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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 &

For questions please call Katherine Beamer at 512-245-3616

Claims Procedure Checklists

Authorization for Release of Information

Employee's Report of Injury

Request for Travel Reimbursement

dwc048_trvlreim (PDF, 168KB)

Witness Statement

Employees Election Regarding Utilization of Sick and Annual Leave

Medical Reimbursement Request Form

SORM-81A (PDF, 372KB)

SORM/CareWorks Network Acknowledgement Form