Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

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Title Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

This form is not available to download. If you are an injured worker, ask your medical provider for a copy of this form or you can complete your portion of the Report of Accident (ROA) online at Please note only medical providers may order this form from the Warehouse.

Our supply of paper ROAs is currently out of stock, but medical provider offices can file their Report of Accident (ROA) within 30 minutes online through FileFast at Filing online gives you immediate claim confirmation and speeds claim processing by 5 days.  Provider offices also can get reimbursed $10 (billing code 1040M) for each ROA filed online. If you have questions or concerns about using FileFast, please call 360-902-6393.

We anticipate receiving additional ROAs in our Warehouse by February 9, 2015.

Document number F242-130-000
How to get this document
Alt Language(s)
Valid dates 10/2012
Contact information
Websites Workers' Comp Claims

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