Accident Prevention Services Worksheet {DWC-105} | Pdf Fpdf Doc Docx | Texas

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Accident Prevention Services Worksheet {DWC-105} | Pdf Fpdf Doc Docx | Texas

Last updated: 1/3/2025

Accident Prevention Services Worksheet {DWC-105}

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Description

DWC-105 - ACCIDENT PREVENTION SERVICES WORKSHEET. Insurance companies undergoing inspections by the Texas Department of Insurance, Division of Workers’ Compensation (DWC) required by 28 Texas Administrative Code Section 166.5 (Inspections of Adequacy of Accident Prevention Facilities and Services) must file the DWC Form-105. Insurance companies are responsible for timely and accurately filing the DWC Form-105. An insurance company must file a completed DWC Form-105 for each policy that DWC selects at least 10 days before the scheduled date of the inspection. You must complete all fields each time you file the DWC Form-105. A DWC Form-105 is considered filed with DWC only when it accurately contains all the required data elements. www.FormsWorkflow.com

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