Worker’s Compensation

Texas Forms

Employee’s Notice of Injury

Injury Reporting Protocol (Texas)

Injury Reporting Protocol (Other States)

Workwell TX Employee Acknowledgement Form

Supervisor Accident Analysis Report

Worker’s Comp Certificate of Insurance Request (Contact Risk Management for this form)

Worker’s Comp Experience Modifier Rate (EMR) (Contact Risk Management for this form)

Workwell TX Network Information

Spanish Forms

SPANISH – Employee’s Notice of Injury

SPANISH – Workwell TX Network Information

Outside of Texas Injury Forms

Please contact Risk Management for that state’s specific form