Termination of Agreement (Rescission)

Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Termination of Agreement (Rescission)
Description To be filled out by the injured worker who wants to return hearing aids.
Document number F245-050-000
How to get this document
Alt Language(s)
Valid dates 05/2004
Contact information Claims for Job Injuries, Employer Services
Related information
Documents

Hearing Services Worker Information


Hearing Impairment Calculation Worksheet
Occupational Disease Employment History Hearing Loss
Occupational Disease Employment History Hearing Loss (Continuation)
Occupational Hearing Loss Questionnaire
Websites For Medical Providers, 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.