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 Si usted TIENE que remover este resguardo 8.5 x 5.5


Sticker: 8.5 inches X 3.5 inches

FSP0-993-999

3 Things to Know About L&I's Medical Provider Network - Spanish (3 Cosas que Debe Conocer Sobre la Red de Proveedores Médicos de L&I)


 

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.

 

F242-406-999

A Guide to Workplace Safety and Health in Washington State-Spanish (Una Guía de Seguridad y Salud del Lugar de Trabajo en el Estado de Washington)


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

F416-132-999

Accountability Agreement - (Spanish) Acuerdo de Responsabilidad


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.

F280-016-999

Address Change Request for Injured Workers - (Spanish) Solicitud para Cambio de Direccion para Trabajadores Lesionados


Completed and signed by a State Fund injured worker to notify L&I of a change in address. All address changes must be submitted in writing and signed by the injured worker.

F242-388-999

Address Change Request for Pensioners - (Spanish) Solicitud para Cambio de Direccion para Pensionados


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.

F242-107-999

Affidavit_for_Time_Loss_Compensation_Benefits (Spanish) Declaración Firmada para Compensación de Tiempo Perdido


Affidavit_for_Time_Loss_Compensation_Benefits (Spanish) Declaración Firmada para Compensación de Tiempo Perdido 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 F242-052-999 Worker Verification Form.

F242-395-999

Agreement - Farm Labor Contractors and Workers - Spanish - Acuerdo entre Contratistas Agrícolas y Trabajadores


Employment wages and conditions agreement with Farm Labor Contractors and Workers

F700-046-999

Agricultural Employment Standards - Chapter 296-131 WAC (Spanish) Estándares de Trabajo Agrícola


Agricultural Employment Standards - Chapter 296-131 WAC (Spanish) Estándares de Trabajo Agrícola

F700-085-999

Alleged Safety Or Health Hazards (DOSH Complaint Form) Spanish - Presuntos Riesgos de Salud y Seguridad (Formulario de Queja de DOSH)


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

F418-052-999

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.

F622-011-999

Aplicando para su Licencia de Negocio en Washington: Una Guía Detallada


Pamphlet: Concise, easy-to-read pamphlet that explains the steps to apply for a business license and what to do if you plan to employ workers. Includes how to apply to be a registered construction contractor.

F101-079-999

Application for Benefits- Crime Victims Spanish - Instrucciones para: Solicitud para Beneficios para Víctimas de Crimen


Instructions in Spanish to complete the English form F800-042-000 Application for Crime Victim benefits. The form is 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. This 12-10 version is internet only.

F800-042-999

Application for L.E.P. Compensation Medical (Spanish) Solicitud para Compensación por Reducción de Ingresos (Médicos)


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

F242-208-909

Application for Pension Benefits by Spouse or Children - (Spanish) Aplicación para Beneficios de Pensión Presentado por el Cónyuge o Hijos


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.

F242-391-999

Application to Reopen Claim - Spanish Aplicación para Reabrir un Reclamo Debido al Empeoramiento de la Condición


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.

F800-031-999

Application to Reopen Claim due to Worsening Condition - Spanish Aplicación para Reabrir un Reclamo Debido al Empeoramiento de la Condición 


Spanish version. 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.

F242-079-999

Application to Reopen Claim due to Worsening Condition - Spanish APLICACIÓN PARA REABRIR UN RECLAMO


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.

F242-079-909

Assessing Your Ability to Work: Your Rights and Responsibilities -- Spanish (Evaluando su Capacidad para Trabajar: Sus Derechos y Responsabilidades, Servicios de Rehabilitación Vocacional)


Booklet: Explains the basics of the assessment phase of vocational services to injured workers. L&I sends this booklet to injured workers when they are referred for assessment services.

F280-017-999

Authorization for Deposit of Payments Spanish Autorización para Depósitos de Pagos (English/Spanish)


Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution. NOTE: F242-177-999 is the Direct Deposit Letter in Spanish

F242-174-909

Autorización para Proveer Información de Reclamos


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.

F101-010-999

Avoid Liability for Your Farm Labor Contractor's Unpaid Debits (English/Spanish) / Evite su Obligación por las Deudas no Pagadas de su Contratista de Trabajadores Agrícolas


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.

F700-154-909

Beneficios de Compensación para los Trabajadores: Una guía para los Trabajadores Lesionados - English (Workers' Compensation Benefits: A Guide for Injured Workers)


Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la ley de seguro industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: Anteriormente titulado, Guía de Beneficios del Seguro Industrial para los Trabajadores.  

