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lign="left">Employer’s Guide to the Hazard Communication Rule  

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-000



Alt Language(s):
中国的
한국의
Español
Vi?t
 

lign="left">Employer’s Guide to the Hazard Communication Rule  

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-000



Alt Language(s):
中国的
한국의
Español
Vi?t
 

lign="left">Employer’s Guide to the Hazard Communication Rule  

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-000



Alt Language(s):
中国的
한국의
Español
Vi?t
 

lign="left">Employer’s Guide to the Hazard Communication Rule  

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-000



Alt Language(s):
中国的
한국의
Español
Vi?t
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Form
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Publication
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Form
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Publication
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Form
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Publication
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Form
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Publication
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Form
F249-008-999



Alt Language(s):
Inglés
 
¿Lesionado por un tercero? Usted tiene opciones legales

Folleto: Un resumen de los derechos legales y opciones que tiene un trabajador lesionado si una acción contra un tercero está relacionada con su reclamo de compensación para los trabajadores. Incluye el Formulario de elección contra terceros que debe ser completado por el trabajador. Aviso:  El formulario debe imprimirse, firmarse y enviarse por correo.

 



Publication
F249-008-999



Alt Language(s):
Inglés
 
¿Necesita un doctor?

Tarjeta: Proporciona información a los trabajadores lesionados sobre con quien comunicarse si necesitan ayuda para encontrar un proveedor de cuidado de la salud que pueda darle tratamiento para su lesión o enfermedad ocupacional.  Este documento en formato PDF imprime una hoja de 8.5x11 pulgadas de tamaño carta que tiene 12 copias de la tarjeta.  Aviso: La información del descargo de responsabilidad en la página 2 puede que no esté alineada correctamente con la impresión en ambos lados.



Publication
F160-006-999



Alt Language(s):
Inglés
 
¿Necesita un doctor?

Tarjeta: Proporciona información a los trabajadores lesionados sobre con quien comunicarse si necesitan ayuda para encontrar un proveedor de cuidado de la salud que pueda darle tratamiento para su lesión o enfermedad ocupacional.  Este documento en formato PDF imprime una hoja de 8.5x11 pulgadas de tamaño carta que tiene 12 copias de la tarjeta.  Aviso: La información del descargo de responsabilidad en la página 2 puede que no esté alineada correctamente con la impresión en ambos lados.



Publication
F160-006-999



Alt Language(s):
Inglés
 
 Safety Standards for WAC 296-56 - Longshore, Stevedore and Waterfront Related Operations

The rules included in this chapter apply to any and all waterfront operations for longshore, stevedore and waterfront  related operations, cargo handling, and related terminal operations and equipment under the jurisdiction of the  Department of  Labor and  Industries.



Manual
F414-034-000


 
2005 Annual Report - Department of Labor & Industries

Provides a statistical overview of results achieved in fiscal year 2005 (July 1, 2004, through June 30, 2005), budget information and a narrative introduction to the Department of Labor and Industries.



Publication
F101-068-000


 
2005 Annual Report - Department of Labor & Industries

Provides a statistical overview of results achieved in fiscal year 2005 (July 1, 2004, through June 30, 2005), budget information and a narrative introduction to the Department of Labor and Industries.



Publication
F101-068-000


 
2005 Annual Report - Department of Labor & Industries

Provides a statistical overview of results achieved in fiscal year 2005 (July 1, 2004, through June 30, 2005), budget information and a narrative introduction to the Department of Labor and Industries.



Publication
F101-068-000


 
2008 Annual Report - Department of Labor & Industries

Provides a statistical overview of operations in fiscal year 2008 (July 1, 2007, through June 30, 2008), budget information and a summary of accomplishments during the fiscal year.



Publication
F101-089-000


 
2008 Annual Report - Department of Labor & Industries

Provides a statistical overview of operations in fiscal year 2008 (July 1, 2007, through June 30, 2008), budget information and a summary of accomplishments during the fiscal year.



Publication
F101-089-000


 
2008 Annual Report - Department of Labor & Industries

Provides a statistical overview of operations in fiscal year 2008 (July 1, 2007, through June 30, 2008), budget information and a summary of accomplishments during the fiscal year.



Publication
F101-089-000


 
2008 Annual Report for the Washington State Fund: Washington's State-run Workers' Compensation Program

Book: Introduces Washington State's Workers' Compensation Program, including rate-setting and investment policies, financial statement overview, and services available to help employers control workers' comp costs.



Publication
F101-086-000


 
2008 Annual Report for the Washington State Fund: Washington's State-run Workers' Compensation Program

Book: Introduces Washington State's Workers' Compensation Program, including rate-setting and investment policies, financial statement overview, and services available to help employers control workers' comp costs.



Publication
F101-086-000


 
2008 Annual Report for the Washington State Fund: Washington's State-run Workers' Compensation Program

Book: Introduces Washington State's Workers' Compensation Program, including rate-setting and investment policies, financial statement overview, and services available to help employers control workers' comp costs.



Publication
F101-086-000


 
2015 Workplace Safety and Health Calendar: Preventing Sprains and Strains - Washington’s Leading Workplace Injury

Calendar: Features real Washington State businesses and employees in jobs where sprains and strains are most common. The calendar includes suggested weekly safety and health tips for preventing sprains and strains to the neck, shoulders, back, hands/wrists, knees, and elbows.



Publication
F417-251-000


 
2015 Workplace Safety and Health Calendar: Preventing Sprains and Strains - Washington’s Leading Workplace Injury

Calendar: Features real Washington State businesses and employees in jobs where sprains and strains are most common. The calendar includes suggested weekly safety and health tips for preventing sprains and strains to the neck, shoulders, back, hands/wrists, knees, and elbows.



Publication
F417-251-000


 
2015 Workplace Safety and Health Calendar: Preventing Sprains and Strains - Washington’s Leading Workplace Injury

Calendar: Features real Washington State businesses and employees in jobs where sprains and strains are most common. The calendar includes suggested weekly safety and health tips for preventing sprains and strains to the neck, shoulders, back, hands/wrists, knees, and elbows.



Publication
F417-251-000


 
2015 Workplace Safety and Health Calendar: Preventing Sprains and Strains - Washington’s Leading Workplace Injury

Calendar: Features real Washington State businesses and employees in jobs where sprains and strains are most common. The calendar includes suggested weekly safety and health tips for preventing sprains and strains to the neck, shoulders, back, hands/wrists, knees, and elbows.



Publication
F417-251-000


 
3 Things to Know about L&I's Medical Provider Network

Handout: Explains to workers the basic information about L&I’s Medical Provider Network. The handout can be used with workers covered both by L&I and by self-insured employers. Applies to workers in Washington state. Includes website and phone number contact information.



Publication
F242-406-000



Alt Language(s):
Español
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim.



Publication
F207-085-000



Alt Language(s):
Español
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim.



Publication
F207-085-000



Alt Language(s):
Español
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim.



Publication
F207-085-000



Alt Language(s):
Español
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim.



Publication
F207-085-000



Alt Language(s):
Español
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim.



Publication
F207-085-000



Alt Language(s):
Español
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim.



Publication
F207-085-000



Alt Language(s):
Español
 
A Guide to Workplace Safety and Health in Washington State

Pamphlet/booklet: Provides an overview of the Washington Industrial Safety and Health Act (WISHA), worker and employer rights and responsibilities, enforcement of WISHA rules, and consultation and education services L&I provides. Previously titled A Guide to WISHA



Publication
F416-132-000



Alt Language(s):
Español
 
A Guide to Workplace Safety and Health in Washington State

Pamphlet/booklet: Provides an overview of the Washington Industrial Safety and Health Act (WISHA), worker and employer rights and responsibilities, enforcement of WISHA rules, and consultation and education services L&I provides. Previously titled A Guide to WISHA



Publication
F416-132-000



Alt Language(s):
Español
 
A Guide to Workplace Safety and Health in Washington State

Pamphlet/booklet: Provides an overview of the Washington Industrial Safety and Health Act (WISHA), worker and employer rights and responsibilities, enforcement of WISHA rules, and consultation and education services L&I provides. Previously titled A Guide to WISHA



Publication
F416-132-000



Alt Language(s):
Español
 
Account Deposit for Contractor's or Miscellaneous Account Holder's

Used to deposit money into your L&I account (Electrical).



Form
F500-080-000


 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Form
F622-081-000


 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Form
F622-081-000


 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Form
F622-081-000


 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Form
F622-081-000


 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Form
F622-081-000


 
Accountability Agreement

This document provides the facts necessary to make an informed decision regarding vocational retraining benefits and explains the responsibilities you and your vocational counselor (VRC) have. For OJT retraining plans, please refer to form F280-029-000.



Form
F280-016-000



Alt Language(s):
Español
 
Acuerdo de propiedad de herramientas y equipo para el plan de formacion profesional

Formulario: El trabajador lesionado está de acuerdo con los términos de propiedad de las herramientas y/o el equipo comprado como parte de su plan de capacitación de L&I.



Form
F245-351-999



Alt Language(s):
Inglés
 
Acuerdo de responsabilidad

Formulario: Este documento proporciona los datos necesarios para tomar una decisión informada con referencia a los beneficios de capacitación vocacional y explica las responsabilidades que usted y su consejero vocacional (VRC, por su sigla en inglés) tienen.



Form
F280-016-999



Alt Language(s):
Inglés
 
Acuerdo de responsabilidad

Formulario: Este documento proporciona los datos necesarios para tomar una decisión informada con referencia a los beneficios de capacitación vocacional y explica las responsabilidades que usted y su consejero vocacional (VRC, por su sigla en inglés) tienen.



Form
F280-016-999



Alt Language(s):
Inglés
 
Acuerdo de responsabilidad

Formulario: Este documento proporciona los datos necesarios para tomar una decisión informada con referencia a los beneficios de capacitación vocacional y explica las responsabilidades que usted y su consejero vocacional (VRC, por su sigla en inglés) tienen.



Form
F280-016-999



Alt Language(s):
Inglés
 
Acuerdo entre contratistas agrícolas y trabajadores

Formulario:  Acuerdo con los contratistas agrícolas y trabajadores sobre salarios de empleo y condiciones 



Form
F700-046-999



Alt Language(s):
Inglés
 
Adaptación previa al trabajo solicitudad de ayuda

Formulario:  Este formulario puede utilizarlo un terapeuta o proveedor vocacional para solicitar una modificación de empleo para un trabajador lesionado antes de que el trabajador lesionado sea empleado, posiblemente en un programa de capacitación.  Esto puede incluir herramientas y equipo comprado por L&I.





Form
F245-350-999



Alt Language(s):
Inglés
 
Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.



Form
F242-107-000



Alt Language(s):
Español
 
Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.



Form
F242-107-000



Alt Language(s):
Español
 
Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.



Form
F242-107-000



Alt Language(s):
Español
 
Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.



Form
F242-107-000



Alt Language(s):
Español
 
Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.



Form
F242-107-000



Alt Language(s):
Español
 
Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.



Form
F242-107-000



Alt Language(s):
Español
 
Administrator / Electrician / Master Electrician Certificate Renewal

To renew your electrical certificate. Fee varies depending on renewal type.



Form
F500-045-000


 
Administrator / Electrician / Master Electrician Certificate Renewal

To renew your electrical certificate. Fee varies depending on renewal type.



Form
F500-045-000


 
Administrator / Electrician / Master Electrician Certificate Renewal

To renew your electrical certificate. Fee varies depending on renewal type.



Form
F500-045-000


 
Administrator / Electrician / Master Electrician Certificate Renewal

To renew your electrical certificate. Fee varies depending on renewal type.



Form
F500-045-000


 
Adolescentes en el trabajo: información para empleadores, padres y adolescentes

Folleto: Responde a preguntas que los empleadores, padres y adolescentes podrían tener cuando contratan trabajadores adolescentes (edades 14-17). Explica las reglas de trabajo no agrícolas, incluyendo los permisos necesarios, horas y condiciones de trabajo. Proporciona enlaces para otros recursos.



Publication
F700-022-999



Alt Language(s):
Inglés
 
Adolescentes en el trabajo: información para empleadores, padres y adolescentes

Folleto: Responde a preguntas que los empleadores, padres y adolescentes podrían tener cuando contratan trabajadores adolescentes (edades 14-17). Explica las reglas de trabajo no agrícolas, incluyendo los permisos necesarios, horas y condiciones de trabajo. Proporciona enlaces para otros recursos.



Publication
F700-022-999



Alt Language(s):
Inglés
 
Adolescentes en el trabajo: información para empleadores, padres y adolescentes

Folleto: Responde a preguntas que los empleadores, padres y adolescentes podrían tener cuando contratan trabajadores adolescentes (edades 14-17). Explica las reglas de trabajo no agrícolas, incluyendo los permisos necesarios, horas y condiciones de trabajo. Proporciona enlaces para otros recursos.



Publication
F700-022-999



Alt Language(s):
Inglés
 
Affidavit for Time Loss Compensation Benefits

Completed by injured workers contending eligibility for payment of back time loss benefits for a period that exceeds six months or $25,000. Injured workers requesting benefits for current time missed from work due to a work-related injury should use the F242-052-000 Worker Verification Form.



Form
F242-395-000



Alt Language(s):
Español
 
Affidavit for Time Loss Compensation Benefits

Completed by injured workers contending eligibility for payment of back time loss benefits for a period that exceeds six months or $25,000. Injured workers requesting benefits for current time missed from work due to a work-related injury should use the F242-052-000 Worker Verification Form.



Form
F242-395-000



Alt Language(s):
Español
 
Affidavit for Time Loss Compensation Benefits

Completed by injured workers contending eligibility for payment of back time loss benefits for a period that exceeds six months or $25,000. Injured workers requesting benefits for current time missed from work due to a work-related injury should use the F242-052-000 Worker Verification Form.



Form
F242-395-000



Alt Language(s):
Español
 
Affidavit of Continuity Medical Gas Installation

Affidavit of Continuity



Form
F627-043-000


 
Affidavit of Continuity Medical Gas Installation

Affidavit of Continuity



Form
F627-043-000


 
Affidavit of Continuity Medical Gas Installation

Affidavit of Continuity



Form
F627-043-000


 
Affidavit of Experience - Plumbers

This form is required to report plumber trainee's plumbing experience for credit towards journey level or specialty status.



Form
F627-004-000


 
Affidavit of Experience

This affidavit is used to record the hours of a trainee's electrical experience with direct supervision under a Washington certified journeyman, master or specialty electrician.



Form
F500-043-000


 
Affidavit of Experience

This affidavit is used to record the hours of a trainee's electrical experience with direct supervision under a Washington certified journeyman, master or specialty electrician.



Form
F500-043-000


 
Affidavit of Experience

This affidavit is used to record the hours of a trainee's electrical experience with direct supervision under a Washington certified journeyman, master or specialty electrician.



Form
F500-043-000


 
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


 
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


 
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


 
Affidavit of Wages Paid Addendum A Additional List of Crafts

Please use this addendum to list additional Crafts/Trades/Occupations when filing an Affidavit of Wages of Paid and you need to list more Crafts/Trades/Occupations than the Affidavit of Wages Paid form can accommodate. This is the addendum A to form F700-007-000.



Form
F700-161-000


 
Affidavit of Wages Paid Addendum A Additional List of Crafts

Please use this addendum to list additional Crafts/Trades/Occupations when filing an Affidavit of Wages of Paid and you need to list more Crafts/Trades/Occupations than the Affidavit of Wages Paid form can accommodate. This is the addendum A to form F700-007-000.



Form
F700-161-000


 
Affidavit of Wages Paid Addendum A Additional List of Crafts

Please use this addendum to list additional Crafts/Trades/Occupations when filing an Affidavit of Wages of Paid and you need to list more Crafts/Trades/Occupations than the Affidavit of Wages Paid form can accommodate. This is the addendum A to form F700-007-000.



Form
F700-161-000


 
Affidavit of Wages Paid Addendum B List of Next Tier Subcontractors - Public Works Contract

Copies of the 05-2008 version will be available in the warehouse later in July.



Form
F700-143-000


 
Affidavit of Wages Paid Addendum C Additional Information

Please use this addendum to provide any additional information you want to communicate to L&I when you file an Affidavit of Wages of Paid. Addendum C is for form F700-007-000.



Form
F700-162-000


 
Affidavit of Wages Paid Addendum C Additional Information

Please use this addendum to provide any additional information you want to communicate to L&I when you file an Affidavit of Wages of Paid. Addendum C is for form F700-007-000.



Form
F700-162-000


 
Affidavit of Wages Paid Addendum C Additional Information

Please use this addendum to provide any additional information you want to communicate to L&I when you file an Affidavit of Wages of Paid. Addendum C is for form F700-007-000.



