Occupational Disease Work History - Continuation

Occupational Disease Work History - Continuation - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Occupational Disease Work History - Continuation (A fillable form - 248 KB PDF)
Description

This is a continuation page to the Occupational Disease Work History (F242-071-000) to add additional work history.

Detail
Form number F242-071-111
Availability
Order it
Keywords claim information, claims, diseases, industrial insurance, injury, medical, occupational diseases, repetitive trauma, work history, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 10-2005
Contact information Claims and Insurance

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.