Occupational health requirements for general contractors in Texas come from three directions at once: federal OSHA standards, a workers’ compensation system that is optional for most private employers, and the contracts that tie a general contractor to its subcontractors. Texas is unusual on the first two, and the combination creates gaps that general contractors in other states rarely face.
This guide is written for owners, safety directors, and project managers at Texas general contractors. It covers the medical obligations OSHA places on every site, how subscriber and non-subscriber status changes injury care and reporting, and what to require from subcontractors so one injured worker does not become a site-wide compliance problem.
OSHA in Texas: Federal Rules, Enforced Directly
Texas does not run a state OSHA plan for private employers. Federal OSHA enforces the construction standards in 29 CFR Part 1926 on every Texas job site, so there is no state-specific layer to track, but also no state program offering alternative consultation or interpretation.
For general contractors, the most important enforcement concept is OSHA’s multi-employer citation policy. On a multi-employer site, OSHA can cite the employer that created a hazard, the employer whose workers were exposed, the employer responsible for correcting it, and the controlling employer, usually the general contractor, if it failed to exercise reasonable care to prevent and detect violations. That means a subcontractor’s missing medical clearances or first aid coverage can become the general contractor’s citation.
The Medical Obligations on Every Texas Construction Site
These are the occupational health requirements that most often apply to Texas construction projects. Each employer is responsible for its own workers, but the general contractor needs to verify that subcontractors are meeting them.
| Requirement | Standard | What the GC should verify |
| First aid and medical services | 29 CFR 1926.50: trained first aid when no clinic or hospital is reasonably accessible, emergency numbers posted, transport or communication arranged | Trained first-aid providers on each crew and a site emergency plan |
| Respirator medical evaluation | 29 CFR 1926.103 and 1910.134: medical evaluation before fit testing or respirator use | Written clearance for every respirator user |
| Silica medical surveillance | 29 CFR 1926.1153: exams offered to workers required to wear respirators 30+ days a year, initially within 30 days and at least every 3 years | Written medical opinions on file for covered workers |
| DOT physicals and testing | FMCSA rules for commercial drivers; PHMSA rules for covered pipeline work | Current medical certificates and a DOT-compliant testing program |
| Injury recordkeeping | 29 CFR Part 1904: each employer records its own employees’ cases; the GC records workers it supervises day to day | Injuries reported to the GC the same shift |
For detail, see our guides to OSHA 1926.50 first aid requirements, OSHA medical surveillance requirements, and DOT vs. non-DOT drug testing.
A privacy note: general contractors should collect written medical opinions and clearances, not full medical records. The silica standard, for example, limits what the employer’s written opinion contains, and workers’ medical information should stay with the examining provider.
Texas Workers’ Comp: Subscriber vs. Non-Subscriber
Texas is the only state where most private employers can choose not to carry workers’ compensation. That choice changes how injuries are handled, reported, and litigated.
| Area | Subscriber (carries workers’ comp) | Non-subscriber (opts out) |
| Injured worker’s remedy | Benefits through the workers’ comp system | Employer’s own injury benefit plan, if any, or a lawsuit |
| Employer defenses | Workers’ comp is generally the exclusive remedy | Loses key common-law defenses such as contributory negligence and assumption of risk |
| Notice duties | Notify employees of coverage | File an annual notice of non-coverage with DWC and notify employees |
| Injury reporting | First report of injury to the carrier within 8 days of more than one day off work; immediately for occupational disease or death | DWC Form-007 for injuries with more than one day of lost time, occupational illnesses, and fatalities (employers with 5+ non-exempt employees) |
| Return to work tools | Work Status Reports and bona fide offers of modified duty | Set by the employer’s own plan |
Contractors working on Texas government contracts are generally required to provide workers’ compensation coverage, and most general contractors require it from subcontractors by contract regardless of state law.
How Subcontractor Coverage Changes Injury Care on Your Site
On a busy Texas project, the same injury can follow very different paths depending on whose employee is hurt:
- A subscriber’s employee enters the workers’ comp system, with Work Status Reports and modified-duty offers available. Our light duty program guide covers how Texas bona fide offers work.