Form
F700-162-000


 
Affidavit of Wages Paid Addendum D

Please use this addendum to provide the details of the Apprentices associated with your Affidavit of Wages of Paid. Addendum D is for form F700-007-000.



Form
F700-165-000


 
Affidavit of Wages Paid Addendum D

Please use this addendum to provide the details of the Apprentices associated with your Affidavit of Wages of Paid. Addendum D is for form F700-007-000.



Form
F700-165-000


 
Affidavit to Release Public Records

This form is to request L&I to release public records in the contractors registration section.



Form
F625-066-000


 
Affidavit to Release Public Records

This form is to request L&I to release public records in the contractors registration section.



Form
F625-066-000


 
Affidavit to Release Public Records

This form is to request L&I to release public records in the contractors registration section.



Form
F625-066-000


 
Agreement - Farm Labor Contractors and Workers

Employment wages and conditions agreement with Farm Labor Contractors and Workers



Form
F700-046-000



Alt Language(s):
Español
 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Form
F207-040-001


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Form
F207-040-000


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Form
F207-040-000


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Form
F207-040-000


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Form
F207-040-000


 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Form
F207-040-000


 
Agricultural Employer Worksheet

Used by agricultural employers to assist them in determining if they are following the state Agricultural Employment Standards and the Minimum Wage Act for their employees.



Form
F700-125-000


 
Agricultural Employer Worksheet

Used by agricultural employers to assist them in determining if they are following the state Agricultural Employment Standards and the Minimum Wage Act for their employees.



Form
F700-125-000


 
Air Conditioner/Heat Pump Pre-Inspection Checklist

This checklist is designed to be generic in content and may not include all requirements for your particular installation.



Form
F622-014-000


 
Air Conditioner/Heat Pump Pre-Inspection Checklist

This checklist is designed to be generic in content and may not include all requirements for your particular installation.



Form
F622-014-000


 
Air Conditioner/Heat Pump Pre-Inspection Checklist

This checklist is designed to be generic in content and may not include all requirements for your particular installation.



Form
F622-014-000


 
Alleged Safety Or Health Hazards (DOSH Complaint Form)

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



Form
F418-052-000



Alt Language(s):
Español
 
Alleged Safety Or Health Hazards (DOSH Complaint Form)

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



Form
F418-052-000



Alt Language(s):
Español
 
Alleged Safety Or Health Hazards (DOSH Complaint Form)

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



Form
F418-052-000



Alt Language(s):
Español
 
Alleged Safety Or Health Hazards (DOSH Complaint Form)

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



Form
F418-052-000



Alt Language(s):
Español
 
Alteration Fire Safety Pre-Inspection Checklist

Checklist for homeowners on how to upgrade their pre-HUD homes to approach the HUD standards in the area of fire safety.



Form
F622-011-000



Alt Language(s):
Español
 
Alteration Fire Safety Pre-Inspection Checklist

Checklist for homeowners on how to upgrade their pre-HUD homes to approach the HUD standards in the area of fire safety.



Form
F622-011-000



Alt Language(s):
Español
 
Alteration Polybutylene Re-Pipe Pre-Inspection Checklist

This checklist is used by the contractor when altering a polybutylene re-pipe. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-053-000


 
Alteration Polybutylene Re-Pipe Pre-Inspection Checklist

This checklist is used by the contractor when altering a polybutylene re-pipe. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-053-000


 
Alteration Polybutylene Re-Pipe Pre-Inspection Checklist

This checklist is used by the contractor when altering a polybutylene re-pipe. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-053-000


 
Alteration Polybutylene Re-Pipe Pre-Inspection Checklist

This checklist is used by the contractor when altering a polybutylene re-pipe. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-053-000


 
Alteration Re-Roofing for Low Slope Roofing

Checklist used by the contractor when altering a low slope roof.



Form
F622-039-000


 
Alteration Re-Roofing for Low Slope Roofing

Checklist used by the contractor when altering a low slope roof.



Form
F622-039-000


 
Alteration Re-Roofing for Low Slope Roofing

Checklist used by the contractor when altering a low slope roof.



Form
F622-039-000


 
Always Wear Eye Protection

Sticker: 7.25 inches X 4.25 inches.



Sticker
FSP0-941-000


 
Amendment of Irrevocable Standby Letter of Credit

Used by a self-insured employer to change items on the surety document such as amount of letter of credit issued as collateral.



Form
F207-112-111


 
Amendment of Irrevocable Standby Letter of Credit

Used by a self-insured employer to change items on the surety document such as amount of letter of credit issued as collateral.



Form
F207-112-111


 
Amendment of Irrevocable Standby Letter of Credit

Used by a self-insured employer to change items on the surety document such as amount of letter of credit issued as collateral.



Form
F207-112-111


 
Amendment of Irrevocable Standby Letter of Credit

Used by a self-insured employer to change items on the surety document such as amount of letter of credit issued as collateral.



Form
F207-112-111


 
Amendment of Irrevocable Standby Letter of Credit

Used by a self-insured employer to change items on the surety document such as amount of letter of credit issued as collateral.



Form
F207-112-111


 
Amendment of Irrevocable Standby Letter of Credit

Used by a self-insured employer to change items on the surety document such as amount of letter of credit issued as collateral.



Form
F207-112-111


 
An Annual Electrical Permits Saves Time and Money. Would it Work for You?

Flier: Describes when facility operators/owners qualify for an annual electrical permit.



Publication
F500-123-000


 
An Annual Electrical Permits Saves Time and Money. Would it Work for You?

Flier: Describes when facility operators/owners qualify for an annual electrical permit.



Publication
F500-123-000


 
An Employer's Intro to L&I

Info card: Provides information on the Employer's Intro to L&I workshop, including statewide schedule of workshops. Designed for employers and managers, the workshop covers a number of topics, including workers' compensation insurance, workplace safety, and overtime.



Publication
F101-101-000


 
An Employer's Intro to L&I

Info card: Provides information on the Employer's Intro to L&I workshop, including statewide schedule of workshops. Designed for employers and managers, the workshop covers a number of topics, including workers' compensation insurance, workplace safety, and overtime.



Publication
F101-101-000


 
An Employer's Intro to L&I

Info card: Provides information on the Employer's Intro to L&I workshop, including statewide schedule of workshops. Designed for employers and managers, the workshop covers a number of topics, including workers' compensation insurance, workplace safety, and overtime.



Publication
F101-101-000


 
Annual Supplemental Surety Information

Used by self-insured employers to assist in fulfilling surety requirements.



Form
F207-125-000


 
Annual Supplemental Surety Information

Used by self-insured employers to assist in fulfilling surety requirements.



Form
F207-125-000


 
Annual Supplemental Surety Information

Used by self-insured employers to assist in fulfilling surety requirements.



Form
F207-125-000


 
Annual Supplemental Surety Information

Used by self-insured employers to assist in fulfilling surety requirements.



Form
F207-125-000


 
Annual Supplemental Surety Information

Used by self-insured employers to assist in fulfilling surety requirements.



Form
F207-125-000


 
Annual Supplemental Surety Information

Used by self-insured employers to assist in fulfilling surety requirements.



Form
F207-125-000


 
Application / Renewal for an Electrical Training Certificate

This the application for an Electrical Training Certificate or the renewal of. (This does NOT make you a registered apprentice).



Form
F626-048-000


 
Application / Renewal for an Electrical Training Certificate

This the application for an Electrical Training Certificate or the renewal of. (This does NOT make you a registered apprentice).



Form
F626-048-000


 
Application / Renewal for an Electrical Training Certificate

This the application for an Electrical Training Certificate or the renewal of. (This does NOT make you a registered apprentice).



Form
F626-048-000


 
Application / Renewal for an Electrical Training Certificate

This the application for an Electrical Training Certificate or the renewal of. (This does NOT make you a registered apprentice).



Form
F626-048-000


 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Form
F500-097-000


 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Form
F500-097-000


 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Form
F500-097-000


 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Form
F500-097-000


 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Form
F500-097-000


 
Application for Accreditation of Engineer to Approve Industrial Utilization Equipment

Used by an Engineer to apply for accreditation by L&I to approve unlisted equipment.



Form
F500-101-000


 
Application for Amusement Ride Inspector Certification

Application to be certified as an amusement ride inspector.



Form
F500-065-000


 
Application for Amusement Ride Inspector Certification

Application to be certified as an amusement ride inspector.



Form
F500-065-000


 
Application for Amusement Ride or Air Supported Structure Operating Permit

To apply for a decal for an amusement ride or air supported structure.



Form
F500-010-000


 
Application for Apprenticeship

EXAMPLE ONLY: Example of an application to apply for an apprenticeship. Registered Apprenticeship Programs use their own forms. NOT TO BE USED TO REQUEST PLUMBER or ELECTRICAL TRAINEE CARD.



Form
F100-033-000


 
Application for Backflow Specialty Exam

This form is used to apply for the backflow specialty examination.



Form
F627-035-000


 
Application for Backflow Specialty Exam

This form is used to apply for the backflow specialty examination.



Form
F627-035-000


 
Application for Backflow Specialty Exam

This form is used to apply for the backflow specialty examination.



Form
F627-035-000


 
Application for Backflow Specialty Exam

This form is used to apply for the backflow specialty examination.



Form
F627-035-000


 
Application for Backflow Specialty Exam

This form is used to apply for the backflow specialty examination.



Form
F627-035-000


 
Application for Backflow Trainee Certificate

This form is used to apply for a backflow trainee certificate.



Form
F627-033-000


 
Application for Backflow Trainee Certificate

This form is used to apply for a backflow trainee certificate.



Form
F627-033-000


 
Application for Backflow Trainee Certificate

This form is used to apply for a backflow trainee certificate.



Form
F627-033-000


 
Application for Backflow Trainee Certificate

This form is used to apply for a backflow trainee certificate.



Form
F627-033-000


 
Application for Backflow Trainee Certificate

This form is used to apply for a backflow trainee certificate.



Form
F627-033-000


 
Application for Benefits - Crime Victims

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



Alt Language(s):
Español
 
Application for Certificate of Competency as an Inspector of Pressure Retaining Items

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.



Form
F620-040-000


 
Application for Certificate of Competency as an Inspector of Pressure Retaining Items

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.



Form
F620-040-000


 
Application for Certificate of Competency as an Inspector of Pressure Retaining Items

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.



Form
F620-040-000


 
Application for Certificate of Competency as an Inspector of Pressure Retaining Items

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.



Form
F620-040-000


 
Application for Charter Boat Operators License

Use this form to apply for an operators license of a charter vessel.



Form
F416-034-000


 
Application for Charter Boat Operators License

Use this form to apply for an operators license of a charter vessel.



Form
F416-034-000


 
Application for Construction Contractor Registration

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



Form
F625-001-000


 
Application for Copies of Citation and Notice

Used by an employee to apply for copies of citation and notices issued to their employer.



Form
F418-023-000


 
Application for Elective Coverage - Sole Proprietor, Partners, For-Profit Corporate Officers, or Member/Managers of Limited Liability Company (LLC)

Used by employers to apply for workers' compensation coverage for non-mandatory employment. Shows a list of categories of employment that are not considered mandatory to have workers' compensation.



Form
F213-042-000


 
Application for Elective Coverage - Sole Proprietor, Partners, For-Profit Corporate Officers, or Member/Managers of Limited Liability Company (LLC)

Used by employers to apply for workers' compensation coverage for non-mandatory employment. Shows a list of categories of employment that are not considered mandatory to have workers' compensation.



Form
F213-042-000


 
Application for Elective Coverage - Sole Proprietor, Partners, For-Profit Corporate Officers, or Member/Managers of Limited Liability Company (LLC)

Used by employers to apply for workers' compensation coverage for non-mandatory employment. Shows a list of categories of employment that are not considered mandatory to have workers' compensation.



Form
F213-042-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Elective Coverage of Excluded Employments

Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation.



Form
F213-112-000


 
Application for Electrical Contractors License

Application used to get an electrical contractors license



Form
F500-018-000


 
Application for Electrical Contractors License

Application used to get an electrical contractors license



Form
F500-018-000


 
Application for Electrical Contractors License

Application used to get an electrical contractors license



Form
F500-018-000


 
Application for Electrician Examination

Application and instructions for a Washington State electrician's certificate examination.



Form
F626-001-000


 
Application for Electrician Examination

Application and instructions for a Washington State electrician's certificate examination.



Form
F626-001-000


 
Application for Electrician Examination

Application and instructions for a Washington State electrician's certificate examination.



Form
F626-001-000


 
Application for Electrician Examination

Application and instructions for a Washington State electrician's certificate examination.



Form
F626-001-000


 
Application for Electrician Examination

Application and instructions for a Washington State electrician's certificate examination.



Form
F626-001-000


 
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)

To exclude or include coverage for a family farm's children.



Form
F213-113-000


 
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)

To exclude or include coverage for a family farm's children.



Form
F213-113-000


 
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)

To exclude or include coverage for a family farm's children.



Form
F213-113-000


 
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)

To exclude or include coverage for a family farm's children.



Form
F213-113-000


 
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)

To exclude or include coverage for a family farm's children.



Form
F213-113-000


 
Application for Farm Internship

Application form: Small farm owners wishing to participate in the pilot small farm internship program must complete this form and submit it to the department. The information requested on the form is required to process an application for approval in order to issue a certificate of participation.



Form
F700-158-000


 
Application for Farm Internship

Application form: Small farm owners wishing to participate in the pilot small farm internship program must complete this form and submit it to the department. The information requested on the form is required to process an application for approval in order to issue a certificate of participation.



Form
F700-158-000


 
Application for Farm Internship

Application form: Small farm owners wishing to participate in the pilot small farm internship program must complete this form and submit it to the department. The information requested on the form is required to process an application for approval in order to issue a certificate of participation.



Form
F700-158-000


 
Application for Farm Labor Contractor License

Used to apply or renew a license.



Form
F700-014-000


 
Application for Farm Labor Contractor License

Used to apply or renew a license.



Form
F700-014-000


 
Application for Farm Labor Contractor License

Used to apply or renew a license.



Form
F700-014-000


 
Application for Farm Labor Contractor License

Used to apply or renew a license.



Form
F700-014-000


 
Application for Group Retrospective Rating

Used by organizations to set up an agreement with L&I authorizing their participation in retrospective rating.



Form
F250-004-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for Insignia Conversion Vendor/Medical Units

Used to apply for an official insignia for conversion vendor or medical unit factory-assembled structures. See sample form for instructions about how to fill out the form correctly.



Form
F623-021-000


 
Application for Insignia Conversion Vendor/Medical Units

Used to apply for an official insignia for conversion vendor or medical unit factory-assembled structures. See sample form for instructions about how to fill out the form correctly.



Form
F623-021-000


 
Application for Insignia Conversion Vendor/Medical Units

Used to apply for an official insignia for conversion vendor or medical unit factory-assembled structures. See sample form for instructions about how to fill out the form correctly.



Form
F623-021-000


 
Application for Insignia for Commercial Coaches

Manufacturer uses this form to apply for an official insignia for commercial coaches that have a plan approval number.



Form
F623-019-000


 
Application for Insignia for Commercial Coaches

Manufacturer uses this form to apply for an official insignia for commercial coaches that have a plan approval number.



Form
F623-019-000


 
Application for Insignia for Commercial Coaches

Manufacturer uses this form to apply for an official insignia for commercial coaches that have a plan approval number.



Form
F623-019-000


 
Application for Insignia for Factory Assembled Structures

Manufacturers uses this form to apply for an official insignia for a factory-built structure that has a plan approval number.



Form
F623-014-000


 
Application for Insignia for Factory Assembled Structures

Manufacturers uses this form to apply for an official insignia for a factory-built structure that has a plan approval number.



Form
F623-014-000


 
Application for Insignia for Factory Assembled Structures

Manufacturers uses this form to apply for an official insignia for a factory-built structure that has a plan approval number.



Form
F623-014-000


 
Application for Licensure as an Elevator Mechanic

This is an application for certification as an Elevator Mechanic and is NOT a license to perform work. A contractor's license is still required by L&I.



Form
F621-067-000


 
Application for Licensure as an Elevator Mechanic

This is an application for certification as an Elevator Mechanic and is NOT a license to perform work. A contractor's license is still required by L&I.



Form
F621-067-000


 
Application for Licensure as an Elevator Mechanic

This is an application for certification as an Elevator Mechanic and is NOT a license to perform work. A contractor's license is still required by L&I.



Form
F621-067-000


 
Application for Licensure as an Elevator Mechanic

This is an application for certification as an Elevator Mechanic and is NOT a license to perform work. A contractor's license is still required by L&I.



Form
F621-067-000


 
Application for Master Electrician Certification Examination

Use this form to apply for the master electrician exam.



Form
F500-088-000


 
Application for Master Electrician Certification Examination

Use this form to apply for the master electrician exam.



