Workers' Compensation

Workers' Compensation Insurance Carrier

P.O. Box 13777
Austin, Texas 78711
Phone: (512) 475-1440
Toll Free: (877) 445-0006
Fax: (512) 370-9025

SORM

Workers’ Compensation Forms

Submit completed forms to the Human Resources Claims Coordinator
  • Supervisor’s Investigation of Employee’s Accident/Incident Currently Unavailable
  • Employee’s Report of Injury Currently Unavailable
  • Authorization for Release of Information Currently Unavailable
  • Witness Statement Currently Unavailable
  • Employee’s Election Regarding Utilization of Sick and Annual Leave Currently Unavailable
  • Return to Work Status Form Currently Unavailable