F242-104-999

Cómo calcular su salario en agricultura - (English) How To Calculate Your Wage in Agriculture


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

F700-171-999

Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas


Used by only self-insured employers to comply with WAC 296-15-400. The form provides information and instructions to employees of self-insured employers in case of an injury or development of an occupational disease.

F207-155-999

Cartel - PELIGRO


Large lettering: PELIGRO

FSP1-030-999

Casas prefabricadas y mviles: Lo que los dueos de casas y contratistas deben saber al modificar una vivienda


Pamphlet/booklet: Covers things you should consider when altering your home. Defines what is meant by alteration, repair and replacement and includes tips for hiring a registered contractor. It also includes contact information for L&I Consumer Assistance Program for owners of new manufactured/mobile homes.

F622-049-999

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

Claim for Pension by Spouse or Children -  Reclamo para Beneficios de Pensión Presentado por el Cónyuge, Pareja Doméstica Registrada o los Hijos (Spanish)


Used by a spouse or dependents of a deceased worker. The workers' fatal accident or occupational disease incurred in the course of their employment. This application is needed to determine if applicant(s) is/are entitled to a survivor benefit.

F242-056-999

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.

F413-012-999

Construction Checklist - Safety - Spanish - Lista de Verificación de Seguridad en la Construcción


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

F418-055-999

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.

F242-071-911

Contratistas de Construcción: Obtenga los Datos, Regístrese


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

F625-040-999

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.

F252-095-999

Crime Victim Worker Verification - Spanish - Formulario de Verificación de Empleo


Crime Victim Worker Verification - Spanish - Formulario de Verificación de Empleo

F800-110-999

Cuestionario Sobre la Pérdida del Sentido Auditivo en el Trabajo


Used by injured worker who has filed an occupational hearing loss claim to provide more specific information regarding how the hearing loss occurred. This is requested by the Claim Manager and sent to the Injured Worker.

F262-016-999

Danger, Workers Above-Spanish (Peligro - Trabajadores en el Nivel Superior)


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

FSP1-012-999

Declaración de Derechos para Dependiente del Trabajador Fallecido Bajo el Programa de Compensación y Beneficios para Trabajadores


Used by a dependent of a worker whose death was related to an on the job injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits.

F242-173-933

Declaración de Derechos para Padres o Tutor Bajo el Programa de Compensación y Beneficios para Trabajadores


Used by a guardian or other person having custody of the minor or disabled children or dependents of a deceased worker to declare their entitlement to receive the pension benefits for those children/dependents in their care and custody.

F242-173-922

Declaración de Derechos para Viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores


Used by the widow/widower whose spouse died of a work related injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of your benefits.

F242-173-911

Declaración de Derechos para los Beneficios de un Trabajador Totalmente Discapacitado Bajo las Leyes del Seguro Industrial


Used by a totally permanently disabled worker. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits.

F242-173-944

Declaración de Servicios de Capacitación y Modificación de Trabajo


Formulario de cobro para proveedores que facturan al Departamento por capacitación y servicios de modificación de trabajo.

F245-030-999

Declaración para Servicios Misceláneos


Este 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.

F245-072-999

Discriminación de seguridad y salud en el lugar de trabajo (Safety and Health Discrimination in the Workplace)


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.

F417-244-999

Elección para Prueba de Sangre de Colinesterasa


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

F413-064-999

Employment History Form Spanish Formulario de Historial de Empleo


Used by injured worker to report their employment history for the past three years and the wages at each job.

F242-109-999

F242-208-999 Application for LEP compensation medical - Spanish Solicitud para Compensación por Reducción de Ingresos (Médico)


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

F242-208-999

F242-209-909 Application for LEP Vocational English/Spanish Solicitud para Compensación por Reducción de Ingresos (Vocacional)


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

F242-209-909

F242-209-999 application for LEP - Voc Spanish -  Aplicación para Compensación por Reducción de Ingresos (Vocacional)


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

F242-209-999

Farm Labor Contractor Registration-Spanish (Registro para un Contratista de Trabajadores Agrícolas)


Fact Sheet: Explains how to get a farm labor contractor license in order to operate legally as a farm labor contractor in Washington State.

F700-088-999

Formulario de Queja en Contra de un Contratista de Trabajores Agrícolas (Farm Labor Contractor Complaint)


Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.

