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Application for Inclusion on List of Eligible Attorneys
Used by attorneys to be included on the Workers' Compensation Special Assistant Attorney General Program eligible list for Third Party claims.

Form
F249-017-000
 
Construction Checklist - Safety

Construction Checklist - Safety



Form
F418-055-000

Alt Language(s):
Español
 
Construction Checklist - Safety - Spanish - Lista de Verificación de Seguridad en la Construcción

Construction Checklist - Safety - Spanish - Lista de verificación de seguridad en la construcción



Form
F418-055-999

Alt Language(s):
Inglés
 
Pre-Inspection Checklist for Hot Water Heating or Hot Water Supply Boilers
Checklist which reflects the most common violations encountered by Field Inspectors. This checklist should be gone through prior to requesting inspection of Hot Water Heating or Hot Water Supply Boilers

Form
F620-050-000
 
Pre-Inspection Checklist for Potable Water Heaters - ASME "HLW" Stamped Water Heaters
Checklist which reflects the most common violations found by Field Inspectors. This checklist should be gone through prior to calling for an inspection of Potable Water Heaters-HLW

Form
F620-051-000
 
Pre-Inspection Checklist for Low Pressure Steam Boilers

Checklist which reflects the most common violations found by Field Inspectors. This checklist should be gone through prior to calling for an inspection of Low Pressure Steam Boilers



Form
F620-052-000
 
Pre-Inspection Checklist for High Pressure Boilers

Checklist which reflects the most common violations found by Field Inspectors. This checklist should be gone through prior to calling for an inspection of High Pressure Boilers



Form
F620-053-000
 
Inservice Inspection checklist
Inservice Inspection checklist for power boilers, low pressure boilers, pressure vessels, and hot water boilers.

Form
F620-060-000
 
New Elevator Installation Checklist

Checklist for the elevator company/contractor to complete before the call L&I for an elevator inspection. Includes DEc 2010 letter on ASME checklists.



Form
F621-057-000
 
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 -Spanish Lista de Comprobación para la Preinspección de Seguridad contra Incendios

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



Form
F622-011-999

Alt Language(s):
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
 
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
 
Wood / Pellet Stove / Fireplace Pre-Inspection Checklist

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



Form
F622-015-000
 
Low Voltage Fire / Intrusion Alarm Checklist

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



Form
F622-038-000
 
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
 
Steel or Wrought-Iron Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing steel or wrought-iron gas line. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-044-000
 
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
 
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
 
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
 
Vendor / Medical Conversion Units Pre-Inspection Checklist

Pre-Inspection Checklist to assist vendor owners, manufacturers, and others on what they need to know to get their vendor/medical unit approved by Labor and Industries.



Form
F622-072-000
 
RCW 43.22.380 Exemptions Fire and Safety Checklist for Vendor/Medical Conversion Units
Generic Checklist to determine if the particular installation includes all requirements prior to calling for an inspection. Must be able to answer YES to all questions prior to calling.

Form
F622-073-000
 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-000

Alt Language(s):
Español
 
Lista de Comprobacion para un Contratista de Trabajores Agrícolas (Farm Labor Contactor Checklist)

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-999

Alt Language(s):
Inglés
 
Interested Party Checklist for the Filing of Prevailing Wage Complaints

Checklist used for the filing of Prevailing Wage Complaints by "Interested parties" ONLY.



Form
F700-129-000
 
Restaurant Employee Safety Orientation Checklist
Fact Sheet: Download this checklist to help with the safety orientation of new restaurant employees.

Publication
F700-140-000
 
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 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
 
Washington State Apprenticeship Programs Catalog
Book: Provides an overview of apprenticeship, explains general requirements, lists the apprenticeship programs in Washington State and, and provides contact information. The version available online may contain more up-to-date information than the June 2012 printed edition.

Publication
F100-041-000
 
Request for Recognition of Apprenticeship Committee

Used to establish a new apprenticeship committee and list it's employer/employee representatives.



Form
F100-504-000
 
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
 
Workplace Posters: Required and Recommended
Fact sheet: Lists posters that Washington State and federal agencies require or recommend employers post in their places of business. The URLs for posters available online and and telephone numbers to request printed posters are also provided. Also includes online resources and contact numbers for state agencies that issue posters.

