All applications and forms can be downloaded. Please complete the appropriate application/form and fax it back to our offices. Please note that Adobe Reader is required to view these forms.
Texas Fax: (713) 880-7166
Arkansas Fax: (479) 649-0534
If you have any questions regarding the correct form, please click here.
EMPLOYER’S WAGE STATEMENT
Download now – Employer’s Wage Statement
EMPLOYER’S ILLNESS OR INJURY REPORT
Download now – Employer’s First Report of Injury or Illness
SUPPLEMENTAL REPORT OF INJURY
Download now – Supplemental Report of Injury
You will need the Adobe Acrobat Reader to view or print these files. You can view or print PDF’s just by clicking on the PDF you wish to examine. If you wish to download the file from Internet Explorer, point your mouse over the Application and right click and select “Save Target As…”.
For a free download of Adobe Acrobat Reader, click the image below.