- A non-subscriber’s employee is covered only by that employer’s own injury plan, if it has one. Without a clear process, these workers are often sent to the emergency department by default, and the claim or lawsuit that follows can reach the general contractor.
- A worker covered under a GC-provided agreement. Texas Labor Code §406.123 lets a general contractor and subcontractor agree in writing that the general contractor will provide coverage for the subcontractor and its employees, with the agreement filed with the GC’s carrier.
The practical answer is one site-wide injury response protocol for every trade. First aid, triage, and the decision about the right level of care should be the same no matter who employs the injured worker. The case then moves into the correct employer’s benefit pathway. That consistency protects the worker and keeps the general contractor from inheriting a mismanaged case.
What to Require From Subcontractors
- Proof of workers’ comp coverage, or a clear agreement on coverage, before mobilization
- Written respirator and silica clearances for covered workers
- Current DOT medical certificates for commercial drivers
- A drug and alcohol testing program that meets DOT rules where they apply and your site policy elsewhere
- Â First aid and CPR-trained people on each crew
- Same-shift injury reporting to the general contractor
- Participation in the site injury response and emergency plan
Common Gaps on Texas Job Sites
- Assumed coverage. A certificate on file that lapsed months ago, or a sole proprietor with no coverage at all.
- No unified injury protocol. Each trade handles injuries its own way, and minor injuries go to the ER by default.
- Missed surveillance. Crews rotating in mid-project without silica or respirator clearances.
- Late reporting. Subcontractor injuries reach the general contractor days later, if at all.
- Non-subscriber reporting missed. Injuries with more than one day of lost time never reported to DWC.
Each gap raises cost as well as compliance exposure. We explain the cost side in how to reduce workers’ comp costs in construction.
How Occucare Supports Texas General Contractors
Occucare International gives Texas general contractors one medical standard across every trade on the site. Board-certified occupational medicine physicians provide injury triage and corporate medical direction, our clinics and mobile units handle respirator, silica, and DOT exams, and our drug consortium supports DOT and non-DOT testing programs. Occupational health reporting gives safety teams physician-reviewed injury classification and audit-ready records.
We serve contractors from clinics in Houston, Deer Park, and the Galleria area, with support for projects across Texas and beyond through a network of 3,000+ vetted clinics. Learn more about our occupational health programs for construction and workers’ comp injury management.
Frequently Asked Questions
Does Texas have its own OSHA program for private contractors?
No. Texas does not operate a state OSHA plan for private employers, so federal OSHA enforces the construction standards in 29 CFR Part 1926 directly on Texas job sites.
Is workers’ compensation required for general contractors in Texas?
For most private employers, no. Texas lets private employers choose whether to carry workers’ compensation. Employers that opt out are non-subscribers; they lose certain common-law defenses in injury lawsuits and have their own notice and reporting duties. Contractors working on government contracts in Texas are generally required to provide coverage, and most general contractors require subcontractors to carry it by contract.
What must a Texas non-subscriber report after a workplace injury?
Non-subscribers with five or more non-exempt employees must report to the Texas Department of Insurance, Division of Workers’ Compensation, on DWC Form-007, each work-related injury that causes more than one day of lost time, every occupational illness, and every fatality. Non-subscribers also file an annual notice of non-coverage and must notify their employees.
Can a general contractor be cited by OSHA for a subcontractor’s hazard?
Yes. Under OSHA’s multi-employer citation policy, a controlling employer, typically the general contractor, can be cited if it did not exercise reasonable care to prevent and detect violations on the site, even when the exposed workers belong to a subcontractor.
Which medical exams do construction workers need under OSHA silica rules?
Under 29 CFR 1926.1153, employers must offer medical surveillance at no cost to each worker required to use a respirator under the silica standard for 30 or more days a year. The initial exam is due within 30 days of assignment and is repeated at least every three years, and respirator users also need a medical evaluation before fit testing.
Put One Medical Standard Across Every Trade
Occucare’s physicians will review your site’s first aid coverage, surveillance program, and subcontractor requirements and build an injury response protocol that works for every trade. Request a construction occupational health consultation.
