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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 ehs@txstate.edu & kb1569@txstate.edu

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