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Name of person completing this form, 14. INSTRUCTIONS FOR COMPLETING ACCIDENT PREVENTION SERVICES WORKSHEET (DWC Form-105). 1a.Name of policyholder and "dba" if applicable; e.g. Download Accident Prevention Services Worksheet (DWC105) – Insurance (Texas) form. No information is available for this page. What information will be gathered under an Accident Prevention inspection? The Workbook presents a comprehensive program for sharps injury prevention. You may obtain help from WISHA Consultation Services at no cost or from other sources, if needed. You may continue to update the worksheet and save all of your changes until you have completed your list. Complete all portions of the application.