Workers compensation forms are the paper trail behind every claim, and this page lists 45 of them across six states, with each form number, its official name and the job it does. There is no national claim form, because each state runs its own system under its own statute and names its own documents.
That is why the employer’s injury report is Form 5020 in California, Form 19 in North Carolina, Form 801 in Oregon, Form 12A in South Carolina and DWC Form-001 in Texas.
Every row in the table comes from that state’s own verified guide on this site. Use this hub to find the right form quickly, then open the state page to confirm who files it and where.
Click any entry below for its own page, with the address or official PDF, who files, and the deadline.
Quick Facts — Workers compensation forms (2026)
- Fewest forms listed: Oregon and Virginia each have 2 forms in the table. Oregon lists Form 801 and Form 827, and Virginia lists Form 61A and its Claim Form.
- Most forms listed: California has 13 workers compensation forms in the table, from the DWC 1 claim form to the WCAB 45 Petition for Reconsideration.
- The most common rule: 5 of the 6 states list a separate employer injury report: California Form 5020, North Carolina Form 19, Oregon Form 801, South Carolina Form 12A and Texas DWC Form-001.
- The notable outlier: Texas lists DWC Form-005, the notice an employer files when it has no coverage or ends its coverage, plus DWC Form-083 for certain building and construction workers.
- Your injury date can change the form: South Carolina uses Form 16 for injuries before July 1, 2007 and Form 16A for injuries after July 1, 2007. California’s DWC-AD 10133.32 voucher covers injuries on or after 1/1/13.
- True in every state: Each state in the table has a form for the worker’s claim: California DWC 1, North Carolina Form 18, Oregon Form 827, South Carolina Form 50, Texas DWC Form-041 and the Virginia Claim Form.
- Free help: The state workers’ compensation agency is the official source for workers compensation forms and filing questions, and every state page on this site lists that agency’s contact.
Workers compensation forms — 45 Verified Pages
The workers compensation forms table below shows the two figures that frame the question in every state. Here is what each column means:
Form = the official form number, linked to its own page with who files it, the deadline, the fee and the official PDF.
What It Is = the form’s official title as the state agency publishes it.
| State | Form | What It Is |
|---|---|---|
| California | DWC-CA 10214-c | Compromise and Release (settlement agreement) |
| California | DWC-CA 10250.1 | Declaration of Readiness to Proceed (DOR) |
| California | DWC 1 | Workers' Compensation Claim Form |
| California | DWC 3 | Attorney Fee Disclosure Statement |
| California | DWC 7 | Notice to Employees — Injuries Caused by Work (the required workplace poster) |
| California | DWC-AD 100 | Employee's Permanent Disability Questionnaire (DEU 100) |
| California | Form 5020 | Employer's Report of Occupational Injury or Illness (DLSR 5020) |
| California | Form 5021 | Doctor's First Report of Occupational Injury or Illness |
| California | WCAB 45 | Petition for Reconsideration |
| California | DWC PR-2 | Primary Treating Physician's Progress Report |
| California | QME 105 | Request for QME Panel under Labor Code 4062.1 (unrepresented worker) |
| California | DWC Form RFA | Request for Authorization for Medical Treatment (8 CCR 9785.5) |
| California | DWC-AD 10133.32 | Supplemental Job Displacement Non-Transferable Voucher (injuries on or after 1/1/13) |
| North Carolina | Form 90 | Report of Earnings |
| North Carolina | Form 19 | Employer's Report of Employee's Injury or Occupational Disease |
| North Carolina | Form 22 | Statement of Days Worked and Earnings of Injured Employee |
| North Carolina | Form 18 | Notice of Accident to Employer and Claim of Employee |
| North Carolina | Form 28C | Report of Employer or Carrier/Administrator of Compensation Paid (final) |
| Oregon | Form 801 | Report of Job Injury or Illness |
| Oregon | Form 827 | Worker's and Health Care Provider's Report for Workers' Compensation Claims |
| South Carolina | Form 12A | First Report of Injury |
| South Carolina | Form 14B | Physician's Statement |
| South Carolina | Form 15 | Temporary Compensation Report (and hearing request to dispute termination) |
| South Carolina | Form 16 | Agreement for Permanent Disability / Disfigurement Compensation (injuries before July 1… |
| South Carolina | Form 16A | Agreement for Permanent Disability / Disfigurement Compensation (injuries after July 1… |
| South Carolina | Form 17 | Receipt of Compensation |
| South Carolina | Form 18 | Periodic Report |
| South Carolina | Form 19 | Status Report and Compensation Receipt |
| South Carolina | Form 20 | Statement of Earnings of Injured Employee |
| South Carolina | Form 50 | Employee's Notice of Claim and/or Request for Hearing |
| South Carolina | Form 51 | Employer's Answer to Request for Hearing |
| South Carolina | Form 52 | Employee's Notice of Claim, Death Case |
| Texas | DWC Form-001 | Employer's First Report of Injury or Illness |
| Texas | DWC Form-003 | Employer's Wage Statement |
| Texas | DWC Form-005 | Employer Notice of No Coverage or Termination of Coverage (non-subscriber notice) |
| Texas | DWC Form-032 | Request for Designated Doctor Examination |
| Texas | DWC Form-041 | Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease |
| Texas | DWC Form-069 | Report of Medical Evaluation |
| Texas | DWC Form-073 | Work Status Report |
| Texas | DWC Form-042 | Claim for Workers' Compensation Death Benefits |
| Texas | DWC Form-045 | Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC) |
| Texas | DWC Form-048 | Request to Get Reimbursed for Travel Costs |
| Texas | DWC Form-083 | Joint Agreement to Affirm Independent Relationship for Certain Building and Construction… |
| Virginia | Form 61A | Certificate of Workers' Compensation Insurance |
| Virginia | Claim Form | Claim for Benefits |
Every entry was verified on the state agency’s own site before it was listed. States not shown yet have no verified entries on this site; they are added as each one is confirmed.
