Occupational Disease & Employment History
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
Occupational Disease & Employment History (A fillable form - 264 KB PDF)
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| Description | Injured worker fills this out to document possible occupational disease and to show work history. | |
| Detail | ||
| Form number | F242-071-000 | |
| Availability | Order it |
|
| 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 | 12-2010 | |
| Contact information |
Managing Injured Workers' Claims
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| Related information | ||
| Documents | Occupational Disease & Employment History (Cont) |
|
| Web pages | Workers' Comp Claims | |
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