F700-109-999

Getting Back to Work: It's Your Job and Your Future-Spanish (Regresando a Trabajar es su Trabajo y su Futuro)


Pamphlet/booklet: Briefly explains steps to return to work quickly and minimize the economic impact of time-loss. Also provides helpful resources. Intended for injured workers.

F200-001-999

Guía de Beneficios de Compensación para los Trabajadores:  Para los Empleados de Empresas Autoaseguradas - (English) A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses


Pamfleto/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.

F207-085-999

Guía para Contratar Contratistas Independientes en el Estado de Washington


Pamphlet/booklet: Designed to help employers determine if their workers are employees or independents under Washington's workers' compensation, workplace safety, wage and hour and unemployment tax laws. Includes a short "test" and helpful references.

F101-063-999

Have you been injured on the job?-Spanish (Se ha Lesionado en el Trabajo?)


Wallet card: Explains how to file a workers' compensation claim by telephone.

F242-404-999

Heat-related Illness Education Card/Tarjeta de Educación sobre Enfermedades Relacionadas con el Calor (English/Spanish)


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.

F417-218-909

Help for Crime Victims/Ayuda para Víctimas de Crimen (English/Spanish)


Pamphlet/booklet: Answers questions about Washington State's Crime Victims Compensation Program, who may be eligible for benefits and how to apply.

F800-006-909

Help for Injured Workers of Self-Insured Businesses-Spanish (Ayuda para Trabajadores Lesionados de Empresas Autoaseguradas)


Information card: Introduces the Office of the Ombudsman for Self-Insured Injured Workers. The ombudsman is appointed by the Governor to serve as an independent advocate for the rights of injured workers of self-insured employers.

F207-201-999

Hiring teens? / ¿Piensa contratar adolescentes? (English/Spanish)


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.

 

F700-142-909

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.

F242-071-999

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.

F625-111-999

How to Protest a Department of Labor and Industries Decision (English/Spanish) Cómo Protestar una Decisión en su Reclamo del Departamento de Labor e Industrias


Fact sheet: Explains how an injured worker can protest decisions on his/her claim and gives deadlines for taking action.

F242-363-909

If Family Members Work for You, Know Your Obligations (English/Spanish) - Conozca sus Obligaciones Cuando Miembros de su Familia Trabajan para Usted


Fact sheet: Provides an overview and resources to know your obligations when you have family members working for you. Relatives, including children, must be treated as employees with the same rights as any other paid worker in the state of Washington.

F101-077-909

Insurer Activity Prescription Form - Spanish Formulario de Restricciones Laborales del Asegurador


Used by Spanish speaking health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans.

Utilizado por proveedores de cuidado de la salud que hablan español para indicar la condición actual del trabajador lesionado, restricciones físicas, certificación de tiempo perdido y planes de tratamiento.

F242-385-909

Job Safety and Health Law - Spanish Ley de Seguridad y Salud en el Trabajo (English/Spanish)


Required poster: Describes important parts of the Washington Industrial Safety and Health Act (WISHA), which provides for job safety and health of Washington employees. Note: Employers in Washington State must display this poster where workers can see it. When ordering the printed version, you will receive one 22" X 17" poster that includes both languages.

Please order from L&I or print on 11" x 17" paper.

Get poster printing tips.

F416-081-909

Jorge's New Job: Cholinesterase Testing in Washington State - Spanish Un Nuevo Trabajo para Jorge(English/Spanish)


Pamphlet/booklet: Uses a story format with dialogue and photographs to explain the hazards of cholinesterase-inhibiting pesticides, the state's monitoring program and the importance of using proper safety equipment when working with pesticides.

F417-213-909

Keep Your Employees Safe and Working - Spanish (Mantenga a sus empleados seguros y trabajando)


Pamphlet/booklet: Describes the benefits of free employer consultations offered by L&I's Division of Occupational Safety and Health (DOSH). These services include on-site safety and/or industrial hygiene consultations, ergonomics assistance and risk management advice.

F417-209-999

Las Primas de Compensación para Trabajadores no Pagadas por su Subcontratista Podrían Ser su Responsabilidad


Fact sheet: Tells construction contactors how to protect themselves from liability for their subcontractor's unpaid workers' compensation premiums.

F262-262-999

Letter of Intent for School Enrollment - Spanish Carta de Intención de Registro en una Escuela


Letter of Intent for School Enrollment - Spanish CARTA DE INTENCIÓN DE REGISTRO EN UNA ESCUELA

F242-382-999

Lista de Comprobacion para un Contratista de Trabajores Agrícolas (Farm Labor Contactor Checklist)


Farm Labor Contractor's Checklist to ensure compliance.