Workers compensation forms: What Every State Shares
Most workers compensation forms do the same few jobs, whatever the state calls them. First the worker gives notice and makes a claim, as with California’s DWC 1, North Carolina’s Form 18 or Texas DWC Form-041. Then the employer reports the injury, as with California Form 5020 or South Carolina Form 12A.
Doctors add their own reports, such as California Form 5021 and the DWC PR-2, South Carolina’s Form 14B, and Texas DWC Form-069 and DWC Form-073.
After the first reports, the later workers compensation forms track wages, payments and disputes. Wage forms include North Carolina Form 22, South Carolina Form 20 and Texas DWC Form-003. Payment records include North Carolina Form 28C and South Carolina Forms 17, 18 and 19.
When the two sides disagree, there is a form to ask for a hearing or a review, such as California’s Declaration of Readiness to Proceed, South Carolina Form 50 and Form 51, and Texas DWC Form-045 for a Benefit Review Conference.
Workers compensation forms: What Makes It Different
The biggest difference is the statute. Each state’s law decides which forms exist and what goes on them, which is why California’s Request for Authorization cites 8 CCR 9785.5 and its QME 105 panel request is tied to Labor Code 4062.1.
Agency practice matters too. California uses a numbered DWC series plus a separate WCAB petition, Texas numbers everything as DWC Form-001 through DWC Form-083, and Virginia lists just a Claim Form and Form 61A, the certificate of insurance.
Your own situation also changes which workers compensation forms apply. A California worker with a lawyer will see the DWC 3 Attorney Fee Disclosure Statement, while an unrepresented worker uses QME 105 to request a panel. A death claim uses its own form, such as South Carolina Form 52 or Texas DWC Form-042.
Choices like asking for a designated doctor with Texas DWC Form-032, or seeking travel costs with DWC Form-048, add forms that other workers never touch.
Tell your employer about the injury and file your state’s worker claim form as soon as you can. The employer’s report is not the same as your claim, so keep a copy of everything you sign or send.
Workers compensation forms: What to Do Next
Start by finding your state in the table and writing down the worker claim form and the employer report form. If you are a worker, file your claim form and ask your employer to confirm that their report went in. If you are an employer, file the injury report, post any required notice such as California’s DWC 7 poster, and send wage details when the state asks for them.
Next, open the state page for each form you need. Every state page on this site carries the statute citation and the agency contact, so you can check the current version of a form before you file it.
Keep dated copies of all your workers compensation forms, and if a payment stops or a claim is denied, look for your state’s hearing or review form and call the agency for free help with the next step.
Find Your Workers compensation forms
Looking for a workers compensation forms? Use the table above, or browse the full category below.
Browse All Workers compensation forms Guides →
Related Master Guides
Official Sources
- State agency forms pages: each form page links the official PDF on the agency site
- U.S. Dept. of Labor, State Workers’ Compensation Officials: www.dol.gov — the agency that publishes each form
Workers compensation forms data compiled from each state’s verified guide on this site, which cites the statute and the agency. Figures change by statute and by year, so each row links to the page that explains it. Last reviewed October 2026.
Disclaimer: This page is for general informational purposes only and is not legal advice. No attorney-client relationship is created by reading it. Rules, deadlines and figures vary by state and change over time. For advice about your specific situation, consult a licensed attorney or your state workers’ compensation agency.