Workers' Compensation Process and Forms

Click on the links to view forms or documents:

Workers' Compensation Claim Process & Flowchart is designed to provide assistance in completing the necessary paperwork for an on-the-job injury.

First Report of Injury or Illness (DWC 1) should be completed by the employee’s immediate supervisor and faxed (with the Witness Statement, if available) to the Workers’ Compensation Office (WCO) at 979-847-8546 within 24 hours of the injury/illness. These DWC 1 instructions are specific to Texas A&M University. Provide the employee with this handout entitled, “Notice of Injured Employee Rights and & Responsibilities”.

Witness Statement- Online Form OR Print and Complete by hand should be filled out by a willing supervisor or employee who personally witnessed a work-related injury and sent in with the First Report of Injury or as soon as possible thereafter.

Request for Paid Leave should be faxed to the WCO at 979-847-8546 as soon as the supervisor becomes aware that the employee is losing time due to a work related injury. If the employee is unavailable for signing, it may be completed by a supervisor after consultation with the employee.

Supplemental Form of Injury or Illness (DWC 6) accounts for any period of time lost from work for which the injured worker might be entitled to Workers’ Compensation benefits. It also serves as written notice of an employee's time lost from work and return to work after a period of temporary disability or of any change in pay status. Should be faxed to the WCO at 979-847-8546.

Wage Statement (DWC 3) is required whenever the employing department knows or should have known an employee will miss more than 7 days cumulatively for a work related injury.

The Bona Fide Offer of Employment (BOE) is required when an employee is returned to work with temporary restrictions that have been placed on the employee by the treating physician, if the department has work in line with the physician's restrictions. The BOE must be signed by the employee before returning to work. Please contact the WCO at 979-845-4170 or email hrwci@tamu.edu if you have questions regarding the BOE.

Notice to Employees of Workers' Compensation Insurance: Sign this form to acknowledge receipt of the notice that Workers' Compensation Insurance has been provided to you as an employee.