Form
F500-088-000


 
Application for Master Electrician Certification Examination

Use this form to apply for the master electrician exam.



Form
F500-088-000


 
Application for out of State Supplemental Reporting

The purpose of form 212-234-000 -Out of state applications- is to provide a means for an employer to formally request to receive the out-of-state supplemental report for a specific year and state. The form will also allow the department to convey out-of-state reporting requirements and to obtain information needed by the department to set a business up for supplemental reporting.



Form
F212-234-000


 
Application for out of State Supplemental Reporting

The purpose of form 212-234-000 -Out of state applications- is to provide a means for an employer to formally request to receive the out-of-state supplemental report for a specific year and state. The form will also allow the department to convey out-of-state reporting requirements and to obtain information needed by the department to set a business up for supplemental reporting.



Form
F212-234-000


 
Application for out of State Supplemental Reporting

The purpose of form 212-234-000 -Out of state applications- is to provide a means for an employer to formally request to receive the out-of-state supplemental report for a specific year and state. The form will also allow the department to convey out-of-state reporting requirements and to obtain information needed by the department to set a business up for supplemental reporting.



Form
F212-234-000


 
Application for Pension Benefits by Spouse or Children

Used by a spouse or dependent that was chosen by the deceased worker to receive a survivor benefit. At the time the worker was determined to be totally permanently disabled he/she made a decision to leave a survivor benefit to a spouse or dependent if the worker dies.



Form
F242-391-000



Alt Language(s):
Español
 
Application for Pension Benefits by Spouse or Children

Used by a spouse or dependent that was chosen by the deceased worker to receive a survivor benefit. At the time the worker was determined to be totally permanently disabled he/she made a decision to leave a survivor benefit to a spouse or dependent if the worker dies.



Form
F242-391-000



Alt Language(s):
Español
 
Application for Pension Benefits by Spouse or Children

Used by a spouse or dependent that was chosen by the deceased worker to receive a survivor benefit. At the time the worker was determined to be totally permanently disabled he/she made a decision to leave a survivor benefit to a spouse or dependent if the worker dies.



Form
F242-391-000



Alt Language(s):
Español
 
Application for Pension Benefits by Spouse or Children

Used by a spouse or dependent that was chosen by the deceased worker to receive a survivor benefit. At the time the worker was determined to be totally permanently disabled he/she made a decision to leave a survivor benefit to a spouse or dependent if the worker dies.



Form
F242-391-000



Alt Language(s):
Español
 
Application for Permit to Operate Radio System in Designated Area

This form is used by the logging industry to apply for a permit to operate a radio signal system. What you type in the top form appears in the bottom one, so you have a copy.



Form
F416-087-000


 
Application for Permit to Operate Radio System in Designated Area

This form is used by the logging industry to apply for a permit to operate a radio signal system. What you type in the top form appears in the bottom one, so you have a copy.



Form
F416-087-000


 
Application for Plumber Examination, Reciprocal, Medical Gas Endorsement, or Temporary Permit

This form is used to apply for plumber examination, reciprocal and medical gas endorsement.



Form
F627-008-000


 
Application for Plumber Examination, Reciprocal, Medical Gas Endorsement, or Temporary Permit

This form is used to apply for plumber examination, reciprocal and medical gas endorsement.



Form
F627-008-000


 
Application for Plumber Examination, Reciprocal, Medical Gas Endorsement, or Temporary Permit

This form is used to apply for plumber examination, reciprocal and medical gas endorsement.



Form
F627-008-000


 
Application for Plumber Trainee Certificate

This form is used to apply for a plumber trainee certificate.



Form
F627-003-000


 
Application for Plumber Trainee Certificate

This form is used to apply for a plumber trainee certificate.



Form
F627-003-000


 
Application for Plumber Trainee Certificate

This form is used to apply for a plumber trainee certificate.



Form
F627-003-000


 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Form
F500-104-000


 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Form
F500-104-000


 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Form
F500-104-000


 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Form
F500-104-000


 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Form
F500-104-000


 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Form
F500-104-000


 
Application for Replacement of Lost or Stolen Asbestos Certification Card

This application is for any certified asbestos worker or supervisor that has lost or had their card stolen.



Form
F413-068-000


 
Application for Self-Insurance Certification

Used by employers to apply for self-insurance certification.



Form
F207-001-000


 
Application for Self-Insurance Certification

Used by employers to apply for self-insurance certification.



Form
F207-001-000


 
Application for Self-Insurance Certification

Used by employers to apply for self-insurance certification.



Form
F207-001-000


 
Application for Self-Insurance Certification

Used by employers to apply for self-insurance certification.



Form
F207-001-000


 
Application for Self-Insurance Certification

Used by employers to apply for self-insurance certification.



Form
F207-001-000


 
Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing Wage Rate

Employer Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing



Form
F700-122-000


 
Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing Wage Rate

Employer Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing



Form
F700-122-000


 
Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing Wage Rate

Employer Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing



Form
F700-122-000


 
Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing Wage Rate

Employer Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing



Form
F700-122-000


 
Application for Special Certificate to Employ at A Subminimum Wage Rate

Employer Application for Special Certificate to Employ at A Subminimum Wage Rate.



Form
F700-120-000


 
Application for Specialty Electrician Certificate

Application and instructions for the specialty electrician certificate for 03A, 06B, 07A, 07B, 07C, 07D, 07E and 10. Eligibility granted through modified supervision requirements of RCW 19.28.191(1)(g)(ii)



Form
F500-098-000


 
Application for Specialty Electrician Certificate

Application and instructions for the specialty electrician certificate for 03A, 06B, 07A, 07B, 07C, 07D, 07E and 10. Eligibility granted through modified supervision requirements of RCW 19.28.191(1)(g)(ii)



Form
F500-098-000


 
Application for Specialty Electrician Certificate

Application and instructions for the specialty electrician certificate for 03A, 06B, 07A, 07B, 07C, 07D, 07E and 10. Eligibility granted through modified supervision requirements of RCW 19.28.191(1)(g)(ii)



Form
F500-098-000


 
Application for Specialty Electrician Certificate

Application and instructions for the specialty electrician certificate for 03A, 06B, 07A, 07B, 07C, 07D, 07E and 10. Eligibility granted through modified supervision requirements of RCW 19.28.191(1)(g)(ii)



Form
F500-098-000


 
Application for State Plan Insignia for Recreational Vehicles and Recreational Park Trailers

To apply for an insignia for a recreational vehicle.



Form
F622-021-000


 
Application for State Plan Insignia for Recreational Vehicles and Recreational Park Trailers

To apply for an insignia for a recreational vehicle.



Form
F622-021-000


 
Application for State Plan Insignia for Recreational Vehicles and Recreational Park Trailers

To apply for an insignia for a recreational vehicle.



Form
F622-021-000


 
Application for Telecommunications Contractor's License

Application used to get an telecommunications contractors license.



Form
F503-008-000


 
Application for Telecommunications Contractor's License

Application used to get an telecommunications contractors license.



Form
F503-008-000


 
Application for Loss of Earning Power (LEP) - Compensation Medical

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.



Form
F242-208-000



Alt Language(s):
English/Español
Español
 
Application for Loss of Earning Power (LEP) - Compensation Medical

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.



Form
F242-208-000



Alt Language(s):
English/Español
Español
 
Application for Loss of Earning Power (LEP) - Compensation Medical

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.



Form
F242-208-000



Alt Language(s):
English/Español
Español
 
Application for Loss of Earning Power Compensation Medical / Solicitud para compensación por reducción de ingresos (médicos) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-208-909



Alt Language(s):
Inglés
Español
 
Application for Loss of Earning Power Compensation Medical / Solicitud para compensación por reducción de ingresos (médicos) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-208-909



Alt Language(s):
Inglés
Español
 
Application for Loss of Earning Power Compensation Medical / Solicitud para compensación por reducción de ingresos (médicos) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-208-909



Alt Language(s):
Inglés
Español
 
Application for Loss of Earning Power Vocational / Solicitud para compensación por reducción de ingresos (Vocacionales) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-209-909



Alt Language(s):
Inglés
Español
 
Application for Loss of Earning Power Vocational / Solicitud para compensación por reducción de ingresos (Vocacionales) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-209-909



Alt Language(s):
Inglés
Español
 
Application for Loss of Earning Power Vocational / Solicitud para compensación por reducción de ingresos (Vocacionales) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-209-909



Alt Language(s):
Inglés
Español
 
Application for Loss of Earning Power Vocational / Solicitud para compensación por reducción de ingresos (Vocacionales) (English/Spanish)

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

El hecho de completar este formulario no es una garantía para recibir beneficios.  Los pagos de beneficios lo decidirá su gerente de reclamo.



Form
F242-209-909



Alt Language(s):
Inglés
Español
 
Application to Establish an Account and Access to L&I's Electrical Permit & Inspection System (EPIS) with L&I's Miscellaneous Accounts

To request access to L&I's EPIS - Miscellaneous Accounts



Form
F500-054-000


 
Application to Establish an Account and Access to L&I's Electrical Permit & Inspection System (EPIS) with L&I's Miscellaneous Accounts

To request access to L&I's EPIS - Miscellaneous Accounts



Form
F500-054-000


 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Form
F120-116-000


 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Form
F120-116-000


 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Form
F120-116-000


 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Form
F120-116-000


 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Form
F120-116-000


 
Application to Reopen Claim due to Worsening Condition / Solictud para volver a abrir un reclamo (English/español)

Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days.

Usado por los trabajadores lesionados y doctores para volver a abrir un reclamo de lesión industrial o enfermedad ocupacional que ha estado cerrado por más de 60 días.



Form
F242-079-909



Alt Language(s):
Inglés
Español
 
Application to Reopen Claim due to Worsening Condition / Solictud para volver a abrir un reclamo (English/español)

Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days.

Usado por los trabajadores lesionados y doctores para volver a abrir un reclamo de lesión industrial o enfermedad ocupacional que ha estado cerrado por más de 60 días.



Form
F242-079-909



Alt Language(s):
Inglés
Español
 
Application to Reopen Claim due to Worsening Condition / Solictud para volver a abrir un reclamo (English/español)

Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days.

Usado por los trabajadores lesionados y doctores para volver a abrir un reclamo de lesión industrial o enfermedad ocupacional que ha estado cerrado por más de 60 días.



Form
F242-079-909



Alt Language(s):
Inglés
Español
 
Application to Reopen Claim due to Worsening Condition / Solictud para volver a abrir un reclamo (English/español)

Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days.

Usado por los trabajadores lesionados y doctores para volver a abrir un reclamo de lesión industrial o enfermedad ocupacional que ha estado cerrado por más de 60 días.



Form
F242-079-909



Alt Language(s):
Inglés
Español
 
Application to Reopen Claim Due to Worsening Condition

This application is by injured workers and providers to apply to reopen an industrial injury or occupational disease claim due to worsening condition for claims that have been claims 60 days or longer.



Form
F242-079-000



Alt Language(s):
English/Español
Español
 
Application to Reopen Claim Due to Worsening Condition

This application is by injured workers and providers to apply to reopen an industrial injury or occupational disease claim due to worsening condition for claims that have been claims 60 days or longer.



Form
F242-079-000



Alt Language(s):
English/Español
Español
 
Application to Reopen Claim Due to Worsening Condition

This application is by injured workers and providers to apply to reopen an industrial injury or occupational disease claim due to worsening condition for claims that have been claims 60 days or longer.



Form
F242-079-000



Alt Language(s):
English/Español
Español
 
Application to Reopen Claim Due to Worsening Condition

This application is by injured workers and providers to apply to reopen an industrial injury or occupational disease claim due to worsening condition for claims that have been claims 60 days or longer.



Form
F242-079-000



Alt Language(s):
English/Español
Español
 
Application to Reopen Crime Victim Claim Due to Worsening of Condition

Benefits are limited to $50,000 per claim. if your claim has met or exceeded this cap, your reopening application will be denied and we will be unable to pay any further benefits. Used by victims of crime and medical or mental health providers to request a claim be reopened.



Form
F800-031-000



Alt Language(s):
Español
 
Application to Reopen Crime Victim Claim Due to Worsening of Condition

Benefits are limited to $50,000 per claim. if your claim has met or exceeded this cap, your reopening application will be denied and we will be unable to pay any further benefits. Used by victims of crime and medical or mental health providers to request a claim be reopened.



Form
F800-031-000



Alt Language(s):
Español
 
Application for Loss of Earning Power (LEP) - Vocational

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.



Form
F242-209-000



Alt Language(s):
English/Español
Español
 
Application for Loss of Earning Power (LEP) - Vocational

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.



Form
F242-209-000



Alt Language(s):
English/Español
Español
 
Application to Access L&I’s Electronic Permit & Inspection System (EPIS) From Secure Access Washington and Utilize Contractor Deposit Account Via The Internet


Form
F621-094-000


 
Application to Access L&I’s Electronic Permit & Inspection System (EPIS) From Secure Access Washington and Utilize Contractor Deposit Account Via The Internet


Form
F621-094-000


 
Apprenticeship Complaint (Not for Apprenticeship Appeals)

Used to file a complaint on a apprenticeship program, committee, training agent, etc. NOT be used by Apprentices appealing Committee Decisions.



Form
F100-505-000


 
Apprenticeship Related Supplemental Instruction (RSI) Plan Review

Used by apprenticeship programs/sponsors as part of the process of getting new programs/standards/occupations approved.



Form
F100-520-000


 
Apprenticeship Related Supplemental Instruction (RSI) Plan Review

Used by apprenticeship programs/sponsors as part of the process of getting new programs/standards/occupations approved.



Form
F100-520-000


 
Apprenticeships For Tribal Members

 

Brochure: Designed for tribal members, this brochure provides an overview of apprenticeship. Topics include the benefits of apprenticeship, career options, how to apply and contact information.

 



Publication
F100-532-000


 
Approved Training Agent

Used to allow an employer to train apprentices as part of a Registered Apprenticeship program.



Form
F100-508-000


 
Asbestos Abatement Project Notice of Intent and L&I DOSH Asbestos Program

Notice is not required for any asbestos project involving less than forty-eight (48) square feet of surface area, or less than ten (10) linear feet of pipe unless the surface area of the pipe is greater than forty-eight (48) square feet. Get instructions to complete the form.



Form
F413-025-000


 
Assessment Closing Report

Used by only private sector vocational rehabilitation providers to document vocational assessment to determine if a worker is employable based upon transferable skills.



Form
F252-029-000


 
Assessment Closing Report

Used by only private sector vocational rehabilitation providers to document vocational assessment to determine if a worker is employable based upon transferable skills.



Form
F252-029-000


 
Assessment Closing Report

Used by only private sector vocational rehabilitation providers to document vocational assessment to determine if a worker is employable based upon transferable skills.



Form
F252-029-000


 
Assessment Eligible Quality Assurance Review Form

For use internally by L&I Vocational Service Specialists (VSSs) to determine if all required components are included in the submitted assessment.  Can be used by VRCs as a tool.  DO NOT SUBMIT TO L&I.



Form
F280-008-000


 
Assessment Eligible Quality Assurance Review Form

For use internally by L&I Vocational Service Specialists (VSSs) to determine if all required components are included in the submitted assessment.  Can be used by VRCs as a tool.  DO NOT SUBMIT TO L&I.



Form
F280-008-000


 
Assessment Eligible Quality Assurance Review Form

For use internally by L&I Vocational Service Specialists (VSSs) to determine if all required components are included in the submitted assessment.  Can be used by VRCs as a tool.  DO NOT SUBMIT TO L&I.



Form
F280-008-000


 
Attending Provider's Referral Form

Attending Providers send this form to refer injured workers for medical opinion consultations, specialty/surgical consultations, concurrent care (authorization required), transfer of care consultation, or closing exam and impairment rating. Give a copy of the completed form to the injured worker.




F252-098-000


 
Attending Provider's Referral Form

Attending Providers send this form to refer injured workers for medical opinion consultations, specialty/surgical consultations, concurrent care (authorization required), transfer of care consultation, or closing exam and impairment rating. Give a copy of the completed form to the injured worker.




F252-098-000


 
Attending Provider's Referral Form

Attending Providers send this form to refer injured workers for medical opinion consultations, specialty/surgical consultations, concurrent care (authorization required), transfer of care consultation, or closing exam and impairment rating. Give a copy of the completed form to the injured worker.




F252-098-000


 
Attending Provider's Referral Form

Attending Providers send this form to refer injured workers for medical opinion consultations, specialty/surgical consultations, concurrent care (authorization required), transfer of care consultation, or closing exam and impairment rating. Give a copy of the completed form to the injured worker.




F252-098-000


 
Authorization for Deposit of Payments

Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution.



Form
F242-174-000



Alt Language(s):
English/Español
 
Authorization for Deposit of Payments

Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution.