Poster
F101-054-000
 
Field Operations-Regional Boundaries and Office Information

Fact sheet: Shows which L&I region serves which counties and the location of offices. Side Two lists the address and telephone number for each office.



Publication
F101-100-000
 
Five Steps to File
Flyer: Reviews the steps for filing workers' compensation quarterly reports online and lists the filing due dates.

Publication
F212-243-000
 
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
 
Excluded and Exempt Employments

Quick reference card: Provides a list of employments excluded from workers' compensation coverage, including those eligible for optional coverage. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.



Publication
F214-013-000
 
Notice of Completion of Public Works Contract

This is the form used by public agencies to request L&I's approval to release retainage. All contractors are to be listed on the request form with their associated affidavit id number.  Notices received without affidavit id numbers or incomplete information will not be processed and will be returned to the awarding agency. The first EXCEL document is in Office 2007 format. The second file, with the same title, is in Office 2003 format.



Form
F215-038-000
 
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
 
Independent Medical Examination (IME) Provider Exam Sites

List the locations where the doctor does independent medical exams on a regular basis.



Form
F245-047-000
 
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
 
Payroll Service Provider - Quarterly Reporting Bulk Filing Enrollment Form

Used by payroll services to enroll and register with L&I for downloading/uploading account information from the Express Filing site using an electronic list (text file) of accounts.



Form
F248-343-000
 
Retrospective Rating Adjustment Protest

Used by employers to present L&I with a list of decisions they are protesting by adjustment period. The form requests all necessary elements needed for L&I to process a request for reconsideration.



Form
F250-024-000
 
Plan Development 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 plan. Can be used by VRCs as a tool. DO NOT SUBMIT TO L&I.



Form
F280-007-000
 
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
 
OJT Information Request and Recommendation form

VRCs can use this form to request information on a specific on -the -job (OJT) training opportunity listed on L&I's website, or to recommend an OJT training opportunity.



Form
F280-032-000
 
Chemical Hazard Communication: Helpful information for employers
Book: Provides employers a checklist on the requirements of the chemical hazard communication rule. Contains an extensive question-and-answer section and information on starting an employee-training program.

Publication
F413-012-000

Alt Language(s):
中国的
한국의
Español
Việt
 
Chemical Hazard Communication: Helpful information for employers (Vietnamese)
Book: Provides employers a checklist on the requirements of the chemical hazard communication rule. Contains an extensive question-and-answer section and information on starting an employee-training program.

Publication
F413-012-555

Alt Language(s):
中国的
Inglés
한국의
Español
 
Chemical Hazard Communication: Helpful information for employers (Korean)
Book: Provides employers a checklist on the requirements of the chemical hazard communication rule. Contains an extensive question-and-answer section and information on starting an employee-training program.

Publication
F413-012-777

Alt Language(s):
中国的
Inglés
Español
Việt
 
Chemical Hazard Communication: Helpful information for employers (Chinese)
Book: Provides employers a checklist on the requirements of the chemical hazard communication rule. Contains an extensive question-and-answer section and information on starting an employee-training program.

Publication
F413-012-888

Alt Language(s):
Inglés
한국의
Español
Việt
 
Comunicación sobre Peligros Químicos: Información Útil para los Empleadores

Book: Provides employers a checklist on the requirements of the chemical hazard communication rule. Contains an extensive question-and-answer section and information on starting an employee-training program.



Publication
F413-012-999

Alt Language(s):
中国的
Inglés
한국의
Việt
 
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 - 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
 
Pocket Guide to Caution Zone Jobs

Pamphlet/booklet: This advisory pocket guide reviews 14 workplace risk factors that can lead to soft tissue injuries such as back strain, tendinitis and carpal tunnel syndrome. Suggests ways to identify the risk factors. Lists helpful resources from L&I.



Publication
F417-195-000
 
Forklift Safety: Training requirements and helpful tips

Fact sheet: Provides answers to the most-often asked questions about forklift training. Includes a checklist that employer may use to document that employees have been trained and/or evaluated in the required topics.



