Order Self Insurer Accident Report (SIF-2) Form

You now have 2 options for ordering SIF-2s. You may order:

The paper forms as usual (in bundles of 100), with the claim numbers pre-printed on them,
OR
Claim numbers (in bundles of 100), for use with our Microsoft Word® version of the SIF-2. This option requires that you do all of the following:
- Keep track of the claim numbers assigned to you.
- Key in a unique claim number (from those assigned to you) in the top right hand corner of the Word® form for each new claim.
- Use electronic signatures OR print and sign.
- Send the completed SIF-2 to the Department by faxing to 360-902-6900 or by postal mail.
- Provide to the worker an electronic or printed copy of A Guide to Industrial Insurance Benefits for Employees of Self-insured Businesses (Form F207-085-000 6/2010 version)

Note: Only self-insured businesses or their third party claims administrators can order SIF-2 forms.

Order Self Insurer Accident Report (F207-002-000) Forms
Order Self Insurer Accident Report Forms (F207-002-000)
* Enter your request in the spaces below.	indicates required field
Word® document (fill, save, print) This version requires you order a series of claims numbers, insert the claim numbers in the top right hand corner, and keep track of assigned claim numbers. Paper forms Claim number is pre-filled.
* How many bundles of 100 forms or sets of 100 claim numbers?
* Assign these forms to: (self-insured company name)
* Self-insured Account ID:
* Contact name:
* Contact phone:	-- Ext:
Email forms (Word version) and Claim #s to:
* Email address:
Mail paper forms to:
* Business name:
* Mailing address:
Mailing address (cont.):
* City, State, and Zip:
Click to submit >

Labor & Industries (L&I), Washington State