Form
F242-174-000



Alt Language(s):
English/Español
 
Authorization for Deposit of Payments

Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution.



Form
F242-174-000



Alt Language(s):
English/Español
 
Authorization for Deposit of Payments

Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution.



Form
F242-174-000



Alt Language(s):
English/Español
 
Authorization for Deposit of Payments

Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution.



Form
F242-174-000



Alt Language(s):
English/Español
 
Authorization for Deposit of Payments

Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution.



Form
F242-174-000



Alt Language(s):
English/Español
 
Authorization to Release Claim Information

Used by the worker to designate a person(s) as an authorized representative for the worker's claim. An authorized representative can access claim information.



Form
F101-010-000



Alt Language(s):
Español
 
Authorization to Release Claim Information

Used by the worker to designate a person(s) as an authorized representative for the worker's claim. An authorized representative can access claim information.



Form
F101-010-000



Alt Language(s):
Español
 
Authorization to Release Claim Information

Used by the worker to designate a person(s) as an authorized representative for the worker's claim. An authorized representative can access claim information.



Form
F101-010-000



Alt Language(s):
Español
 
Autorización para proveer información de reclamos

Usado por el trabajador para designar a una persona(s) como representante(s) autorizado(s) del reclamo del trabajador.  Un representante autorizado puede obtener acceso a la información de reclamo.



Form
F101-010-999



Alt Language(s):
Inglés
 
Autorización para proveer información de reclamos

Usado por el trabajador para designar a una persona(s) como representante(s) autorizado(s) del reclamo del trabajador.  Un representante autorizado puede obtener acceso a la información de reclamo.



Form
F101-010-999



Alt Language(s):
Inglés
 
Autorización para proveer información de reclamos

Usado por el trabajador para designar a una persona(s) como representante(s) autorizado(s) del reclamo del trabajador.  Un representante autorizado puede obtener acceso a la información de reclamo.



Form
F101-010-999



Alt Language(s):
Inglés
 
Autorización para proveer información de reclamos

Usado por el trabajador para designar a una persona(s) como representante(s) autorizado(s) del reclamo del trabajador.  Un representante autorizado puede obtener acceso a la información de reclamo.



Form
F101-010-999



Alt Language(s):
Inglés
 
Autorization del trabajador para obtener registros de trabajos despachados por el sindicato

Autorización del trabajador para obtener registros de trabajos despachados por el sindicato.



Form
F242-410-999



Alt Language(s):
Inglés
 
Avoid Liability for Your Farm Labor Contractor's Unpaid Debits / Evite su obligación por las deudas no pagadas de su contratista de trabajadores agrícolas (English/español)

Fact sheet: Explains how employers could be liable for unpaid workers' compensation premiums, unpaid wages, damages and civil penalties when hiring a farm labor contractor. Outlines ways to protect against potential liability.

Hoja de información:  Explica cómo los empleadores pueden ser responsables por las primas de compensación para los trabajadores, salarios no pagados, daños y multas civiles al contratar un contratista agrícola.  Indica maneras para protegerse contra una posible responsabilidad.

 



Publication
F700-154-909


 
Avoid Liability for Your Farm Labor Contractor's Unpaid Debits / Evite su obligación por las deudas no pagadas de su contratista de trabajadores agrícolas (English/español)

Fact sheet: Explains how employers could be liable for unpaid workers' compensation premiums, unpaid wages, damages and civil penalties when hiring a farm labor contractor. Outlines ways to protect against potential liability.

Hoja de información:  Explica cómo los empleadores pueden ser responsables por las primas de compensación para los trabajadores, salarios no pagados, daños y multas civiles al contratar un contratista agrícola.  Indica maneras para protegerse contra una posible responsabilidad.

 



Publication
F700-154-909


 
Ayuda para trabajadores lesionados de empresas autoaseguradas

Tarjeta de información:  Es una introducción a la Oficina del Defensor (Ombudsman en inglés) para trabajadores lesionados autoasegurados.  El defensor es nombrado por el Governador para servir como un defensor independiente de los derechos de los trabajadores lesionados de empleadores autoasegurados.



Publication
F207-201-999



Alt Language(s):
Inglés
 
Ayuda para trabajadores lesionados de empresas autoaseguradas

Tarjeta de información:  Es una introducción a la Oficina del Defensor (Ombudsman en inglés) para trabajadores lesionados autoasegurados.  El defensor es nombrado por el Governador para servir como un defensor independiente de los derechos de los trabajadores lesionados de empleadores autoasegurados.



Publication
F207-201-999



Alt Language(s):
Inglés
 
Ayuda para trabajadores lesionados de empresas autoaseguradas

Tarjeta de información:  Es una introducción a la Oficina del Defensor (Ombudsman en inglés) para trabajadores lesionados autoasegurados.  El defensor es nombrado por el Governador para servir como un defensor independiente de los derechos de los trabajadores lesionados de empleadores autoasegurados.



Publication
F207-201-999



Alt Language(s):
Inglés
 
Ayuda para trabajadores lesionados de empresas autoaseguradas

Tarjeta de información:  Es una introducción a la Oficina del Defensor (Ombudsman en inglés) para trabajadores lesionados autoasegurados.  El defensor es nombrado por el Governador para servir como un defensor independiente de los derechos de los trabajadores lesionados de empleadores autoasegurados.



Publication
F207-201-999



Alt Language(s):
Inglés
 
Ayuda para trabajadores lesionados de empresas autoaseguradas

Tarjeta de información:  Es una introducción a la Oficina del Defensor (Ombudsman en inglés) para trabajadores lesionados autoasegurados.  El defensor es nombrado por el Governador para servir como un defensor independiente de los derechos de los trabajadores lesionados de empleadores autoasegurados.



Publication
F207-201-999



Alt Language(s):
Inglés
 
Ayuda para víctimas de crimen (cartel grande)

Cartel:  Documento con las medidas 11 X 17 pulgadas. Resalta el Programa de Compensación para Víctimas de Crimen y proporciona información para comunicarse con el programa. La intención es ponerlo a la vista en clínicas, organizaciones judiciales y de servicios sociales. Puede descargarse e imprimirse o solicitarse de L&I.  Hay una versión disponible más pequeña (8.5 X 11 pulgadas).



Poster
F800-041-999



Alt Language(s):
Inglés
 
Ayuda para víctimas de crimen

Cartel:  Documento con las medidas 8.5 X 11 pulgadas.  Resalta el programa de compensación para víctimas de crimen y proporciona información para comunicarse con el programa. La intención es ponerlo a la vista en clínicas, organizaciones judiciales y de servicios sociales.  Puede descargarse e imprirse o solicitarse de L&I. Hay una versión disponible más grande (11 X 17 pulgadas).



Poster
F800-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Billing Guidelines for Sexual Assault Examinations: Crime Victims Compensation Program

Provides information health-care providers need to bill the Crime Victims Compensation Program for medical services.



Manual
F800-100-000


 
Board of Boiler Rules Interpretation and Revision Request Form

Used to submit written requests for interpretations and revisions to the definitions, rules and regulations found in WAC 296-104. These must be submitted 45 days prior to the Board of Boiler Rules Meeting date. F620-056-000 Chief Inspector Clarification and Interpretation Request Form must be submitted before using this form.



Form
F620-017-000


 
Board of Boiler Rules Interpretation and Revision Request Form

Used to submit written requests for interpretations and revisions to the definitions, rules and regulations found in WAC 296-104. These must be submitted 45 days prior to the Board of Boiler Rules Meeting date. F620-056-000 Chief Inspector Clarification and Interpretation Request Form must be submitted before using this form.



Form
F620-017-000


 
Board of Boiler Rules Interpretation and Revision Request Form

Used to submit written requests for interpretations and revisions to the definitions, rules and regulations found in WAC 296-104. These must be submitted 45 days prior to the Board of Boiler Rules Meeting date. F620-056-000 Chief Inspector Clarification and Interpretation Request Form must be submitted before using this form.



Form
F620-017-000


 
Board of Boiler Rules Interpretation and Revision Request Form

Used to submit written requests for interpretations and revisions to the definitions, rules and regulations found in WAC 296-104. These must be submitted 45 days prior to the Board of Boiler Rules Meeting date. F620-056-000 Chief Inspector Clarification and Interpretation Request Form must be submitted before using this form.



Form
F620-017-000


 
Business and Industry Category Guide

Manual: Provides assistance to retro groups in determining if a prospective employer qualifies for their retrospective rating group program.



Manual
F250-025-000


 
Business and Industry Category Guide

Manual: Provides assistance to retro groups in determining if a prospective employer qualifies for their retrospective rating group program.



Manual
F250-025-000


 
Business and Industry Category Guide

Manual: Provides assistance to retro groups in determining if a prospective employer qualifies for their retrospective rating group program.



Manual
F250-025-000


 
Business and Industry Category Guide

Manual: Provides assistance to retro groups in determining if a prospective employer qualifies for their retrospective rating group program.



Manual
F250-025-000


 
Cómo calcular su salario en agricultura

Hoja de información: Muestra a los trabajadores por contrato cómo calcular sus salarios y verificar si le están pagando salario mínimo.



Publication
F700-171-999



Alt Language(s):
Inglés
 
Cómo calcular su salario en agricultura

Hoja de información: Muestra a los trabajadores por contrato cómo calcular sus salarios y verificar si le están pagando salario mínimo.



Publication
F700-171-999



Alt Language(s):
Inglés
 
Cómo calcular su salario en agricultura

Hoja de información: Muestra a los trabajadores por contrato cómo calcular sus salarios y verificar si le están pagando salario mínimo.



Publication
F700-171-999



Alt Language(s):
Inglés
 
Cómo calcular su salario en agricultura

Hoja de información: Muestra a los trabajadores por contrato cómo calcular sus salarios y verificar si le están pagando salario mínimo.



Publication
F700-171-999



Alt Language(s):
Inglés
 
Cómo calcular su salario en agricultura

Hoja de información: Muestra a los trabajadores por contrato cómo calcular sus salarios y verificar si le están pagando salario mínimo.



Publication
F700-171-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas

Usado solamente por los empleadores autoasegurados para cumplir con el Código Administrativo de Washington (WAC, por su sigla en inglés) 296-15-400.  El formulario proporciona información e instrucciones para los empleados de empleadores autoasegurados en caso de una lesión o desarrollo de una enfermedad ocupacional.



Form
F207-155-999



Alt Language(s):
Inglés
 
Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers

Used by an employer to cancel workers' compensation coverage for Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers.



Form
F213-004-000


 
Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers

Used by an employer to cancel workers' compensation coverage for Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers.



Form
F213-004-000


 
Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers

Used by an employer to cancel workers' compensation coverage for Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers.



Form
F213-004-000


 
Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers

Used by an employer to cancel workers' compensation coverage for Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers.



Form
F213-004-000


 
Cancellation of Elective Coverage for Excluded Employments

Used by employers to get the categories of employment that are not considered mandatory to have workers' compensation. If they had elected to have coverage this form is used to cancel previously elected coverage of workers' compensation.



Form
F213-005-000


 
Cancellation of Elective Coverage for Excluded Employments

Used by employers to get the categories of employment that are not considered mandatory to have workers' compensation. If they had elected to have coverage this form is used to cancel previously elected coverage of workers' compensation.



Form
F213-005-000


 
Cancellation of Elective Coverage for Excluded Employments

Used by employers to get the categories of employment that are not considered mandatory to have workers' compensation. If they had elected to have coverage this form is used to cancel previously elected coverage of workers' compensation.



Form
F213-005-000


 
Carta de intención de registro en una escuela

Utilizado por un estudiante de tiempo completo que tiene derecho a recibir beneficios de pensión.  El estudiante debe tener por lo menos 18 años de edad y no ser mayor de 23 años de edad.  Este formulario es para demostrar la intención del estudiante de registrarse en una escuela acreditada durante el próximo trimestre/semestre.



Form
F242-382-999



Alt Language(s):
Inglés
 
Carta de intención de registro en una escuela

Utilizado por un estudiante de tiempo completo que tiene derecho a recibir beneficios de pensión.  El estudiante debe tener por lo menos 18 años de edad y no ser mayor de 23 años de edad.  Este formulario es para demostrar la intención del estudiante de registrarse en una escuela acreditada durante el próximo trimestre/semestre.



Form
F242-382-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Caution: Hard Hat Area / Precaución: obligatorio usar un casco (English/español)

Picture of hard hats. Get poster printing tips.

Fotografía de cascos.  Obtenga información sobre cómo imprimir carteles.



Poster
FSP0-928-999



Alt Language(s):
Inglés
 
Certificado de cobertura - ejemplo

Ejemplo que muestra una copia del certificado de cobertura.  Usted debe solicitar el formulario, no puede descargarlo de la Internet.



Form
F211-141-999



Alt Language(s):
Inglés
 
Certificado de cobertura - ejemplo

Ejemplo que muestra una copia del certificado de cobertura.  Usted debe solicitar el formulario, no puede descargarlo de la Internet.



Form
F211-141-999



Alt Language(s):
Inglés
 
Certificado de cobertura - ejemplo

Ejemplo que muestra una copia del certificado de cobertura.  Usted debe solicitar el formulario, no puede descargarlo de la Internet.



Form
F211-141-999



Alt Language(s):
Inglés
 
Certificate of Coverage - SAMPLE ONLY

Sample of what the Certificate of Coverage looks like. You must order the form, you cannot download it off the internet.



Form
F211-141-000



Alt Language(s):
Español
 
Certificate of Coverage - SAMPLE ONLY

Sample of what the Certificate of Coverage looks like. You must order the form, you cannot download it off the internet.



Form
F211-141-000



Alt Language(s):
Español
 
Certificate of Coverage - SAMPLE ONLY

Sample of what the Certificate of Coverage looks like. You must order the form, you cannot download it off the internet.



Form
F211-141-000



Alt Language(s):
Español
 
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


 
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


 
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


 
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


 
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


 
Challenges and Change: Managing and Innovating through The Great Recession — L&I from 2005-2012

Booklet: Discusses the impact of the Great Recession on L&I’s programs and highlights accomplishments from 2005 to 2012.



Publication
F101-102-000


 
Change Assignment of Administrator/Master Certificate

To assign or unassign your status as an administrator or master.



Form
F503-009-000


 
Change Assignment of Administrator/Master Certificate

To assign or unassign your status as an administrator or master.



Form
F503-009-000


 
Change Assignment of Administrator/Master Certificate

To assign or unassign your status as an administrator or master.



Form
F503-009-000


 
Change Assignment of Primary Point of Contact

Change Assignment of Primary Point of Contact



Form
F621-095-000


 
Change Assignment of Primary Point of Contact

Change Assignment of Primary Point of Contact



Form
F621-095-000


 
Change Assignment of Primary Point of Contact

Change Assignment of Primary Point of Contact



Form
F621-095-000


 
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


 
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


 
Chapter 296-131 WAC Agriculture Employment Standard


Form
F700-085-000



Alt Language(s):
Español
 
Chapter 296-131 WAC Agriculture Employment Standard


Form
F700-085-000



Alt Language(s):
Español
 
Chapter 296-131 WAC Agriculture Employment Standard


Form
F700-085-000



Alt Language(s):
Español
 
Chapter 296-131 WAC Agriculture Employment Standard


Form
F700-085-000



Alt Language(s):
Español
 
Chapter 296-131 WAC Agriculture Employment Standard


Form
F700-085-000



Alt Language(s):
Español
 
Chapter 296-807 WAC - Portable Power Tools

Portable power tools applies to hand-held power tools; circular saws, belt sanding machines, compressed air powered tools, powder actuated fastening systems designed to use the expanding gases from a powder load to propel a stud, pin, fastener, or other object into hard structural material, consumer and commercial power lawnmowers, portable hand- or power-operated hydraulic, mechanical ratchet and mechanical screw jacks.



Manual
F414-089-000


 
Chapter 296-807 WAC - Portable Power Tools

Portable power tools applies to hand-held power tools; circular saws, belt sanding machines, compressed air powered tools, powder actuated fastening systems designed to use the expanding gases from a powder load to propel a stud, pin, fastener, or other object into hard structural material, consumer and commercial power lawnmowers, portable hand- or power-operated hydraulic, mechanical ratchet and mechanical screw jacks.



Manual
F414-089-000


 
Chapter 296-807 WAC - Portable Power Tools

Portable power tools applies to hand-held power tools; circular saws, belt sanding machines, compressed air powered tools, powder actuated fastening systems designed to use the expanding gases from a powder load to propel a stud, pin, fastener, or other object into hard structural material, consumer and commercial power lawnmowers, portable hand- or power-operated hydraulic, mechanical ratchet and mechanical screw jacks.



