First Report of Injury

The Employers First Report of Injury or Illness Form (DWC 1) is not a Texas A&M University
form. It is an official form of the State of Texas.  An employer who fails to file the report without
good cause may be assessed an administrative penalty not to exceed $500.00.  The First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant’s employment and circumstances surrounding the injury or illness are also requested.  If handwriting the information, it must be legible and in black ink. It is preferable that the form be
typed using capital letters in large bold font. Where dates are required enter MM/DD/YY (example: 01/17/07).

Complete instructions for filling out the form is located at: Instructions

The form is available at: First Report of Injury Form