Order L&I Report of Industrial Injury or Occupational Disease (ROA) forms

Order your updated Report of Accident forms here – It's required

The health-care provider and the injured worker complete this form when filing a workers compensation claim.

  • Use new forms as soon as they arrive:  discard copies of the outdated version.
  • Check out the changes to the ROA, including instructions for workers now available in 16 languages. Read more.

Order now: (Note:  Please limit your order to a three-month supply, at the most. Our warehouse reserves the right to mail a smaller order.)

Submit your online order

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Use this form to FAX your order

Online Filing of the ROA

L&I offers a financial incentive to providers who file the Report of Accident on our website at www.FileFast.Lni.wa.gov.

Learn more about FileFast.

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