Publication
F417-202-000
 
Tractor Safety: Rollover Protection and Seatbelts

Pamphlet: Summarizes the safety rules for rollover protective structures (ROPS) and seatbelts on tractors. Also lists exemptions and provides other information about safe operation of tractors.



Publication
F417-234-000

Alt Language(s):
Español
 
Tractor Safety: Rollover Protection and Seatbelts (Seguridad con los tractores: Proteccin contra vuelcos ylos cinturones de seguridad)
Pamphlet: Summarizes the safety rules for rollover protective structures (ROPS) and seatbelts on tractors. Also lists exemptions and provides other information about safe operation of tractors.

Publication
F417-234-999

Alt Language(s):
Inglés
 
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
 
Online Electrical Services: Tools for Property Owners, Contractors and Electricians
Fact Sheet: Describes the online services available from L&I's Electrical Program, including URLs for different topics covered on the Web, how to sign up for the Electrical listserv (to receive updates by e-mail), and how to sign up for the monthly e-newsletter, also provided by e-mail.

Publication
F500-113-000
 
Alteration Re-Roofing for Low Slope Roofing

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



Form
F622-039-000
 
Panel Load Calculations

Listing of Connected Loads and the Demand Loads. Used for all appliances that are fastened in place, permanently connected on specific circuit. Single Phase Panel Schedule and Three Phase Panel Scheule inlcude. Sample diagram included.



Form
F623-017-000
 
What You Should Know About Hiring a Contractor, Remodeler, or Handyman

Pamphlet/booklet: Provides a checklist for consumers considering hiring a general or specialty construction contractor, reviews the permitting process, and suggests ways to avoid lien problems. Washington State law requires contractors to register with L&I.



Publication
F625-084-000

Alt Language(s):
Español
 
What You Should Know About Hiring a Contractor, Remodeler, or Handyman - Spanish (Lo que Usted Debe Saber paraContratar a un Contratista, Remodelador o Empleado de Mantenimiento (Handyman))  

Fact sheet: Provides a checklist for consumers considering hiring a general or specialty construction contractor, reviews the permitting process, and suggests ways to avoid lien problems. Washington State law requires construction contractors to register with L&I.



Publication
F625-084-999

Alt Language(s):
Inglés
 
Protect My Home Hire Smart Worksheet

Checklist: Provides information to help screen potential contractors for home construction or repair/remodel projects. Presented in an organized, step-by-step format.



Publication
F625-111-000
 
Hoja para Contratar un Contratista con Éxito

Lista: Proporciona información para ayudar a  escrutinar  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
 
Parent / School Authorization for Employment of a Minor and Special Variance

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

For hiring youth only during non-school weeks, you may use form F700-168-000 Parent Authorization Summer Work  



Form
F700-002-000
 
Congratulations! You've been approved to hire minors
Card: Reminds employers of special work rules for employees under age 18. Lists key points and provides a Web address for where to find more detailed information. Sent to all employers who obtain a minor work permit endorsement on the master business license.

Publication
F700-136-000
 
Youth in Construction - English/Spanish (Adolescentes en construcción)
Booklet/pamphlet: Explains the limits on work teens under age 18 can perform in the construction industry, discusses the importance of training and emphasizes safety. Includes a checklist of "do's" and "don'ts" for employers, plus other resources.

Publication
F700-145-909
 
Statement of Intent to Pay Prevailing Wages Addendum A

Please use this addendum to list additional Crafts/Trades/Occupations when you need to add more Crafts/Trades/Occupations than the Statement of Intent to Pay Prevailing Wages form can accommodate. Addendum A is for form F700-029-000.



Form
F700-160-000
 
Parent Authorization Summer Work

This form is for summer employment of minors, only, and is for parents or legal guardians to approve the hours and work activities for a minor employee to work according to terms listed by the employer.  All parties must sign to approve the work schedule and duties for a minor prior to permitting them to work.  This is NOT a work permit.  Employers must obtain a minor work permit endorsement on their Business License where they employ workers under 18.



Form
F700-168-000
 
Subscription Request for Construction Contractor and Electrical Basic - CD

This form is to be used to purchase the CD ROM of registered construction contractors, registered electrical contractors, plumbers and electricians.



Form
F625-051-000
 





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