Forms and Publications

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Title Number / Language
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses  F207-085-000 (English)
 F207-085-999 (Spanish)
Affidavit for Time Loss Compensation Benefits  F242-395-000 (English)
 F242-395-999 (Spanish)
Application for Benefits - Homicide Claims  F800-120-000 (English)
 F800-120-999 (Spanish)
Application for Benefits - Injury Claims  F800-042-214 (Cambodian)
 F800-042-220 (Chinese Simplified)
 F800-042-221 (Chinese Traditional)
 F800-042-000 (English)
 F800-042-255 (Korean)
 F800-042-294 (Russian)
 F800-042-303 (Somali)
 F800-042-999 (Spanish)
 F800-042-319 (Vietnamese)
Beneficiary Application for Claim Benefits  F242-056-000 (English)
 F242-056-303 (Somali)
 F242-056-999 (Spanish)
Crime Victims’ Application for Benefits – Homicide Claims  F800-120-214 (Cambodian)
 F800-120-220 (Chinese Simplified)
 F800-120-221 (Chinese Traditional)
 F800-120-255 (Korean)
 F800-120-294 (Russian)
 F800-120-303 (Somali)
 F800-120-319 (Vietnamese)
Declaration of Entitlement - Disabled Child or Guardian Benefits  F242-421-000 (English)
 F242-421-999 (Spanish)
Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance  F242-422-000 (English)
 F242-422-999 (Spanish)
Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance  F242-423-000 (English)
 F242-423-249 (Japanese)
 F242-423-294 (Russian)
 F242-423-999 (Spanish)
Employee Paid Sick Leave Benefits Notification  F700-191-000 (English)
 F700-191-999 (Spanish)
How Social Security Benefits May Reduce Your Workers' Compensation Payments  F242-427-000 (English)
 F242-427-999 (Spanish)
L&I Benefits for Workers Who Are Terminally Ill  F252-094-000 (English)
Pension and Survivor Benefits in Washington State's Workers' Compensation Program  F242-352-909 (English/Spanish)
Pension Benefits Questionnaire  F242-393-000 (English)
 F242-393-999 (Spanish)
Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers  F207-011-000 (English)
Request for Discretionary Over 7/10 Disability Benefits  F242-428-000 (English)
 F242-428-999 (Spanish)
Request for Survivor Counseling Benefits  F800-057-909 (English/Spanish)
Workers' Compensation Benefits: A Guide for Injured Workers  F242-104-000 (English)
 F242-104-999 (Spanish)

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