The TDI requires all reports to be submitted on their most current forms. Please check back regularly to verify that you are using the most current forms available. These forms require Microsoft Word and can be printed and mailed or e-mailed. Alternatively, you can click the Fill Online button and submit your document electronically.
E-mail all forms to Lisa Folsom at firstname.lastname@example.org .
*You can still access the downloadable Word Doc files by clicking the link on form name.
Click Here to Download DWC-1 Employer’s First Report of Injury
Click Here to Download DWC-3 Employer’s Wage Statement
Click Here to Download DWC-3-SD Employer’s Wage Statement for School Districts
Click Here to Download DWC-6 Supplemental Report of Injury
Click Here to Download DWC-48 Request for Travel Reimbursement (PDF only)
Click Here to Download DWC-53 Request to Change Treating Doctor
Click Here to Download DET-111 Voluntary Use of Paid Leave
1. Download and save the forms to your computer.
2. Fill out the repetitious information and save the form again.
3. Filling out a form is a simple “type and tab” process. After
4. E-mail the form to email@example.com or FAX the form to
5. We acknowledge receipt of all e-mailed forms by return
Annual – Payroll Request Form
***Click on the Link that applies to You!***
***Please include all Payroll: Fulltime, Part time, Overtime and Substitutes!
DETSIF requires this at least Annually, however Quarterly would be preferred.