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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 & dt03@txstate.edu

For questions please call Diana Trelles 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 (PDF, 56 KB)

Employees Election Regarding Utilization of Sick and Annual Leave

SORM-80_SickAnnualleave[2] : Sick & Annual Leave Usage Election (PDF, 141 KB)

Medical Reimbursement Request Form

SORM-81A (PDF, 372 KB)

SORM/IMO Network Acknowledgement Form