Job Modification Assistance Application

Job Modification Assistance Application - (Forms/Publications)
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Title Job Modification Assistance Application (A fillable form - 434 KB PDF)

For use by an vocational counselor, employer, etc. to request modification for the injured workers job. This may involve tools and equipment that is purchased through L&I.

Form number F245-346-000
Online only. See document above to download.
Keywords accident, claims, disability, disabled, employability, industrial insurance, injury, occupational injuries, provider, returning to work, voc rehab, vocational, vocational provider, vocational rehab, workers compensation, workers' compensation
Languages English
Valid dates 12-2008
Contact information Managing Injured Workers' Claims
Vocational Resources
Claims for Job Injuries
Related information

Vocational Training Plan Ownership Agreement for Tools and Equipment

Web pages Workers' Comp Claims
For Medical Providers

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