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 claims@detsif.com . |
Online Forms *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 InjuryClick Here to Download DWC-3 Employer’s Wage StatementClick Here to Download DWC-3-SD Employer’s Wage Statement for School DistrictsClick Here to Download DWC-6 Supplemental Report of InjuryClick Here to Download DWC-48 Request for Travel Reimbursement (PDF only)Click Here to Download DWC-53 Request to Change Treating DoctorClick Here to Download DET-111 Voluntary Use of Paid LeaveClick Here to Download Refusal of Medical TreatmentClick Here to Download Internal Accident Investigation ReportClick Here to Download On-Site Supervisor’s Accident Investigation Report Click Here to Download Witness Statement Click Here to Download Witness Statement (Spanish) Click Here to Download Employee Statement of Injury Click Here to Download Employee State of Injury (Spanish) Click Here to Download GASB Statement Instructions: 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 claims@detsif.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!*** *Schools*Cities*Counties*Districts
***Please include all Payroll: Fulltime, Part time, Overtime and Substitutes! DETSIF requires this at least Annually, however Quarterly would be preferred. |