Manual
F414-089-000


 
Chapter 296-807 WAC - Portable Power Tools

Portable power tools applies to hand-held power tools; circular saws, belt sanding machines, compressed air powered tools, powder actuated fastening systems designed to use the expanding gases from a powder load to propel a stud, pin, fastener, or other object into hard structural material, consumer and commercial power lawnmowers, portable hand- or power-operated hydraulic, mechanical ratchet and mechanical screw jacks.



Manual
F414-089-000


 
Chapter 51.24 RCW Actions at Law for Injury or Death - Spanish Capítulo 51.24 Acciones Legales por Lesiones o Fallecimiento

Actualización de la Publicación de 2001 – Código Revisado de Washington (RCW, por su sigla en inglés) 51.24.060(6)(7).  Esta actualización cambia el requisito de entrega por correo registrado o certificado por ‘entrega por un método cuya recepción puede ser confirmada o localizada.'

 

 




F242-138-999



Alt Language(s):
Inglés
 
Chapter 51.24 RCW Actions at Law for Injury or Death

Distribution of Amount Recovered—Lien (RCW 51.24.060).  Update to 2001 Publication – RCW 51.24.060(6)(7).  The PDF is 8 1/2" x 14" if you print a copy.




F242-138-111



Alt Language(s):
Español
 
Chemical Exposure Questionnaire Packet

Packet that contains:

F242-409-000 Chemical Exposure Questionnaire

F242-410-000 Worker Release for Union Dispatch Records

F262-005-000 Authorization to Release Information

Request for Social Security Earnings Information with the L&I address.



Form
F242-409-000



Alt Language(s):
Español
 
Chief Inspector Clarification and Interpretation Request Form

Form is used to ask the Chief Inspector to consider written requests for clarification and interpretation to the definitions, rules and regulations in WAC 296-104. Thsi form must be completed before F620-017-000 Board of Boiler Rules Interpretation and Revision Request form can be submitted.



Form
F620-056-000


 
Chief Inspector Clarification and Interpretation Request Form

Form is used to ask the Chief Inspector to consider written requests for clarification and interpretation to the definitions, rules and regulations in WAC 296-104. Thsi form must be completed before F620-017-000 Board of Boiler Rules Interpretation and Revision Request form can be submitted.



Form
F620-056-000


 
Chief Inspector Clarification and Interpretation Request Form

Form is used to ask the Chief Inspector to consider written requests for clarification and interpretation to the definitions, rules and regulations in WAC 296-104. Thsi form must be completed before F620-017-000 Board of Boiler Rules Interpretation and Revision Request form can be submitted.



Form
F620-056-000


 
Chief Inspector Clarification and Interpretation Request Form

Form is used to ask the Chief Inspector to consider written requests for clarification and interpretation to the definitions, rules and regulations in WAC 296-104. Thsi form must be completed before F620-017-000 Board of Boiler Rules Interpretation and Revision Request form can be submitted.



Form
F620-056-000


 
Chief Inspector Clarification and Interpretation Request Form

Form is used to ask the Chief Inspector to consider written requests for clarification and interpretation to the definitions, rules and regulations in WAC 296-104. Thsi form must be completed before F620-017-000 Board of Boiler Rules Interpretation and Revision Request form can be submitted.



Form
F620-056-000


 
Cholinesterase Blood Testing Choice

Use this form to say whether or not you choose to have the Cholinesterase blood tests performed.



Form
F413-064-000



Alt Language(s):
Español
Español
 
Cholinesterase Blood Testing Choice

Use this form to say whether or not you choose to have the Cholinesterase blood tests performed.



Form
F413-064-000



Alt Language(s):
Español
Español
 
Cholinesterase Blood Testing Choice

Use this form to say whether or not you choose to have the Cholinesterase blood tests performed.



Form
F413-064-000



Alt Language(s):
Español
Español
 
Cholinesterase Blood Testing Choice

Use this form to say whether or not you choose to have the Cholinesterase blood tests performed.



Form
F413-064-000



Alt Language(s):
Español
Español
 
Cholinesterase Monitoring Health Care Provider Recommendations

Filled out by the provider. This form gives the recommendations by the provider of what needs to be done based on the test results on the employee.



Form
F413-070-000



Alt Language(s):
Español
Español
 
Cholinesterase Monitoring Health Care Provider Recommendations

Filled out by the provider. This form gives the recommendations by the provider of what needs to be done based on the test results on the employee.



Form
F413-070-000



Alt Language(s):
Español
Español
 
Cholinesterase Monitoring Health Care Provider Recommendations

Filled out by the provider. This form gives the recommendations by the provider of what needs to be done based on the test results on the employee.



Form
F413-070-000



Alt Language(s):
Español
Español
 
Cholinesterase Monitoring Reimbursement Request

Employers use this form to request reimbursement for the reasonable costs of training, travel, recordkeeping, and medical expenses for Cholinesterase Monitoring.



Form
F413-062-000


 
Cholinesterase Monitoring Reimbursement Request

Employers use this form to request reimbursement for the reasonable costs of training, travel, recordkeeping, and medical expenses for Cholinesterase Monitoring.



Form
F413-062-000


 
Cholinesterase Monitoring Reimbursement Request

Employers use this form to request reimbursement for the reasonable costs of training, travel, recordkeeping, and medical expenses for Cholinesterase Monitoring.



Form
F413-062-000


 
Claim Suppression Complaint

An injured worker may submit this form if their employer has suppressed their right to file an injury claim.



Form
F262-024-000



Alt Language(s):
Español
 
Class B Labels: What You Should Know

Fact Sheet: Explains Class B label electrical work, scope and limitations, and provides general instructions for using Class B labels.



Publication
F500-112-000


 
Class B Labels: What You Should Know

Fact Sheet: Explains Class B label electrical work, scope and limitations, and provides general instructions for using Class B labels.



Publication
F500-112-000


 
Class B Labels: What You Should Know

Fact Sheet: Explains Class B label electrical work, scope and limitations, and provides general instructions for using Class B labels.



Publication
F500-112-000


 
Class B Labels: What You Should Know

Fact Sheet: Explains Class B label electrical work, scope and limitations, and provides general instructions for using Class B labels.



Publication
F500-112-000


 
Class B Labels: What You Should Know

Fact Sheet: Explains Class B label electrical work, scope and limitations, and provides general instructions for using Class B labels.



Publication
F500-112-000


 
Comentarios Sobre el Exámen Médico Independente

Usado por el trabajador lesionado para proporcionarle comentarios a L&I sobre su examen médico reciente de un Examen Médico Independiente (IME, por su sigla en inglés).



Form
F245-053-999



Alt Language(s):
Inglés
 
Comentarios Sobre el Exámen Médico Independente

Usado por el trabajador lesionado para proporcionarle comentarios a L&I sobre su examen médico reciente de un Examen Médico Independiente (IME, por su sigla en inglés).



Form
F245-053-999



Alt Language(s):
Inglés
 
Comentarios Sobre el Exámen Médico Independente

Usado por el trabajador lesionado para proporcionarle comentarios a L&I sobre su examen médico reciente de un Examen Médico Independiente (IME, por su sigla en inglés).



Form
F245-053-999



Alt Language(s):
Inglés
 
Comentarios Sobre el Exámen Médico Independente

Usado por el trabajador lesionado para proporcionarle comentarios a L&I sobre su examen médico reciente de un Examen Médico Independiente (IME, por su sigla en inglés).



Form
F245-053-999



Alt Language(s):
Inglés
 
Comentarios Sobre el Exámen Médico Independente

Usado por el trabajador lesionado para proporcionarle comentarios a L&I sobre su examen médico reciente de un Examen Médico Independiente (IME, por su sigla en inglés).



Form
F245-053-999



Alt Language(s):
Inglés
 
Commercial Diving Operations, Chapter 296-37 WAC

This manual contains basic safety and health rules that affect all employers and should cover almost all commercial diving operations. This manual also covers search and rescue and other public safety diving operations.



Manual
F414-039-000


 
Commercial Diving Operations, Chapter 296-37 WAC

This manual contains basic safety and health rules that affect all employers and should cover almost all commercial diving operations. This manual also covers search and rescue and other public safety diving operations.



Manual
F414-039-000


 
Commercial Diving Operations, Chapter 296-37 WAC

This manual contains basic safety and health rules that affect all employers and should cover almost all commercial diving operations. This manual also covers search and rescue and other public safety diving operations.



Manual
F414-039-000


 
Competent Person Evaluation - Excavation & Trenching

The employer uses this checklist to determine the person they have designated as a competent person is competent within the description and intent of the excavation and trenching standards.



Form
F417-104-000


 
Competent Person Evaluation - Fall Restraint & Fall Arrest

The employer uses this checklist to determine the person they have designated as a competent person is competent within the description and intent of the fall restraint and fall arrest standard.



Form
F417-102-000


 
Competent Person Evaluation - Fall Restraint & Fall Arrest

The employer uses this checklist to determine the person they have designated as a competent person is competent within the description and intent of the fall restraint and fall arrest standard.



Form
F417-102-000


 
Competent Person Evaluation - Fall Restraint & Fall Arrest

The employer uses this checklist to determine the person they have designated as a competent person is competent within the description and intent of the fall restraint and fall arrest standard.



Form
F417-102-000


 
Complete Stay at Work Guide for Employers, The

Booklet: Explains Stay at Work, a financial incentive program that encourages Washington employers to find light-duty or transitional jobs for workers recovering from on-the-job injuries. Provides information on reimbursements, what is covered and how to apply. Detailed Q&A section included.



Publication
F243-005-000


 
Complete Stay at Work Guide for Employers, The

Booklet: Explains Stay at Work, a financial incentive program that encourages Washington employers to find light-duty or transitional jobs for workers recovering from on-the-job injuries. Provides information on reimbursements, what is covered and how to apply. Detailed Q&A section included.



Publication
F243-005-000


 
Construction Contractor's Application for Workers' Compensation Account with No Workers or Hours

Used by employers with no employees or worker hours to report but need an open account for contract bidding process.



Form
F625-077-000


 
Construction Contractor's Application for Workers' Compensation Account with No Workers or Hours

Used by employers with no employees or worker hours to report but need an open account for contract bidding process.



Form
F625-077-000


 
Construction Contractors: Get the Facts, Get Registered

Pamphlet/booklet: Explains the steps to register as a construction contractor in Washington State.



Publication
F625-040-000



Alt Language(s):
Español
 
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Allow two weeks for a response. Accuracy and completeness speeds up the processing time.



Form
F621-001-000


 
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Allow two weeks for a response. Accuracy and completeness speeds up the processing time.



Form
F621-001-000


 
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Allow two weeks for a response. Accuracy and completeness speeds up the processing time.



Form
F621-001-000


 
Construction Industry Classification Guide

Book (loose-leaf manual): Helps contractors properly classify for workers' compensation insurance purposes the work being performed by their employees on new wood-frame building construction projects.



Publication
F213-008-000


 
Construction Industry Classification Guide

Book (loose-leaf manual): Helps contractors properly classify for workers' compensation insurance purposes the work being performed by their employees on new wood-frame building construction projects.



Publication
F213-008-000


 
Construction Lien Notice

This form is to be used by suppliers to notify homeowners that they have the ability to file a construction lien against their property if payment is not received.



Form
F625-054-000


 
Construction Lien Notice

This form is to be used by suppliers to notify homeowners that they have the ability to file a construction lien against their property if payment is not received.



Form
F625-054-000


 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Continuación del Historial de Trabajo y de Enfermedad Ocupacional

El trabajador lesionado llena este formulario para documentar una posible enfermedad ocupacional y para mostrar su historia de trabajo.



Form
F242-071-911



Alt Language(s):
Inglés
 
Contract: Report By Contractor - Forest, Range & Timber Industry

This report by the contractor needs to be completed and sent before any contractural agreement with a forest, range and/or timber industry landowner can start any work covered by this agreement.



Form
F213-011-000


 
Contract: Report By Landowner - Forest, Range & Timber Industry

The landowner needs to complete and submit this form before any contractural agreement with a forest, range and/or timber industry contractor can start any work that is covered by this agreement.



Form
F213-010-000


 
Contractor Complaint Form

Used by a home owner to file a complaint against a contractor.



Form
F625-033-000


 
Contractor Electrical Work Permit Application

This application is used to apply for a valid electrical permit from L&I. 4 pages.



Form
F500-093-000


 
Contractor Electrical Work Permit Application

This application is used to apply for a valid electrical permit from L&I. 4 pages.



Form
F500-093-000


 
Contractor Electrical Work Permit Application

This application is used to apply for a valid electrical permit from L&I. 4 pages.



Form
F500-093-000


 
Contractor Electrical Work Permit Application

This application is used to apply for a valid electrical permit from L&I. 4 pages.



Form
F500-093-000


 
Contractor Financial Information

Used by the contractor to request L&I to release assignment of account that they used instead of a surety bond.



Form
F625-061-000


 
Contractor Registration Request for Duplicate License or Address Change  

This form may be faxed to the Contractor Registration office in Tumwater.



Form
F625-108-000


 
Contractors: What if You Get a Notice of Infraction?

Pamphlet/booklet: Tells contractors what their options are and what to do if they get a Notice of Infraction (a non-criminal violation). This publication currently unavailable due to revisions in progress. Check back for updates.



Publication
F625-097-000


 
Contratistas de Construcción: Obtenga los Datos, Regístrese

Folleto: Explica los pasos para registrarse como contratista de construcción en el estado de Washington.



Publication
F625-040-999



Alt Language(s):
Inglés
 
Convenio para el tratamiento con opioides

Utilice este convenio de tratamiento al iniciar la terapia con opioides para controlar el dolor crónico.  El convenio debe ser renovado cada año o cuando hay un proveedor nuevo proporcionándole recetas.



Form
F252-095-999



Alt Language(s):
Inglés
 
Conveyance Installation Approval by Building Official

Used by the installer to notify L&I that a conveyance is proposed for installation in a building.



Form
F621-056-000


 
Conveyance Installation Approval by Building Official

Used by the installer to notify L&I that a conveyance is proposed for installation in a building.



Form
F621-056-000


 
Conveyance Installation Approval by Building Official

Used by the installer to notify L&I that a conveyance is proposed for installation in a building.



Form
F621-056-000


 
Copper Tubing Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing gas lines with copper tubing. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-046-000


 
Copper Tubing Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing gas lines with copper tubing. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-046-000


 
Copper Tubing Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing gas lines with copper tubing. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-046-000


 
Copper Tubing Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing gas lines with copper tubing. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-046-000


 
Court Form Granting Permission for Employment of Minors

Form from Court Granting Permission for Employment of Minors to the employer.



Form
F700-119-000


 
Court Form Granting Permission for Employment of Minors

Form from Court Granting Permission for Employment of Minors to the employer.



Form
F700-119-000


 
Coverage Agreement

An agreement between a worker and employer which states the worker's employment is principally localized in Washington state or another state.



Form
F212-044-000


 
Coverage Agreement

An agreement between a worker and employer which states the worker's employment is principally localized in Washington state or another state.



Form
F212-044-000


 
Coverage Agreement

An agreement between a worker and employer which states the worker's employment is principally localized in Washington state or another state.



Form
F212-044-000


 
Crime Victims Compensation Program Initial Response and Assessment: Form II

Used by the clinical provider to request authorization to provide more than six sessions. This form must be submitted by the sixth session. (6 pages)



Form
F800-081-000


 
Crime Victims Compensation Program Progress Note: Form III

Used by the clinical provider to submit a request for preauthorization for payment of additional sessions.



Form
F800-082-000


 
Crime Victims Compensation Program Treatment Report: Form IV

Used by the clinical provider to request preauthorization for payment of additional sessions.



Form
F800-083-000


 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-070-000


 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-070-000


 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-070-000


 
Crime Victims Statement for Pharmacy Services

Used by Crime Victims Compensation Program providers to bill for pharmacy services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-058-000


 
Crime Victims Statement for Pharmacy Services

Used by Crime Victims Compensation Program providers to bill for pharmacy services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-058-000


 
Crime Victims Provider's Request for Adjustment

Used by providers to request an adjustment to their bill if their entire bill was paid in error, or if a portion of the bill was overpaid or underpaid. Attach required reports and/or documentation to support the request.



Form
F800-064-000


 
Crime Victims Provider's Request for Adjustment

Used by providers to request an adjustment to their bill if their entire bill was paid in error, or if a portion of the bill was overpaid or underpaid. Attach required reports and/or documentation to support the request.



Form
F800-064-000


 
Crime Victims Provider's Request for Adjustment

Used by providers to request an adjustment to their bill if their entire bill was paid in error, or if a portion of the bill was overpaid or underpaid. Attach required reports and/or documentation to support the request.



Form
F800-064-000


 
Crime Victims Provider's Request for Adjustment

Used by providers to request an adjustment to their bill if their entire bill was paid in error, or if a portion of the bill was overpaid or underpaid. Attach required reports and/or documentation to support the request.



