Occupational Disease & Employment History

Occupational Disease & Employment History - (Forms/Publications)
Document Information
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Title Occupational Disease & Employment History (A fillable form - 371 KB PDF)
Description

Injured worker fills this out to document possible occupational disease and to show work history.

Detail
Form number F242-071-000
Availability
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Keywords claim information, claims, diseases, espanol, industrial insurance, injury, medical, occupational injuries, repetitive trauma, spanish, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 10-2005
Contact information Managing Injured Workers' Claims
Web pages Workers' Comp Claims

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