Form Title |
Form Number |
Date Revised |
Purpose |
Instruction |
PDF |
Excel |
Employer's First Report of Alleged Occupational Injury or Disease |
DWC-01 |
01/03 |
|
Instructions |
|
DWC-01 |
Employee's Objection to Wage Transcript |
DWC-31 |
01/03 |
|
Instructions |
|
Not available |
Wage Statement: Full Time |
DWC-03F |
01/03 |
|
Instructions | Tips |
|
DWC-03F |
Wage Statement: Part Time |
DWC-03P |
01/03 |
|
Instructions | Tips |
|
DWC-03P |
Wage Statement: Seasonal |
DWC-03S |
01/03 |
|
Instructions | Tips |
|
DWC-03S |
Employee's Certificate of Dependency Status |
DWC-04 |
01/03 |
|
Not available |
|
Not available |
| Election by Exempt Corporate Officer to Become Subject to Workers' Compensation |
DWC-11C |
04/05 |
|
Not available |
|
Not available |
| Notice of Claim of Common Law Rights (Waiver) |
DWC-11 |
01/03 |
|
Not available |
|
Not available |
| Notice of Designation as an Independent Contractor |
DWC-11-IC |
01/03 |
|
Not available |
|
DWS-11-IC |
| Notice of Insurance Policy Change |
Electronic |
4-99 |
|
Not available |
|
Not available |
| Notice of Withdrawal of Designation as Independent Contractor |
DWC-11-ICR |
01/03 |
|
Not available |
|
DWC-11-ICR |
| Rescind Notice of Claim of Common Law Rights |
DWC-11R |
01/03 |
|
Not available |
|
Not available |
| WC Act Summary Poster (English) |
DWC-08 |
01/03 |
|
Not available |
|
Not available |
| WC Act Summary Poster (Spanish) |
DWC-08S |
01/03 |
|
Not available |
|
Not available |