Form
F800-064-000


 
Cuando un ser querido fallece en el lugar de trabajo

Folleto: Proporciona información para los seres queridos de trabajadores que mueren de una lesión o enfermedad relacionada con el trabajo, incluyendo cómo solicitar beneficios de sobreviviente. Explica la investigación de L&I por una muerte y cómo los miembros de la familia pueden mantenerse informados sobre el estado de la investigación.



Publication
F417-240-999



Alt Language(s):
Inglés
 
Cuando un ser querido fallece en el lugar de trabajo

Folleto: Proporciona información para los seres queridos de trabajadores que mueren de una lesión o enfermedad relacionada con el trabajo, incluyendo cómo solicitar beneficios de sobreviviente. Explica la investigación de L&I por una muerte y cómo los miembros de la familia pueden mantenerse informados sobre el estado de la investigación.



Publication
F417-240-999



Alt Language(s):
Inglés
 
Cuestionario de exposición a sustancias químicas

Formulario: Contiene el  Cuestionario de exposición a sustancias químicas F242-409-999, la Autorización para proveer información  F262-005-999 y la versión en inglés solamente de un formulario del Seguro Social que contiene la información apropiada de L&I.



Form
F242-409-999



Alt Language(s):
Inglés
 
Cuestionario para beneficios de pensión

Usado por un trabajador lesionado que recibe una orden estableciendo que él o ella está total y permanentemente discapacitado.  Este cuestionario debe completarse en su totalidad y debe adjuntarse todos los documentos necesarios antes de que pueda calcularse sus opciones de beneficios de pensión.



Form
F242-393-999



Alt Language(s):
Inglés
 
Cuestionario para beneficios de pensión

Usado por un trabajador lesionado que recibe una orden estableciendo que él o ella está total y permanentemente discapacitado.  Este cuestionario debe completarse en su totalidad y debe adjuntarse todos los documentos necesarios antes de que pueda calcularse sus opciones de beneficios de pensión.



Form
F242-393-999



Alt Language(s):
Inglés
 
Cuestionario para beneficios de pensión

Usado por un trabajador lesionado que recibe una orden estableciendo que él o ella está total y permanentemente discapacitado.  Este cuestionario debe completarse en su totalidad y debe adjuntarse todos los documentos necesarios antes de que pueda calcularse sus opciones de beneficios de pensión.



Form
F242-393-999



Alt Language(s):
Inglés
 
Cuestionario para beneficios de pensión

Usado por un trabajador lesionado que recibe una orden estableciendo que él o ella está total y permanentemente discapacitado.  Este cuestionario debe completarse en su totalidad y debe adjuntarse todos los documentos necesarios antes de que pueda calcularse sus opciones de beneficios de pensión.



Form
F242-393-999



Alt Language(s):
Inglés
 
Cuestionario para beneficios de pensión

Usado por un trabajador lesionado que recibe una orden estableciendo que él o ella está total y permanentemente discapacitado.  Este cuestionario debe completarse en su totalidad y debe adjuntarse todos los documentos necesarios antes de que pueda calcularse sus opciones de beneficios de pensión.



Form
F242-393-999



Alt Language(s):
Inglés
 
Cuestionario para beneficios de pensión

Usado por un trabajador lesionado que recibe una orden estableciendo que él o ella está total y permanentemente discapacitado.  Este cuestionario debe completarse en su totalidad y debe adjuntarse todos los documentos necesarios antes de que pueda calcularse sus opciones de beneficios de pensión.



Form
F242-393-999



Alt Language(s):
Inglés
 
Cuestionario sobre la pérdida del sentido auditivo en el trabajo

Usada por el trabajador lesionado que ha presentado un reclamo por pérdida de audición para proporcionar información más específica referente a cómo ocurrió la pérdida de audición.  Esto es solicitado por el gerente de reclamo y enviado al trabajador lesionado.



Form
F262-016-999



Alt Language(s):
Inglés
 
Cuestionario sobre la pérdida del sentido auditivo en el trabajo

Usada por el trabajador lesionado que ha presentado un reclamo por pérdida de audición para proporcionar información más específica referente a cómo ocurrió la pérdida de audición.  Esto es solicitado por el gerente de reclamo y enviado al trabajador lesionado.



Form
F262-016-999



Alt Language(s):
Inglés
 
Cuestionario sobre la pérdida del sentido auditivo en el trabajo

Usada por el trabajador lesionado que ha presentado un reclamo por pérdida de audición para proporcionar información más específica referente a cómo ocurrió la pérdida de audición.  Esto es solicitado por el gerente de reclamo y enviado al trabajador lesionado.



Form
F262-016-999



Alt Language(s):
Inglés
 
Cuestionario sobre la pérdida del sentido auditivo en el trabajo

Usada por el trabajador lesionado que ha presentado un reclamo por pérdida de audición para proporcionar información más específica referente a cómo ocurrió la pérdida de audición.  Esto es solicitado por el gerente de reclamo y enviado al trabajador lesionado.



Form
F262-016-999



Alt Language(s):
Inglés
 
Cuestionario sobre la pérdida del sentido auditivo en el trabajo

Usada por el trabajador lesionado que ha presentado un reclamo por pérdida de audición para proporcionar información más específica referente a cómo ocurrió la pérdida de audición.  Esto es solicitado por el gerente de reclamo y enviado al trabajador lesionado.



Form
F262-016-999



Alt Language(s):
Inglés
 
Cuestionario Vocacional/Historia de trabajo

Cuestionario vocacional/historia de trabajo para uso de los proveedores vocacionales que sirven a los trabajadores lesionados.



Form
F280-038-999


 
Cuestionario Vocacional/Historia de trabajo

Cuestionario vocacional/historia de trabajo para uso de los proveedores vocacionales que sirven a los trabajadores lesionados.



Form
F280-038-999


 
Cuestionario Vocacional/Historia de trabajo

Cuestionario vocacional/historia de trabajo para uso de los proveedores vocacionales que sirven a los trabajadores lesionados.



Form
F280-038-999


 
CVCP Opioid Progress Report Chronic, Non-Cancer Pain and Treatment Agreement.

Crime Victims Compensation Opioid Progress Report Chronic, Non-Cancer Pain and Treatment Agreement.



Form
F800-116-000


 
Danger / PELIGRO (English/español)

Large lettering: DANGER. Get poster printing tips.

Cartel: En letras grandes: PELIGRO. Obtenga instrucciones sobre cómo imprimir los carteles.



Poster
FSP1-030-999



Alt Language(s):
Inglés
 
Danger! Minimum Clearance for Counter Balance - Construction

Sticker: 30 inches long.



Sticker
FSP0-974-000


 
Danger, Workers Above / Peligro - Trabajadores en el nivel superior (English/español)

Picture of workers on a high rise. Get poster printing tips.

Fotografía: Trabajadores en una superficie alta.  Obtenga instrucciones sobre cómo imprimir los carteles.



Poster
FSP1-012-999



Alt Language(s):
Inglés
 
Decertification of Manufactured and Mobile Homes

This document shows the steps to decertify a manufactured or mobile home.



Form
F622-063-000


 
Decertification of Manufactured and Mobile Homes

This document shows the steps to decertify a manufactured or mobile home.



Form
F622-063-000


 
Decertification of Manufactured and Mobile Homes

This document shows the steps to decertify a manufactured or mobile home.



Form
F622-063-000


 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para dependientes del trabajador fallecido bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un dependiente de un trabajador cuya muerte estaba relacionada con una lesión o accidente en el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-933



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para padres o tutor bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por un tutor u otra persona que tiene custodia del hijo menor o discapacitado o dependientes de un trabajador fallecido para declarar su  derecho a recibir los beneficios de pensión para aquellos niños/dependientes bajo su cuidado y custodia.



Form
F242-173-922



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores

Usado por una viuda/viudo cuyo cónyuge falleció a causa de una lesión o accidente relacionado con el trabajo.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-911



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de derechos para los beneficios de un trabajador totalmente discapacitado bajo las Leyes del Seguro Industrial

Usado por un trabajador permanentemente y totalmente discapacitado.  Este formulario debe completarse, firmarse, notarizarse y devolverse a L&I dentro de 30 días para que los beneficios no sean interrumpidos.



Form
F242-173-944



Alt Language(s):
Inglés
 
Declaración de servicios de capacitación y modificación de trabajo

Formulario:  Para ser completado por los proveedores que facturan al Departamento por capacitación y servicios de modificación de trabajo.



Form
F245-030-999



Alt Language(s):
Inglés
 
Declaración de servicios de capacitación y modificación de trabajo

Formulario:  Para ser completado por los proveedores que facturan al Departamento por capacitación y servicios de modificación de trabajo.



Form
F245-030-999



Alt Language(s):
Inglés
 
Declaración de servicios de capacitación y modificación de trabajo

Formulario:  Para ser completado por los proveedores que facturan al Departamento por capacitación y servicios de modificación de trabajo.



Form
F245-030-999



Alt Language(s):
Inglés
 
Declaración de servicios de capacitación y modificación de trabajo

Formulario:  Para ser completado por los proveedores que facturan al Departamento por capacitación y servicios de modificación de trabajo.



Form
F245-030-999



Alt Language(s):
Inglés
 
Declaración firmada para compensación de tiempo perdido

Para ser completada por los trabajadores lesionados que reclaman que tenian derecho a recibir el pago de beneficios de tiempo perdido no pagados anteriormente por un periodo que excede seis meses o $25,000.  Los trabajadores lesionados que soliciten beneficios por el tiempo perdido de trabajo actual debido a una lesión relacionada con el trabajo deben usar el Formulario de verificación de empleo, F242-052-999.



Form
F242-395-999



Alt Language(s):
Inglés
 
Declaración firmada para compensación de tiempo perdido

Para ser completada por los trabajadores lesionados que reclaman que tenian derecho a recibir el pago de beneficios de tiempo perdido no pagados anteriormente por un periodo que excede seis meses o $25,000.  Los trabajadores lesionados que soliciten beneficios por el tiempo perdido de trabajo actual debido a una lesión relacionada con el trabajo deben usar el Formulario de verificación de empleo, F242-052-999.



Form
F242-395-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Demounting and Mounting Procedures for Tube-type Truck and Bus Tires

Poster for tire and rim servicing. To be displayed with F417-237-000-A Demounting and Mounting Procedures for Tubeless Truck and Bus Tires and F417-237-000-C Multi-piece Rim Matching Chart. This poster must be printed at least 2'x3' in size.



Poster
F417-237-000-B


 
Demounting and Mounting Procedures for Tube-type Truck and Bus Tires

Poster for tire and rim servicing. To be displayed with F417-237-000-A Demounting and Mounting Procedures for Tubeless Truck and Bus Tires and F417-237-000-C Multi-piece Rim Matching Chart. This poster must be printed at least 2'x3' in size.



Poster
F417-237-000-B


 
Demounting and Mounting Procedures for Tubeless Truck and Bus Tires

Poster for tire and rim servicing. To be displayed with F417-237-000-B Demounting and Mounting Procedures for Tube-type Truck and Bus Tires and F417-237-000-C Multi-piece Rim Matching Chart. This poster must be printed at least 2'x3' in size.



Poster
F417-237-000-A


 
Demounting and Mounting Procedures for Tubeless Truck and Bus Tires

Poster for tire and rim servicing. To be displayed with F417-237-000-B Demounting and Mounting Procedures for Tube-type Truck and Bus Tires and F417-237-000-C Multi-piece Rim Matching Chart. This poster must be printed at least 2'x3' in size.



Poster
F417-237-000-A


 
Department of Employment Security Tax Compliance Certification

Form to gain Department of Employment Security Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-099-000


 
Department of Employment Security Tax Compliance Certification

Form to gain Department of Employment Security Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-099-000


 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.



Form
F247-003-000



Alt Language(s):
Español
 
Department of Revenue Tax Compliance Certification

Form to gain Department of Revenue Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-100-000


 
Discriminación de seguridad y salud en el lugar de trabajo

Folleto: Los empleados tienen derecho a reportar sus inquietudes sobre seguridad y salud en sus lugares de trabajo.  Este folleto describe las “actividades protegidas": bajo la Ley de Seguridad y Salud Industrial de Washington (WISHA, por su sigla en inglés) y explica lo que debe hacer un empleado si él/ella es castigado o despedido por ejercer estos derechos.



Publication
F417-244-999



Alt Language(s):
Inglés
 
Discriminación de seguridad y salud en el lugar de trabajo

Folleto: Los empleados tienen derecho a reportar sus inquietudes sobre seguridad y salud en sus lugares de trabajo.  Este folleto describe las “actividades protegidas": bajo la Ley de Seguridad y Salud Industrial de Washington (WISHA, por su sigla en inglés) y explica lo que debe hacer un empleado si él/ella es castigado o despedido por ejercer estos derechos.



Publication
F417-244-999



Alt Language(s):
Inglés
 
Drywall Contractors

Quick reference guide: Used by drywall contractors to get answers to questions about being a drywall contractor and how it relates to L&I.



Form
F214-024-000


 
Drywall Contractors

Quick reference guide: Used by drywall contractors to get answers to questions about being a drywall contractor and how it relates to L&I.



Form
F214-024-000


 
Drywall Industry - Owner/Sub-Contractor Report

Used by drywall companies to file their quarterly report. Must accompany the Supplemental Quarterly Report for the Drywall Industry (F212-051-000).



Form
F212-050-000


 
Elección para prueba de sangre de colinesterasa

Formulario:  Es utilizado para indicar si usted elije o no que se le hagan examenes de colinesterasa en la sangre.



Form
F413-064-999



Alt Language(s):
Inglés
Inglés
 
Elección para prueba de sangre de colinesterasa

Formulario:  Es utilizado para indicar si usted elije o no que se le hagan examenes de colinesterasa en la sangre.



Form
F413-064-999



Alt Language(s):
Inglés
Inglés
 
Elección para prueba de sangre de colinesterasa

Formulario:  Es utilizado para indicar si usted elije o no que se le hagan examenes de colinesterasa en la sangre.



Form
F413-064-999



Alt Language(s):
Inglés
Inglés
 
Electric / Gas Conversion Pre-Inspection Checklist

This checklist is generic in content and may not include all requirements for your particular installation. The manufacturer's installation instruction must be adhered to and available to the inspector at the time of the inspection.



Form
F622-013-000


 
Electric / Gas Conversion Pre-Inspection Checklist

This checklist is generic in content and may not include all requirements for your particular installation. The manufacturer's installation instruction must be adhered to and available to the inspector at the time of the inspection.



Form
F622-013-000


 
Electric / Gas Conversion Pre-Inspection Checklist

This checklist is generic in content and may not include all requirements for your particular installation. The manufacturer's installation instruction must be adhered to and available to the inspector at the time of the inspection.



Form
F622-013-000


 
Electric / Gas Conversion Pre-Inspection Checklist

This checklist is generic in content and may not include all requirements for your particular installation. The manufacturer's installation instruction must be adhered to and available to the inspector at the time of the inspection.



Form
F622-013-000


 
Electrical / Telecommunication Contractor's License Renewal Notice

This form is used to notify you that your license will expire and for you to use to renew your license.



Form
F500-077-000


 
Electrical / Telecommunication Contractor's License Renewal Notice

This form is used to notify you that your license will expire and for you to use to renew your license.



Form
F500-077-000


 
Electrical / Telecommunication Contractor's License Renewal Notice

This form is used to notify you that your license will expire and for you to use to renew your license.



Form
F500-077-000


 
Electrical Continuing Education Instructor Application

An application to receive approval from L&I to instruct electrical continuing education courses.



Form
F500-090-000


 
Electrical Continuing Education Instructor Application

An application to receive approval from L&I to instruct electrical continuing education courses.



Form
F500-090-000


 
Electrical Education Course Application

Used to get approval of a course as an electrical continuing education class. This application must be received by L&I at least 30 days before the course is offered.



Form
F500-068-000


 
Electrical Education Course Application

Used to get approval of a course as an electrical continuing education class. This application must be received by L&I at least 30 days before the course is offered.



Form
F500-068-000


 
Electrical Education Course Application

Used to get approval of a course as an electrical continuing education class. This application must be received by L&I at least 30 days before the course is offered.



Form
F500-068-000


 
Electrical Installation Variance Application

To apply for a variance which is an allowable deviation from specific requirements of a National Electrical Code section, or the WAC 296-46B where the proposed alternate methods will maintain equivalent safety.



Form
F500-063-000


 
Electrical Installation Variance Application

To apply for a variance which is an allowable deviation from specific requirements of a National Electrical Code section, or the WAC 296-46B where the proposed alternate methods will maintain equivalent safety.



