Worker Verification Form

Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Worker Verification Form

Completed by the injured worker if they are unable to work due to a workplace injury AND their employer is not paying their full wages.


Document number F242-052-000
How to get this document
Keywords benefits, claims, coverage, espanol, industrial insurance, occupational injuries, payment, spanish, time loss compensation, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Alt Language(s) Español
Valid dates 10/2008
Contact information Managing Injured Workers' Claims
Websites Workers' Comp Claims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.