbursement Request Form
SORM-81A
(PDF, 372 KB)
SORM/CareWorks Network Acknowledgement Form
SORM/CareWorks Network Acknowledgement Form
(PDF, 113 KB)