Form
F500-063-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publication
F500-114-000


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

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



Manual
F500-039-222


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

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



Manual
F500-039-222


 
Electrical Telecommunication Principal Member Owner Update Request

Electrical Telecommunication Principal Member Owner Update Request



Form
F500-124-000


 
Electrical Telecommunication Principal Member Owner Update Request

Electrical Telecommunication Principal Member Owner Update Request



Form
F500-124-000


 
Electrical Telecommunication Principal Member Owner Update Request

Electrical Telecommunication Principal Member Owner Update Request



Form
F500-124-000


 
Electrical/Telecommunications Contractor Assignment of Savings Account

This is used to assign ownership interest to a savings account that is held by L&I for one year after a contractor's license has expired or after the contractor ceases business in Washington State.



Form
F500-020-000


 
Electrical/Telecommunications Contractor Assignment of Savings Account

This is used to assign ownership interest to a savings account that is held by L&I for one year after a contractor's license has expired or after the contractor ceases business in Washington State.



Form
F500-020-000


 
Electrical/Telecommunications Contractor Assignment of Savings Account

This is used to assign ownership interest to a savings account that is held by L&I for one year after a contractor's license has expired or after the contractor ceases business in Washington State.



Form
F500-020-000


 
Electrical/Telecommunications Contractor's Bond to the State of WA

Used to show proof of a bond in the State of Washington.



Form
F500-019-000


 
Electronic Billing Authorization

To authorize L&I to accept electronically submitted bills for services provided to injured workers (2 pages).



Form
F248-031-000


 
Electronic Billing Authorization

To authorize L&I to accept electronically submitted bills for services provided to injured workers (2 pages).



Form
F248-031-000


 
ELEVATOR ACCOUNT DEPOSIT FOR CONTRACTOR’S OR MISCELLANEOUS ACCOUNT HOLDER’S

ELEVATOR ACCOUNT DEPOSIT FOR CONTRACTOR’S OR MISCELLANEOUS ACCOUNT HOLDER’S



Form
F621-098-000


 
Elevator Continuing Education Course Application

This is used to apply for approval of elevator related continuing education courses.



Form
F621-077-000


 
Elevator Continuing Education Course Application

This is used to apply for approval of elevator related continuing education courses.



Form
F621-077-000


 
Elevator Continuing Education Course Application

This is used to apply for approval of elevator related continuing education courses.



Form
F621-077-000


 
Elevator Continuing Education Provider / Instructor Application

Application to become an instructor or provider for elevator related courses.



Form
F621-078-000


 
Elevator Continuing Education Provider / Instructor Application

Application to become an instructor or provider for elevator related courses.



Form
F621-078-000


 
Elevator Continuing Education Provider / Instructor Application

Application to become an instructor or provider for elevator related courses.



Form
F621-078-000


 
Elevator Five-Year Safety Test Report

This report is used by elevator company mechanics and left on the job site for review by elevator inspectors.



Form
F621-051-000


 
Elevator Five-Year Safety Test Report

This report is used by elevator company mechanics and left on the job site for review by elevator inspectors.



Form
F621-051-000


 
Elevator Information Update

This form is required by L&I before they can process any changes to the ownership, physical or mailing address.



Form
F621-050-000


 
Elevator Information Update

This form is required by L&I before they can process any changes to the ownership, physical or mailing address.



Form
F621-050-000


 
Elevator Installation Variance Application

Property owner or elevator company can apply for a variance to install an elevator. 4 pages.

Allow 4-6 weeks for a response.  Accuracy and completeness speeds up the processing time.



Form
F621-048-000


 
Elevator Installation Variance Application

Property owner or elevator company can apply for a variance to install an elevator. 4 pages.

Allow 4-6 weeks for a response.  Accuracy and completeness speeds up the processing time.



Form
F621-048-000


 
Elevator Installation Variance Application

Property owner or elevator company can apply for a variance to install an elevator. 4 pages.

Allow 4-6 weeks for a response.  Accuracy and completeness speeds up the processing time.



Form
F621-048-000


 
Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update

Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update



Form
F621-100-000


 
Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update

Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update



Form
F621-100-000


 
Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update

Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update



Form
F621-100-000


 
Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update

Elevator Mechanic and Elevator Temporary Mechanic Address/Mailing Information Update



Form
F621-100-000


 
Employer Petition to The Court for Minor Work Permit Under Age 14

Petition to The Court for Minor Work Permit Under Age 14 by Employer.



Form
F700-118-000


 
Employer Petition to The Court for Minor Work Permit Under Age 14

Petition to The Court for Minor Work Permit Under Age 14 by Employer.



Form
F700-118-000


 
Employer Petition to The Court for Minor Work Permit Under Age 14

Petition to The Court for Minor Work Permit Under Age 14 by Employer.



Form
F700-118-000


 
Employer Rights - Wages Paid

Covers penalties for employer wage violations. Once stock runs out in warehouse, this form will be internet only.



Form
F700-058-000


 
Employer's Guide to the Hazard Communication Rule (Chinese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-888



Alt Language(s):
Inglés
한국의
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Chinese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-888



Alt Language(s):
Inglés
한국의
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Chinese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-888



Alt Language(s):
Inglés
한국의
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Chinese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-888



Alt Language(s):
Inglés
한국의
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Chinese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-888



Alt Language(s):
Inglés
한국의
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Korean)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-777



Alt Language(s):
中国的
Inglés
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Korean)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-777



Alt Language(s):
中国的
Inglés
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Korean)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-777



Alt Language(s):
中国的
Inglés
Español
Vi?t
 
Employer's Guide to the Hazard Communication Rule (Korean)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-777



Alt Language(s):
中国的
Inglés
Español
Vi?t
 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employer's Job Description

Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval.



Form
F252-040-000


 
Employers’ Guide to Workers’ Compensation Insurance in Washington State

Book: Explains the Washington State's workers' compensation program. Suggests ways to protect workers' safety and health and describes L&I programs to help employers control premium costs.



Publication
F101-002-000


 
Employers’ Guide to Workers’ Compensation Insurance in Washington State

Book: Explains the Washington State's workers' compensation program. Suggests ways to protect workers' safety and health and describes L&I programs to help employers control premium costs.



Publication
F101-002-000


 
Employers’ Guide to Workers’ Compensation Insurance in Washington State

Book: Explains the Washington State's workers' compensation program. Suggests ways to protect workers' safety and health and describes L&I programs to help employers control premium costs.



Publication
F101-002-000


 
Employing Children Under Age 14 in Non-Agricultural Jobs

Fact sheet: Explains when employers can and cannot employ minors under age 14 in non-agricultural jobs. Details the process for obtaining court permission when hiring minors under 14 is allowed.



Publication
F700-117-000


 
Employment History Form

Used to provide your employment history for the past three years, including self-employment and volunteer work.

Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history.  If you were unemployed at any time, please explain why.  Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits?  Did you seek employment during the time period?  If no, why didn’t you seek employment?



Form
F242-109-000



Alt Language(s):
Español
 
Employment History Form

Used to provide your employment history for the past three years, including self-employment and volunteer work.

Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history.  If you were unemployed at any time, please explain why.  Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits?  Did you seek employment during the time period?  If no, why didn’t you seek employment?



Form
F242-109-000



Alt Language(s):
Español
 
Employment History Form

Used to provide your employment history for the past three years, including self-employment and volunteer work.

Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history.  If you were unemployed at any time, please explain why.  Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits?  Did you seek employment during the time period?  If no, why didn’t you seek employment?



Form
F242-109-000



Alt Language(s):
Español
 
Employment History Form

Used to provide your employment history for the past three years, including self-employment and volunteer work.

Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history.  If you were unemployed at any time, please explain why.  Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits?  Did you seek employment during the time period?  If no, why didn’t you seek employment?



Form
F242-109-000



Alt Language(s):
Español
 
Encursta para la Evaluacion de los Daños

Sus respuestas a estas preguntas serán utilizadas para ayudar a evaluar sus daños si se presenta un reclamo indicando que un tercero es responsable por los daños.



Form
F242-067-999



Alt Language(s):
Inglés
 
Equal Employment Opportunity (EEO) Resource & Referral Update Form

Used by an organization to get on the Apprenticeship Program equal opportunity resources list or use to update their information on the list.



Form
F100-513-000


 
Estándares de Trabajo Agrícola Capítulo 296-131 del Código Administrativo de Washington (WAC, por su sigla en inglés)

Documento Legal: Estándares de trabajo agrícola - Capítulo 296-131 del Código Administrativo de Washington (WAC, por su sigla en inglés)



Manual
F700-085-999



Alt Language(s):
Inglés
 
Estándares de Trabajo Agrícola Capítulo 296-131 del Código Administrativo de Washington (WAC, por su sigla en inglés)

Documento Legal: Estándares de trabajo agrícola - Capítulo 296-131 del Código Administrativo de Washington (WAC, por su sigla en inglés)



Manual
F700-085-999



Alt Language(s):
Inglés
 
Evaluando su capacidad para trabajar: sus derechos y responsabilidades, servicios de rehabilitación vocacional

Folleto: Explica lo básico de la etapa de evaluación de los servicios vocacionales para los trabajadores lesionados. L&I le envia este folleto a los trabajadores lesionados cuando son referidos para servicios de evaluación.



Publication
F280-017-999



Alt Language(s):
Inglés
 
Evaluando su capacidad para trabajar: sus derechos y responsabilidades, servicios de rehabilitación vocacional

Folleto: Explica lo básico de la etapa de evaluación de los servicios vocacionales para los trabajadores lesionados. L&I le envia este folleto a los trabajadores lesionados cuando son referidos para servicios de evaluación.



Publication
F280-017-999



Alt Language(s):
Inglés
 
Evaluating Retro Groups

Fact sheet: Provides information to employers who are considering joining a Retrospective Rating (Retro) group and how to choose one that best fits the need of their company. Explains the process for enrollment, deadlines, group eligibility, assessment, distribution of funds, dues, fees, services, and exit clauses.



Publication
F225-019-000


 
Evaluating Retro Groups

Fact sheet: Provides information to employers who are considering joining a Retrospective Rating (Retro) group and how to choose one that best fits the need of their company. Explains the process for enrollment, deadlines, group eligibility, assessment, distribution of funds, dues, fees, services, and exit clauses.



Publication
F225-019-000


 
Evaluating Retro Groups

Fact sheet: Provides information to employers who are considering joining a Retrospective Rating (Retro) group and how to choose one that best fits the need of their company. Explains the process for enrollment, deadlines, group eligibility, assessment, distribution of funds, dues, fees, services, and exit clauses.



Publication
F225-019-000


 
Extension Request

This form is to request a time extension from an unforeseen circumstances for overdue corrections for conveyances.



Form
F621-053-000


 
Extension Request

This form is to request a time extension from an unforeseen circumstances for overdue corrections for conveyances.



Form
F621-053-000


 
Eye On Safety Card

Reference card: 8.5 X 5.5 card to promote L&I's EyeOnSafety.info website, where you can find video shorts, training videos, investigation stories and other visual resources.



Publication
F417-222-000


 
Fall Protection Work Plan Requirements

This booklet defines the work plan requirements you must meet for fall protection.



Form
F417-107-000


 
Fall Protection Work Plan Requirements

This booklet defines the work plan requirements you must meet for fall protection.



Publication
F417-107-000


 
Fall Protection Work Plan Requirements

This booklet defines the work plan requirements you must meet for fall protection.



Form
F417-107-000


 
Fall Protection Work Plan Requirements

This booklet defines the work plan requirements you must meet for fall protection.



Publication
F417-107-000


 
Fall Protection Work Plan Requirements

This booklet defines the work plan requirements you must meet for fall protection.



Form
F417-107-000


 
Fall Protection Work Plan Requirements

This booklet defines the work plan requirements you must meet for fall protection.



Publication
F417-107-000


 
Farm Internship Agreement

Agreement form: Prior to hiring an intern, farms that have received a Farm Intern Program certificate must complete this agreement with the intern and submit it to the department.



Form
F700-157-000


 
Farm Internship Agreement

Agreement form: Prior to hiring an intern, farms that have received a Farm Intern Program certificate must complete this agreement with the intern and submit it to the department.



Form
F700-157-000


 
Farm Labor Contractor Application/Renewal Packet

This is the packet you would complete to register as a farm labor contractor.



Form
F700-170-000


 
Farm Labor Contractor Application/Renewal Packet

This is the packet you would complete to register as a farm labor contractor.



Form
F700-170-000


 
Farm Labor Contractor Application/Renewal Packet

This is the packet you would complete to register as a farm labor contractor.



Form
F700-170-000


 
Farm Labor Contractor Application/Renewal Packet

This is the packet you would complete to register as a farm labor contractor.



Form
F700-170-000


 
Farm Labor Contractor Assignment of Account or Time Deposit

Farm Labor Contractor assignment of account or tme deposit for employee



Form
F700-060-000


 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-000



Alt Language(s):
Español
 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-000



Alt Language(s):
Español
 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Registration

Fact Sheet: Explains how to get a farm labor contractor license in order to operate legally as a farm labor contractor in Washington State.



Publication
F700-088-000



Alt Language(s):
Español
 
Farm Labor Contractor Registration

Fact Sheet: Explains how to get a farm labor contractor license in order to operate legally as a farm labor contractor in Washington State.



Publication
F700-088-000



Alt Language(s):
Español
 
Farm Labor Contractor Registration

Fact Sheet: Explains how to get a farm labor contractor license in order to operate legally as a farm labor contractor in Washington State.



Publication
F700-088-000



Alt Language(s):
Español
 
Farm Labor Contractor Registration

Fact Sheet: Explains how to get a farm labor contractor license in order to operate legally as a farm labor contractor in Washington State.



Publication
F700-088-000



Alt Language(s):
Español
 
Farm Labor Contractors Bond

Notarized farm labor contractors bond coverage.



Form
F700-066-000


 
Filing Suit Against an Electrical Contractor

Instructions for filing suit against an electrical contractor



Form
F625-053-000


 
Filing Suit Against an Electrical Contractor

Instructions for filing suit against an electrical contractor



Form
F625-053-000


 
Filing Suit Against an Electrical Contractor

Instructions for filing suit against an electrical contractor



Form
F625-053-000


 
Filing Suit Against an Electrical Contractor

Instructions for filing suit against an electrical contractor



Form
F625-053-000


 
Financial Statement Businesses

Requesting Financial Information for Corporations, LLC and Partnerships.



Form
F215-040-000


 
Financial Statement Businesses

Requesting Financial Information for Corporations, LLC and Partnerships.



Form
F215-040-000


 
Financial Statement Businesses

Requesting Financial Information for Corporations, LLC and Partnerships.



Form
F215-040-000


 
Financial Statement Businesses

Requesting Financial Information for Corporations, LLC and Partnerships.



Form
F215-040-000


 
Financial Statement Sole Proprietors and Individuals

Requesting Financial Information for Sole Proprietors and/or Individuals.



Form
F215-039-000


 
Financial Statement Sole Proprietors and Individuals

Requesting Financial Information for Sole Proprietors and/or Individuals.



Form
F215-039-000


 
Firm Vocational Provider Account Change

To change a firm's (payee provider's) branch address within the same service location, contact info, tax info, adding or deleting designee for your firm.



Form
F252-022-000


 
Firm Vocational Provider Account Change

To change a firm's (payee provider's) branch address within the same service location, contact info, tax info, adding or deleting designee for your firm.



Form
F252-022-000


 
Firm Vocational Provider Account Change

To change a firm's (payee provider's) branch address within the same service location, contact info, tax info, adding or deleting designee for your firm.



Form
F252-022-000


 
First Aid

Safety Sticker size 5"x6"



Sticker
FSP1-005-000


 
Flood Damaged Manufactured Home Checklist

Checklist on how to repair a flood damaged manufactured home. After the contractor has done all that is required by the checklist they call L&I for an inspection.



Form
F622-040-000


 
Flood Damaged Manufactured Home Checklist

Checklist on how to repair a flood damaged manufactured home. After the contractor has done all that is required by the checklist they call L&I for an inspection.



Form
F622-040-000


 
Flood Damaged Manufactured Home Checklist

Checklist on how to repair a flood damaged manufactured home. After the contractor has done all that is required by the checklist they call L&I for an inspection.



Form
F622-040-000


 
Formulario de historial de empleo

Usado por el trabajador lesionado para reportar su historial de empleo y el salario de cada trabajo durante los últimos tres años



Form
F242-109-999



Alt Language(s):
Inglés
 
Formulario de historial de empleo

Usado por el trabajador lesionado para reportar su historial de empleo y el salario de cada trabajo durante los últimos tres años



Form
F242-109-999



Alt Language(s):
Inglés
 
Formulario de historial de empleo

Usado por el trabajador lesionado para reportar su historial de empleo y el salario de cada trabajo durante los últimos tres años



Form
F242-109-999



Alt Language(s):
Inglés
 
Formulario de queja en contra de un contratista de trabajores agrícolas

Usado para presentar una queja contra un contratista agrícola,  hacendado, empleador u otro en lo que se refiere a una infracción.