F700-112-999

Lo Básico Sobre la Protección Contra Caídas en Actividades de la Industria de la Construcción


Proporciona un resumen de las normas modificadas de protección contra caídas y de los requisitos para las actividades en la construcción con fecha de vigencia del 1º de abril de 2013.

F414-154-999

Making the Best Treatment Choice for Your Chronic Low-back Pain-Spanish (Cómo Hacer la Mejor Elección de Tratamiento para el Dolor Crónico en la Parte Inferior de su Espalda)


Fact sheet: Reviews the options that an injured worker with low-back pain should consider in determining the best treatment choice.

F252-081-999

Modificaciones de la vivienda para trabajadores con lesiones catastróficas – Preguntas y respuestas para contratistas


Hoja de información: Respuestas sobre el beneficio de la modificación de la vivienda del programa de compensación para los trabajadores del estado de Washington y el proceso de licitación para los contratistas interesados en el trabajo.

F252-061-999

Modificaciones de la vivienda para trabajadores con lesiones catastróficas


Hoja de información: Respuestas sobre el beneficio de la modificación de la vivienda del programa de compensación para los trabajadores del estado de Washington, quienes califican, lo que puede pagar L&I y donde obtener más información.

F252-060-999

Monitoreo de la Colinesterasa - Recomendaciones del Proveedor Médico (Formulario Muestra)


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.

F413-070-999

Notice to Employees -- If a Job Injury Occurs/Aviso a los empleados--Si Ocurre una Lesión en el Trabajo (English/Spanish)


Required poster: Outlines the steps a worker should take if a job-related injury or illness occurs. Also briefly describes the benefits available through Washington's workers' compensation system. Note: 'Employers who receive industrial insurance coverage from L&I must display this poster where workers can see it. English and Spanish online versions will print separately.

F242-191-909

Notice to Employees -- Self-Insurance/Aviso a los Empleados -- Seguro Industrial Propio (English/Spanish)


Required poster for self-insured businesses: Outlines what a worker employed by a self-insured business should do if a work-related injury or illness occurs. Note: Self-insured employers must display this poster where workers can see it.

F207-037-909

Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-NTL


Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid.

F207-165-999

Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-TL


Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid.

F207-164-999

Notificación de Decisión de Cierre para Reclamos Únicamente Médicos para Empleadores Autoasegurados


Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid.

F207-020-999

Notificación de Decisión de Cierre para reclamos de Tiempo Perdido para Empleadores Autoasegurados


Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid.

F207-070-999

Occupational Disease Employment History of Hearing Loss and Continuation Sheet - Spanish - Historia de Trabajo - Pédida de Audición


History of Hearing Loss and Continuation Sheet - Spanish - HISTORIA DE TRABAJO PÉRDIDA DE AUDICIÓN

F262-013-999

OJT Accountability Agreement - Spanish Acuerdo de Responsabilidad de la Capacitación Durante el Transcurso del Trabajo


OJT Accountability Agreement in Spanish

F280-029-999

Option 2 Vocational Benefits Training Enrollment Application/Aplicación y Verificación del Registro (English/Spanish)


State fund workers who have selected Option 2 and closed their claim can use this form to apply for access to their Option 2 training funds. To seek reimbursement, use form F245-030-000 Statement for Retraining and Job Modification Services.

F280-024-909

Peligro - Área en Construcción - Solamente Personas Authorizadas


Large words: Peligro - Área en Construcción -  Solamente Personas Authorizadas. Get poster printing tips.

FSP1-013-999

Pension and Survivor Benefits in Washington State's Workers' Compensation Program--English/Spanish (Beneficios de Pensión y para Sobrevivientes del Programa de Compensacin para Trabajadores de Washington)


Pamphlet/booket: Answers the most common questions about pension and survivor benefits under Washington's workers' compensation program.

F242-352-909

Pension Benefits Questionnaire - Spanish Cuestionario para Beneficios de Pensión


Used by an injured worker who receives an order that states he or she is totally permanently disabled. This questionnaire must be completed in full and all necessary documents attached before his or her pension benefit options can be calculated.

F242-393-999

Plain Talk Summary of Prevailing Wage Laws: Understand Your Responsibilities and Rights When Performing Public Work - Spanish (Resumen de las Leyes de Salario Prevaleciente en Lenguaje Sencillo Entienda sus Responsabilidades y Derechos al Hacer Trabajos Públicos)


8.5" X 11" sheets: Provides a summary of prevailing wage laws and rules in Spanish. This publication is only available in Spanish. For similar information in English, read the Washington State Prevailing Wage Law booklet.

