Non-Subscribers are required to file certain forms at certain times and post notices. Please click on the specific links below to view the form or notice and to read the related instructions for filing the specific form or notice. Please note that these forms should be completed, signed, dated and sent certified mail, return receipt requested, to the address indicated on the form. Keep copies for the file!
If you have any questions please call a staff member for assistance or visit the TDI website at http://www.tdi.state.tx.us/forms/form20employer.html
Texas Employer Notice of No Coverage or Termination of Coverage
Non-Subscribers are required to file the DWC 5 to become a non-subscriber and they must also renew their filing with the TDI (Form 5 & Form 205, if applicable) each year on or before the anniversary date of their initial filing. The purpose of this Form is to notify the TDI of their status as a non-subscriber. The Form 205 is merely an addendum to the Form 5 for employers with multiple locations.
DWC 5 (Formally Known as TWCC 5)
DWC 205 (Formally known as TWCC 205)
Texas Notice to Employees Concerning Workers' Compensation in Texas
Non-Subscribing employers must maintain the Notice 5 in areas of the workplace that allow all employees to see it on a regular basis, including the personnel office (if the company maintains a personnel office). The Notice 5 must be posted in English, Spanish, and any other language that is common to the workplace.
Notice 5 Rules
Notice 5 (English)
Notice 5 (Spanish)
Texas Report of Occupational Illnesses or Injuries
Non-Subscribing employers with five or more employees are required to report certain workplace injuries to the TDI. Injuries that result in more than one day away from the employees regular work schedule, all occupational diseases (regardless of lost time), and all fatalities occurring within any given calendar month must be reported on or before the seventh day of the month following the injury or illness. To report qualifying injuries, non-subscribing employers should utilize the DWC Form 7 and the Supplemental Form 7 (if additional space is needed).
DWC 7 Form with Instructions (Formally known as TWCC form 7)
DWC Form 7 (Supplemental) (Formally known as TWCC form 7 Supplemental)
OSHA Forms for Reporting/Recording Work-Related Illnesses and Injuries
Employers who are not exempt from the Occupational Health and Safety Administration's (OSHA) record keeping requirements must prepare and maintain records of work-related injuries and illnesses. This forms package contains forms for injuries and illnesses occurring in 2004.
OSHA FORMS
CSN 08/2006
