The wage information on this form is for the injured employee or a similar employee.
Wages: report all wages paid in the 13 weeks before the date of injury according to the employee's pay period.
Biweekly or monthly: employers may report 14 weeks if paid biweekly or three months if paid monthly.
Full-time: the employee regularly works 30 hours or more per week.
Average weekly wage: the gross average amount of money the employer paid the injured employee each week in the 13 weeks before the injury or illness.
Questions: call 1-800-252-7031, Monday to Friday, 8 a.m. to 5 p.m., Central time.
| Question | Answer |
|---|---|
| Form Name | DWC003 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 221 |
| Avg. time to fill out | 37 min |
| Edition | Rev. 10/22 |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | DWC003, DWC 3, DWC-3, DWC Form-003, Employer's Wage Statement, Texas workers comp wage statement |
| Official source | DWC003 (Rev 10/22), Texas Department of Insurance, Division of Workers' Compensation |
Dwc Form 3 isn’t the one you’re looking for?