F700-152-999

Plan Development: What Are My Rights & Responsibilities -- Spanish (Plan de Desarrollo: ¿Cuáles son mis Derechos y Responsabilidades? Servicios de Rehabilitación Vocacional)


Booklet: Explains the basics of the plan development phase of vocational services to injured workers. L&I sends this booklet to injured workers when they are referred for plan development services. The assigned vocational rehabilitation counselor is required to review this booklet with the worker at their initial face-to-face meeting.

F280-018-999

Preferred Worker Benefit Frequently Asked Questions - Spanish (Preguntas frecuentes sobre el Beneficio del Programa de Incentivos para Volver a Emplear Trabajadores Lesionados)


Fact sheet: Includes information regarding the benefits of Perferred Worker certification, answers to questions frequently asked by workers, phone and website contacts.

F280-052-999

Preferred Worker Program-Spanish (Programa con Incentivos para Reemplear Trabajadores Lesionados)


Pamphlet/booklet: Describes the Preferred Worker Program and the benefits employers receive when hiring a preferred workers. In general, these are workers whose work-related injury or occupational disease prevents them from returning to their old job.

F280-021-999

Prevailing Wage Complaint Instructions - Spanish - Instrucciones para el Registro de una Queja Sobre Salario Prevaleciente


Ask L&I to conduct an investigation into a prevailing wage-related issue that affects one or more employees.

F700-146-999

Protected Leave Complaint Form - Spanish - Queja sobre el Permiso de Ausencia Protegida


Para quejas de ausencia del trabajo: Descargue y complete un formulario de Queja sobre permiso de ausencia protegida (F700-144-999)

F700-144-999

Q&A: Hazard Communication Standard - Spanish (P&R:Comunicación sobre los Riesgos Químicos)


Fact sheet: Provides information about changes to OSHA'S Federal Hazard Communication Standard, which triggers the need for changes to Washington State's standard. Rulemaking is under way in 2013. The changes are intended to improve comprehension of hazard information found in product labels to more effectively prevent injuries, illnesses and fatalities.

F417-242-999

Queja por Discriminación


Used by employees who believe they have been discriminated against by their employer may use this form to file a complaint.

F262-009-999

Quick Tips for Lifting/Consejos Breves para Levantar Cargas (English/Spanish)


Fact sheet: Provides 10 tips for safer lifting. Contains illustrations.

F417-055-909

Reclamo para Beneficios de Pensión Presentado por los Dependientes


Used by dependents of a deceased worker to file a claim for benefits.

F242-062-999

Report of Accident Instructions -- Spanish Instrucciones para el Reporte de Accidente


This document provides instructions in Spanish on how to complete the worker portion only of the Report of Accident (ROA). Please note that the Report of Accident is not available in Spanish. To order these instructions from the L&I Warehouse, please use the link below.

http://www.Lni.wa.gov/ClaimsIns/Providers/FormPub/ROA/OrderROA.asp

F242-130-999

Reporte Todas las Lesiones Inmediatamente


Large words: Report All Injuries Promptly. Get poster printing tips.

FSP1-004-999

Reporte Trimestral para la Industria de Tabla de Yeso


Used by drywall employers as a guide to completing quarterly and supplemental reports. This includes filled out samples of F212-050-000 and F212-051-000.

F212-224-999

Request for Survivor Counseling Benefits (English/Spanish) Solicitud para Beneficios de Apoyo para los Sobrevivientes

 


Used by immediate family members of homicide victims to request mental health counseling.

F800-057-909

Robberies and Abusive Customers: Tips for Preventing Injuries-Spanish (Robos y Clientes Abusivos: Consejos para Prevenir Lesiones)


Tips on handling cash and how to have a safer restaurant or retail environment. Get poster printing tips.

FSP0-919-999

Safety and Health Discriminaiton Complaint - (Spanish) Queja de Discriminación de la División de Seguridad Y Salud Ocupacional


Si Usted piensa que ha sido discriminado o despedido por reportar los peligros existentes en su lugar de trabajo, utilice este formulario para presentar una queja.

