Workers' Compensation

The Workers' Compensation Flowchart is designed to provide assistance in completing the necessary paperwork for an on-the-job injury.

First Report of Injury or Illness (DWC 1) should be completed by the employee's immediate supervisor or authorized department representative and faxed (with the Witness Statement, if available) to TEES Personnel Services at (979) 458-7720 within 24 hours of the injury/illness. Provide the employee with the attached three page handout titled, "Injured Worker Rights & Responsibilities."

The Witness Statement should be filled out by a wiling supervisor or employee who personally witnessed a work-related injury and sent in with the First Report of Injury as soon as possible thereafter.

The Injured Worker Rights and Responsibilities document is to be given to employees who report workplace injuries.

Request for Paid Leave should be faxed to the TEES Personnel Services at (979) 458-7720 as soon as the supervisor becomes aware that the employee is losing time due to a work related injury. If the employee is unavailable for signing, it may be completed by a supervisor after consultation with the employee.

Supplemental Report of Injury or Illness (DWC 6) accounts for any period of time lost from work for which the injured worker might be entitled to Workers Compensation benefits. It also serves as written notice of an employee's time lost from work and return to work after a period of temporary disability or of any change in pay status. Should be faxed to the TEES Personnel Services at (979) 458-7720.

Wage Statement (DWC 3) is required whenever the employing department knows or should have known an employee will miss more than 7 days cumulatively for a work related injury.