Get a Form or Publication: record

Your search for "record" returned 41 documents.

Title Type Number
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
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
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
Employment History Form
Also available in: Spanish

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
Internal Revenue Service Tax Compliance Certification

Form to gain Internal Revenue Service Tax Compliance Certification for registered Farm Labor Contractors. Now includes IRS form 8821 Tax Information Authorization.

Form F700-098-000
Interpretive Services Appointment Record

Used when an interpreter is appointed to interpret for an injured worker during their medical visits.

Form F245-056-000
Request for Public Records

To request public records from Washington State Dept. of Labor and Industries. You can order an earlier version from the LNI warehouse until stock is exhausted.

Form F101-009-000
Training Plan Cost Encumbrance

To record the training costs. For use only with plans approved after 1/1/2008.

Form F245-374-000
Transportation Cost Encumbrance

To record the costs for transportation. For use only with plans approved after 1/1/2008.

Form F245-375-000
Worker's Compensation Insurance Manual Chapter 296-17 WAC General Reporting Rules, Audit, and Recordkeeping

This chapter applies to employer reporting requirements for workers compensation insurance.

Manual F213-170-000
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
Apprentice Work Progress Record

Worksheets used to record the number of hours worked and Related Supplemental Instruction hours during a registered apprenticeship on a monthly basis. If used, a copy is usually given to the program monthly.

Form F100-002-000
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
Computing Worker Hours

Quick reference card: Shows employers how to figure workers' compensation premiums for different types of employees: hourly employees, salaried employees, commissioned personnel or employees paid for piecework. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.

Publication F214-014-000
Corporate Officers

Quick reference card: Explains the criteria to allow a corporate officer to be exempt from industrial insurance (workers' compensation) coverage. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.

Publication F214-010-000
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 Revenue Tax Compliance Certification

Form to gain Department of Revenue Tax Compliance Certification for registered Farm Labor Contractors.

Form F700-100-000
Employers' Guide to Self-Insurance in Washington State

Book: Explains the process for employers to provide their own industrial insurance (workers’ compensation) coverage in Washington State. Also reviews surety requirements for self-insurance, reporting and recordkeeping requirements, claims processing, and compliance and legal issues.

Publication F207-079-000
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
Guide to Crew Safety Meetings

Pamphlet/booklet: Provides a succinct guide to conducting crew safety meetings for general industry and the construction industry. Includes a format for recording meeting minutes.

Publication F417-043-000
Housing and Board Cost Encumbrance

To record the costs for housing and board. For use only with plans approved after 1/1/2008.

Form F245-372-000
Independent Contractors

Quick reference card: Provides information to help determine whether a "subcontractor" working for you meets the legal requirements to be an independent contractor, or whether he/she is actually a covered worker for workers' compensation (industrial insurance) purposes. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.

Publication F214-012-000
Limited Liability Companies (LLC)

Quick reference card: Reviews the requirements for members or managers of limited liability companies to be exempt from workers' compensation (industrial insurance) coverage. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.

Publication F214-021-000
Log of Good Faith Effort Documentation

This is for Registered Apprenticeship Programs to record Good Faith Effort activities in accordance with their Registered Apprenticeship Standards (Equal Employment Opportunity Plan)

Form F100-515-000
Logging Emergency Medical Plan (Logging Safety and Health Meetings)

Use this two part form for employers to record work locations and emergency rescue info and for holding safety meetings for each new jobsite

Form F417-014-000
Minutes of Apprenticeship Committee Meeting

Example of how the minutes for an Apprenticeship Committee meeting should be recorded. Submit this to L&I Apprenticeship section within 30 days of the meeting.

Form F100-029-000
Plan Time Encumbrance

To record the work plan time. For use only with plans approved after 1/1/2008.

Form F245-376-000
Program Equal Employment Opportunity Activity Documentation

Used to record individual equal employment opportunity activities conducted by Apprenticeship Programs.

Form F100-012-000
Record Keeping

Quick reference card: Identifies the type of records employers, including construction contractors, need to keep to allow L&I to compute premiums. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.

Publication F214-011-000
Record Keeping Provisions - Employment Standards

This form is for employers to use to keep records on every employee.

Form, Publication F700-009-000
Request for Archive Records - Contractor Registration

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

Form F625-094-000
Request for Assistance in Obtaining Certified Payroll Records

Used to request copies of Certified Payrolls for prevailing wage projects.

Form F700-141-000
Safety Meeting Minutes
Also available in: Spanish

Use this form to record the minutes from your safety meetings - these records must be retained for one year from the date of each meeting

Form F417-087-000
Safety Meeting Minutes - Spanish - Actas De La Reúnion de Seguridad
Also available in: English

Use this form to record the minutes from your safety meetings - these records must be retained for one year from the date of each meeting

Form F417-087-999
Standard Exception Classification

Quick reference card: Provides basic information about standard exception classifications, which can be separately rated from the basic business classification for determining industrial insurance (workers' compensation) premiums. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.

Publication F214-016-000
Stay at Work Expense Reimbursement Application for Employers Tools, Clothing, Training.

Employer of record can request reimbursement for tools, clothing, or training expenses required to enable an injured worker to return to light duty or transitional work. After completing the form, the employer submits it, along with supporting documentation, to the Stay at Work program for review and approval. For wage reimbursements see F243-001-000.

Form F243-003-000
Stay at Work Wage Reimbursement Application for Employers

Employer of record can request reimbursement for wages paid to an injured worker during light duty or transitional work. After completing the form, the employer submits it, along with supporting documentation, to the Stay at Work program for review and approval. For expense reimbursements see F243-003-000.

Form F243-001-000
Wage Transcription and Computation Sheet

Employer uses this to show time worked and wages earned for an employee.

Form F700-024-000
Workers' Compensation Record Keeping and Reporting Guides

Packet: Contains eight quick reference cards covering topics related to workers' compensation record keeping and reporting. Topics include: computering worker hours, standard exception classifications, excluded employments and corporate officers.

Publication F212-222-000
Your Daily Record of Hours Worked (English/Spanish) / Su Registro de Horas Trabajadas

Pamphlet/booklet: A pocket-sized bilingual booklet to encourage agricultural workers to keep track of their daily work hours and earnings.

Publication F700-105-909
Your Privacy Is Important to Us (English/Spanish)

Fact sheet: Serves as L&I's official privacy notice. States how L&I may use and share the pesonal information it collects. It also informs the public how they can file a complaint if they believe L&I has misused or inappropriately disclosed their personal information.

Publication F101-055-909

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