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

(Also referred to as Report of Industrial Injury or Occupational Disease or ROA. The health care provider and the injured worker completes this from when filing a workers compensation claim.)

• Use the new forms as soon as they arrive: 
  Discard your old Report of Accident forms and use only this updated version.
• Read the new law requiring this change – Registered Domestic Partners 
  This new form incorporates changes required by a new Washington law that, beginning Dec. 3, 2009, gives state Registered Domestic Partners the same rights and benefits as married spouses.

Order now:

Submit your online order

Or

Use this form to FAX your order

Note:  Please order a three-month supply, at the most. Our warehouse reserves the right to mail a smaller order if supplies run low.  

Check other changes we made to this form

• Clearer, simplified instructions and new look
• Time-saving tips for our health care providers
• Better information for injured workers
• Clearer instructions for doctors recommending light-duty