Form
F700-109-999



Alt Language(s):
Inglés
 
Formulario de queja en contra de un contratista de trabajores agrícolas

Usado para presentar una queja contra un contratista agrícola,  hacendado, empleador u otro en lo que se refiere a una infracción.



Form
F700-109-999



Alt Language(s):
Inglés
 
Formulario de queja en contra de un contratista de trabajores agrícolas

Usado para presentar una queja contra un contratista agrícola,  hacendado, empleador u otro en lo que se refiere a una infracción.



Form
F700-109-999



Alt Language(s):
Inglés
 
Formulario de queja en contra de un contratista de trabajores agrícolas

Usado para presentar una queja contra un contratista agrícola,  hacendado, empleador u otro en lo que se refiere a una infracción.



Form
F700-109-999



Alt Language(s):
Inglés
 
Formulario de queja en contra de un contratista de trabajores agrícolas

Usado para presentar una queja contra un contratista agrícola,  hacendado, empleador u otro en lo que se refiere a una infracción.



Form
F700-109-999



Alt Language(s):
Inglés
 
Formulario de queja sobre los derechos laborales

Formulario: queja sobre los derechos laborales.  Las versiones de octubre de 2010 y de diciembre 2011 son válidas.



Form
F700-148-999



Alt Language(s):
Inglés
 
Formulario de queja sobre los derechos laborales

Formulario: queja sobre los derechos laborales.  Las versiones de octubre de 2010 y de diciembre 2011 son válidas.



Form
F700-148-999



Alt Language(s):
Inglés
 
Formulario de queja sobre los derechos laborales

Formulario: queja sobre los derechos laborales.  Las versiones de octubre de 2010 y de diciembre 2011 son válidas.



Form
F700-148-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario de verificación de empleo

El trabajador lesionado debe completarlo si no puede trabajar debido a una lesión en el lugar de trabajo y su empleador no le está pagando su salario completo.  



Form
F242-052-999



Alt Language(s):
Inglés
 
Formulario para trasferencia de proveedor principal para trabajadores autoasegurados

Formulario: Es utilizado por los trabajadores autoasegurados que desean transferir su cuidado médico. Los trabajadores autoasegurados deben completar este formulario y enviarlo a su empleador o a su Representante de Terceros.



Form
F207-114-999



Alt Language(s):
Inglés
 
Formulario para trasferencia de proveedor principal para trabajadores autoasegurados

Formulario: Es utilizado por los trabajadores autoasegurados que desean transferir su cuidado médico. Los trabajadores autoasegurados deben completar este formulario y enviarlo a su empleador o a su Representante de Terceros.



Form
F207-114-999



Alt Language(s):
Inglés
 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
General Provider Billing Manual

General billing information for those providers that bill the department.



Manual
F248-100-000


 
General Provider Billing Manual

General billing information for those providers that bill the department.



Manual
F248-100-000


 
General Provider Billing Manual

General billing information for those providers that bill the department.



Manual
F248-100-000


 
Grinding Wheel - Prevent Accidents

Sticker size 4"x3"



Sticker
FSP1-000-000


 
Guía de beneficios de Compensación para los Trabajadores: para los empleados de empresas autoaseguradas

Folleto: Explica a los empleados de negocios autoasegurados sus derechos y responsabilidades bajo la ley de seguro industrial.  Describe los beneficios y como  presentar un reclamo.



Publication
F207-085-999



Alt Language(s):
Inglés
 
Guía de beneficios de Compensación para los Trabajadores: para los empleados de empresas autoaseguradas

Folleto: Explica a los empleados de negocios autoasegurados sus derechos y responsabilidades bajo la ley de seguro industrial.  Describe los beneficios y como  presentar un reclamo.



Publication
F207-085-999



Alt Language(s):
Inglés
 
Guía de beneficios de Compensación para los Trabajadores: para los empleados de empresas autoaseguradas

Folleto: Explica a los empleados de negocios autoasegurados sus derechos y responsabilidades bajo la ley de seguro industrial.  Describe los beneficios y como  presentar un reclamo.



Publication
F207-085-999



Alt Language(s):
Inglés
 
Guía de beneficios de Compensación para los Trabajadores: para los empleados de empresas autoaseguradas

Folleto: Explica a los empleados de negocios autoasegurados sus derechos y responsabilidades bajo la ley de seguro industrial.  Describe los beneficios y como  presentar un reclamo.



Publication
F207-085-999



Alt Language(s):
Inglés
 
Guía de beneficios de Compensación para los Trabajadores: para los empleados de empresas autoaseguradas

Folleto: Explica a los empleados de negocios autoasegurados sus derechos y responsabilidades bajo la ley de seguro industrial.  Describe los beneficios y como  presentar un reclamo.



Publication
F207-085-999



Alt Language(s):
Inglés
 
Guía para el contratista independiente - Una guía detallada para contratar contratistas independientes en el estado de Washington

Folleto: Una guía detallada para contratar contratistas independientes en el estado de Washington.  Esta publicación es una guía general para ayudarlo a entender cómo y cuándo el Departamento de Labor e Industrias aplica las leyes de compensación para los trabajadores a los contratistas independientes.



Publication
F101-063-999



Alt Language(s):
Inglés
 
Guía sobre la norma de comunicación de riesgos químicos

Folleto:  La norma de comunicación sobre los riesgos químicos se hizo efectiva el 15 de abril de 2013.  Se intenta mejorar el entendimiento de la información de peligro que se encuentra en las etiquetas de los productos.  El folleto incluye los requisitos de capacitación, preguntas y respuestas sobre quien está cubierto, pictogramas, descripciones de los peligros y todo lo que los empleadores necesitan saber y hacer para poder cumplir con la norma.

Los cambios están basados en el Sistema globalmente armonizado de clasificación y etiquetado de productos químicos (GHS, por su sigla en inglés).

 Esta publicación por el momento no está disponible debido a que hay revisiones en progreso.



Publication
F413-012-999



Alt Language(s):
中国的
Inglés
한국의
Vi?t
 
Guía sobre la norma de comunicación de riesgos químicos

Folleto:  La norma de comunicación sobre los riesgos químicos se hizo efectiva el 15 de abril de 2013.  Se intenta mejorar el entendimiento de la información de peligro que se encuentra en las etiquetas de los productos.  El folleto incluye los requisitos de capacitación, preguntas y respuestas sobre quien está cubierto, pictogramas, descripciones de los peligros y todo lo que los empleadores necesitan saber y hacer para poder cumplir con la norma.

Los cambios están basados en el Sistema globalmente armonizado de clasificación y etiquetado de productos químicos (GHS, por su sigla en inglés).

 Esta publicación por el momento no está disponible debido a que hay revisiones en progreso.



Publication
F413-012-999



Alt Language(s):
中国的
Inglés
한국의
Vi?t
 
Guía sobre la norma de comunicación de riesgos químicos

Folleto:  La norma de comunicación sobre los riesgos químicos se hizo efectiva el 15 de abril de 2013.  Se intenta mejorar el entendimiento de la información de peligro que se encuentra en las etiquetas de los productos.  El folleto incluye los requisitos de capacitación, preguntas y respuestas sobre quien está cubierto, pictogramas, descripciones de los peligros y todo lo que los empleadores necesitan saber y hacer para poder cumplir con la norma.

Los cambios están basados en el Sistema globalmente armonizado de clasificación y etiquetado de productos químicos (GHS, por su sigla en inglés).

 Esta publicación por el momento no está disponible debido a que hay revisiones en progreso.



Publication
F413-012-999



Alt Language(s):
中国的
Inglés
한국의
Vi?t
 
Guía sobre la norma de comunicación de riesgos químicos

Folleto:  La norma de comunicación sobre los riesgos químicos se hizo efectiva el 15 de abril de 2013.  Se intenta mejorar el entendimiento de la información de peligro que se encuentra en las etiquetas de los productos.  El folleto incluye los requisitos de capacitación, preguntas y respuestas sobre quien está cubierto, pictogramas, descripciones de los peligros y todo lo que los empleadores necesitan saber y hacer para poder cumplir con la norma.

Los cambios están basados en el Sistema globalmente armonizado de clasificación y etiquetado de productos químicos (GHS, por su sigla en inglés).

 Esta publicación por el momento no está disponible debido a que hay revisiones en progreso.



Publication
F413-012-999



Alt Language(s):
中国的
Inglés
한국의
Vi?t
 
Guía sobre la norma de comunicación de riesgos químicos

Folleto:  La norma de comunicación sobre los riesgos químicos se hizo efectiva el 15 de abril de 2013.  Se intenta mejorar el entendimiento de la información de peligro que se encuentra en las etiquetas de los productos.  El folleto incluye los requisitos de capacitación, preguntas y respuestas sobre quien está cubierto, pictogramas, descripciones de los peligros y todo lo que los empleadores necesitan saber y hacer para poder cumplir con la norma.

Los cambios están basados en el Sistema globalmente armonizado de clasificación y etiquetado de productos químicos (GHS, por su sigla en inglés).

 Esta publicación por el momento no está disponible debido a que hay revisiones en progreso.



Publication
F413-012-999



Alt Language(s):
中国的
Inglés
한국의
Vi?t
 
Guide to the Hazard Communication Rule (Vietnamese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-555



Alt Language(s):
中国的
Inglés
한국의
Español
 
Guide to the Hazard Communication Rule (Vietnamese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-555



Alt Language(s):
中国的
Inglés
한국의
Español
 
Guide to the Hazard Communication Rule (Vietnamese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-555



Alt Language(s):
中国的
Inglés
한국의
Español
 
Guide to the Hazard Communication Rule (Vietnamese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-555



Alt Language(s):
中国的
Inglés
한국의
Español
 
Guide to the Hazard Communication Rule (Vietnamese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publication
F413-012-555



Alt Language(s):
中国的
Inglés
한국의
Español
 
HB 2253 Open Window Opportunity - Affidavit of Hours of Unsupervised Telecommunications Installation Experience

This form is not available until June 12.



Form
F500-127-000


 
HB 2253 Open Window Opportunity - Affidavit of Hours of Unsupervised Telecommunications Installation Experience

This form is not available until June 12.



Form
F500-127-000


 
Hearing Aid Repair Authorization Fax Request

Hearing Aid Repair Authorization Requests. le="font-size: small;">If you need to purchase or replace a hearing aid, fax all of the information required by Medical Aid Rules and Fee Schedule (MARFS) including the le="color: #0000ff; font-size: small;">le="color: #0000ff; font-size: small;">Hearing Services Worker Information le="font-size: small;">(F245-049-000) to 360-902-6252.



Form
F245-384-000


 
Hearing Services Worker Information

This is a list of the rights and conditions when an injured worker applies for hearing aids.



Form
F245-049-000


 
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)

Identifies the effects of heat exhaustion and heat stroke on the body and what to do if you observe symptoms. Reviews prevention steps. PDF file is set up for two copies to print at one time.

Tarjeta: Identifica los efectos del agotamiento por el calor y la insolación en el cuerpo y lo que puede hacer si observa estos síntomas. Revisa los pasos para la prevención.  El archivo en PDF está configurado para que se impriman dos copias al mismo tiempo.



Publication
F417-218-909


 
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)

Identifies the effects of heat exhaustion and heat stroke on the body and what to do if you observe symptoms. Reviews prevention steps. PDF file is set up for two copies to print at one time.

Tarjeta: Identifica los efectos del agotamiento por el calor y la insolación en el cuerpo y lo que puede hacer si observa estos síntomas. Revisa los pasos para la prevención.  El archivo en PDF está configurado para que se impriman dos copias al mismo tiempo.



Publication
F417-218-909


 
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)

Identifies the effects of heat exhaustion and heat stroke on the body and what to do if you observe symptoms. Reviews prevention steps. PDF file is set up for two copies to print at one time.

Tarjeta: Identifica los efectos del agotamiento por el calor y la insolación en el cuerpo y lo que puede hacer si observa estos síntomas. Revisa los pasos para la prevención.  El archivo en PDF está configurado para que se impriman dos copias al mismo tiempo.



Publication
F417-218-909


 
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)

Identifies the effects of heat exhaustion and heat stroke on the body and what to do if you observe symptoms. Reviews prevention steps. PDF file is set up for two copies to print at one time.

Tarjeta: Identifica los efectos del agotamiento por el calor y la insolación en el cuerpo y lo que puede hacer si observa estos síntomas. Revisa los pasos para la prevención.  El archivo en PDF está configurado para que se impriman dos copias al mismo tiempo.



Publication
F417-218-909


 
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)

Identifies the effects of heat exhaustion and heat stroke on the body and what to do if you observe symptoms. Reviews prevention steps. PDF file is set up for two copies to print at one time.

Tarjeta: Identifica los efectos del agotamiento por el calor y la insolación en el cuerpo y lo que puede hacer si observa estos síntomas. Revisa los pasos para la prevención.  El archivo en PDF está configurado para que se impriman dos copias al mismo tiempo.



Publication
F417-218-909


 
Help for Crime Victims (large poster)

Poster (11" X 17"): Highlights the Crime Victims Compensation Program and provides contact information. Intended for display in health-care, criminal-justice and social-service organizations. Can be downloaded and printed, or ordered from L&I. Smaller version is also available (8.5" X 11"). Get 11" X 17" poster printing tips.



Poster
F800-041-000



Alt Language(s):
Español
 
Help for Crime Victims (small poster)

Poster (8.5" X 11"): Highlights the Crime Victims Compensation Program and provides contact information. Intended for display in health-care, criminal-justice, and social-service organizations. Can be downloaded and printed, or ordered from L&I. Larger version is also available (11" X 17").



Poster
F800-104-000



Alt Language(s):
Español
 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring teens? / ¿Piensa contratar adolescentes? (English/español)

Fact sheet: Provides important information about hiring teens, including extra safety precautions, as well as legal requirements regarding minor work endorsement, hours and prohibited duties. Provides telephone, e-mail and Web contacts for more information.

Hoja de información:  Proporciona información importante sobre la contratación de adolescentes, incluyendo precauciones adicionales de seguridad, así como también los requisitos legales referentes al endoso de trabajo para menores, horas y tareas prohibidas.  Proporciona un teléfono, correo electrónico y contactos en la página Web para más información.

 



Publication
F700-142-909


 
Historia de trabajo - pérdida de audición

Hoja de continuación del formulario, Historia de la pérdida de audición.



Form
F262-013-999


 
Historia de trabajo - pérdida de audición

Hoja de continuación del formulario, Historia de la pérdida de audición.



Form
F262-013-999


 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Historial de trabajo (enfermedad ocupacional)

El trabajador lesionado llena este documento para presentar su historia de trabajo.  El formulario de continuación a esta página es F242-071-911.



Form
F242-071-999



Alt Language(s):
Inglés
Español
 
Hoja para contratar un contratista con éxito

Lista de comprobación: Proporciona información para ayudar a seleccionar posibles contratistas para proyectos de construcción de casas o reparación/remodelación.  Presentado en un formato organizado y detallado.



Publication
F625-111-999



Alt Language(s):
Inglés
 
Homeowners Manufactured / Mobile Home Variance Request

This variance request applies only to the installations performed by a previous owner and does not apply to any home during the warranty period.



Form
F622-054-000


 
Homeowners Manufactured / Mobile Home Variance Request

This variance request applies only to the installations performed by a previous owner and does not apply to any home during the warranty period.



Form
F622-054-000


 
Homeowners Manufactured / Mobile Home Variance Request

This variance request applies only to the installations performed by a previous owner and does not apply to any home during the warranty period.



Form
F622-054-000


 
How To Calculate Your Wage in Agriculture

Fact/Information sheet: Shows piece rate workers how to calculate their wages to check if they are being paid minimum wage.



Publication
F700-171-000



Alt Language(s):
Español
 
How To Calculate Your Wage in Agriculture

Fact/Information sheet: Shows piece rate workers how to calculate their wages to check if they are being paid minimum wage.



Publication
F700-171-000



Alt Language(s):
Español
 
How To Calculate Your Wage in Agriculture

Fact/Information sheet: Shows piece rate workers how to calculate their wages to check if they are being paid minimum wage.



Publication
F700-171-000



Alt Language(s):
Español
 
How To Calculate Your Wage in Agriculture

Fact/Information sheet: Shows piece rate workers how to calculate their wages to check if they are being paid minimum wage.



Publication
F700-171-000



Alt Language(s):
Español
 
How to Protest a Department of Labor and Industries Decision / Cómo protestar una decisión en su reclamo del Departamento de Labor e Industrias (English/español)

Fact sheet: Explains how an injured worker can protest decisions on his/her claim and gives deadlines for taking action.

Hoja de información:  Explica como un trabajador