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Title Type Number
Application for Construction Contractor Registration

This is the form you would complete to register as a construction contractor.

Form F625-001-000
Parent / School Authorization for Employment of a Minor and Special Variance 

For legal guardians and school officials to approve the hours and work activities for a minor employee to work according to terms listed by the employer. The Special Variance allows additional hours of work for 16- and 17-year-olds and is described on the form. All parties must sign to approve the hours of work for a minor regardless of the number of hours listed. This is NOT a work permit. Employers must obtain a minor work permit endorsement on their Master Business License where they employ workers under 18.

Form F700-002-000
Worker Rights Complaint Form

Also available in: Spanish

This is the Worker Rights Complaint Form. Both the 12-2011 and 10-2010 versions are valid.

Form F700-148-000
Statement of Intent to Pay Prevailing Wages - Public Works Contract

This form is a fillable Word document that is used by a contractor, company or agency upon accepting work on a public works project. The best way to use this use this document is to bookmark this page as a "Favorite" in your web browser. Then each time when you want to use the document, access the online version of the form. This will ensure you are always utilizing the most recently published form. (We recommend you not download the document and save it for future use because we may make changes to the form that your downloaded version will not contain.) You should file this form immediately after the contract is awarded and before you begin work. Form number F700-160-000 is addendum A and F700-163-000 is addendum C.

Form F700-029-000
Electrical Safety Standards, Administration, and Installation WAC 296-46B

Electrical Safety Standards, Administration, and Installation WAC 296-46B

Manual F500-039-222
Certified Project Payroll

There are instructions in one PDF file, and a blank form that may be printed in the other PDF. The word document is saved in Microsoft 2003 format and is a fillable word form.

Form F700-065-000
Non-Network Provider Application

Includes the F248-036-000 Statewide Payee Registration and W-9 form. For providers to complete that do not want to become a Labor and Industries network provider, or for a specialty that L&I is not accepting network applications for at this time. If you are applying to be a Labor and Industries network provider, please complete application process at www.ProviderNetwork.Lni.wa.gov.

Form F248-011-000
Affidavit of Wages Paid - Public Works Contract and Instructions

This form is a fillable Word document that is used by a contractor, company or agency to show the wages paid to employees on a public works project. The best way to use this document is to bookmark this page as a “Favorite” in your web browser. Then each time when you want to use the document, access the online version of the form. This will ensure you are always utilizing the most recently published form. (We recommend you not download the document and save the form for future use because we may make changes to the form that your downloaded version will not contain.) You must file the Affidavit of Wages Paid form when you have completed your portion of a public works job/project. Addendum A is form number F700-161-000, Addendum C is form number F700-162-000, and the EHB 2805 (RCW 39.04.370) Addendum is form number F700-164-000.

Form F700-007-000
Sample On-The-Job Training Agreement

Sample On-The-Job Training Agreement

Form F252-033-000
Chapter 19.28 RCW - Electricians and Electrical Installations

Simplified version of the Chapter 19.28 RCW - Electricians and Electrical Installations Rules

Manual F500-039-111
Waiver of Lien by Contractor, Subcontractor(s) and Supplier

This is a waiver of lien by a contractor or a subcontractor or supplier.

Form F625-029-000
Application for Benefits - Crime Victims

Also available in: Spanish

Used by victims of a crime in Washington State to receive benefits for time lost from work, loss of financial support, medical or mental health treatment. The Spanish version of the instructions are online as F800-042-999.

Form F800-042-000
Insurer Activity Prescription Form

Also available in: English/Spanish

Used by health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans. To print an APF, click on the title of the form in the box above.

Form F242-385-000
Travel Reimbursement Request

Also available in: Spanish

Bill form for use by workers to request reimbursement for authorized travel expenses.

Form F245-145-000
Employer's Job Description

Employer's Job Description

Form F242-040-000
Certified Project Payroll

There are instructions in one PDF file, and a blank form that may be printed in the other PDF. The word document is saved in Microsoft 2003 format and is a fillable word form.

Form F700-065-000
CMS 1500 (formerly L&I Health Insurance Claim form)

Used by providers to be reimbursed for services. It is NOT for use by injured workers to submit a claim to L&I.

Form F245-127-000
Alleged Safety Or Health Hazards (DOSH Complaint Form)

Also available in: Spanish

Employees use this form to report work place conditions which jeopardize workers safety and health.

Form F418-052-000
Application to Access L&I's Electrical Permit and Inspection System (EPIS) from SecureAccess Washington and Utilize Contractor Deposit Account via the Internet

To establish a contractor deposit account by an electrical contactor or registered construction contractors who are legally required to purchase electrical work permits from L&I.

Form F500-055-000
Worker Verification Form

Also available in: Spanish

Completed by the injured worker if they are unable to work due to a workplace injury AND their employer is not paying their full wages.

Form F242-052-000

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