TDI: New Revised Forms

Austin, TX ( - The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) has adopted revisions to DWC Form-105, Accident Prevention Services, and DWC Form-109, Accident Prevention Services Annual Report. The adoption of these revised forms is necessary to conform these forms to the adoption of new 28 Texas Administrative Code (TAC) §166.2, amended 28 TAC §§166.1, 166.3, and 166.5, and repealed 28 TAC §§166.2, 166.4, 166.6, 166.7, 166.8, and 166.9.

Workers' compensation system participants must use these adopted forms on or after October 1, 2013.

The forms are available for download from the TDI website at

If you have questions regarding the forms, contact Chris D'Amura at (512) 804-4626 or

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