F416-011-999

Safety and Health Discrimination in the Workplace (English/Spanish)/ Discriminación de seguridad y salud en el lugar de trabajo


Poster: Employees have the right to report concerns about safety and health in their workplace. This poster describes "protected activities" under the Washington Industrial Safety and Health Act (WISHA) and explains what an employee should do if he/she has been punished or fired for exercising these rights. Get poster printing tips.

F417-188-909

Safety Meeting Minutes - Spanish - Actas De La Reúnion de Seguridad


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

F417-087-999

Settling your L&I claim might be right for you: A new option for injured workers over 55 - Spanish (Llegar a un acuerdo sobre su reclamo de L&I puede ser lo correcto para usted - Una nueva opción para los trabajadores lesionados que tienen más de 55 años de edad)


Pamphlet/booklet: Explains structured settlement and provides an overview of eligibility and the application and approval processes. The audience for this pamphlet is injured workers who might be eligible.

F240-003-999

Si usted TIENE que remover este resguardo 5 1/2 x 2 1/8


Sticker: 5.5 inches X 2.15 inches

FSP0-993-991

Solicitud de Cuenta para Proveedores Fuera del País


Esta solicitud es para proveedores fuera de los Estados Unidos.  Los proveedores que brindan tratamiento a los trabajadores lesionados deben tener un número de proveedor para poder cobrarle al Departamento.

F248-361-999

Stay at Work: A new program to help employers keep injured workers on the job--pays half the wage plus expenses (Permanezca en el Trabajo: Una Solución Factible -- Un programa para ayudar a los empleadores a mantener a los trabajadores lesionados en el trabajo -- paga la mitad del salario base además de otros gastos).


Pamphlet/booklet: Provides an overview 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. Includes information on eligibility, how to apply, and where to get more information.

F243-006-999

Su Examen Médico Independiente


Panfleto/folleto: Respuestas a las preguntas más comunes sobre los exámenes médicos independientes y cuándo y por qué podría requerirse que un trabajador lesionado asistiera a uno.  Incluye el formulario “Examen Médico Independiente (IME) - Solicitud para el reembolso de gastos de viaje y salario.” Este formulario es solamente para el uso de negocios autoasegurados y sus trabajadores.

F245-224-999

Transfer of Attending Provider Form for Self Insured Workers Spanish Formulario para Trasferencia de Proveedor Principal para Trabajadores Autoasegurados


This form is used by self-insured injured workers who want to transfer their medical care.  Self-insured workers should complete the form and send it to their employer or their Third Party Representative

Este formulario es utilizado por los trabajadores autoasegurados que desean transferir su cuidado mdico. Los trabajadores autoasegurados deben completar este formulario y enviarlo a su empleador o a su Representante de Terceros.

F207-114-999

Transfer of Care Card (Spanish) Tarjeta para Transferencia de Caso


Used by injured worker to notify claim manager and request authorization to transfer care to a different doctor.

F245-037-999

Travel Reimbursement Request - (Spanish) Solicitud para el Reembolso de Gastos de Viaje


Injured workers use this form to request reimbursement for travel expenses used to receive treatment, retraining and/or vocational services.

F245-145-999

Vocational Questionnaire/Work History - Spansih CUESTIONARIO VOCACIONAL/HISTORIA DE TRABAJO


Vocational Questionnaire/Work History for use by Vocational Providers serving injured workers

F280-038-999

What Are Your Rights as a Worker?


Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits.

F101-061-909

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.

F625-084-999

When a Loved One Dies at Work - Spanish (Cuando un ser querido fallece en el lugar de trabajo)


Brochure: Provides information to loved ones of workers who died from a job-related injury or illness, including how to apply for survivor benefits. Explains the L&I fatality investigation and how family members can stay informed of the investigation's status.

F417-240-999

Worker Right Complaint Form (Spanish) Formulario de Queja sobre los Derechos Laborales


Worker Rights Complaint Form. Both the 10-2010 and 12-2011 versions are valid.

F700-148-999

Worker Verification Form - Spanish 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.  

F242-052-999

Your Daily Record of Hours and Units Worked - For Agricultural Workers / Spanish - Su Registro Diario de Horas y Unidades Trabajadas - Para Trabajadores Agrícolas


Booklet: A pocket-sized bilingual guide to encourage agricultural workers to keep track of their daily work hours, units and earnings.

F700-169-909

Your Rights as a Worker in Washington State/ Sus Derechos como Trabajador en el Estado de Washington (English/Spanish)


Required poster: Reviews workers' rights under Washington's wage-and-hour laws. Topics include minimum wage, overtime, meal and rest breaks, pay periods, deductions, and employment of teens under age 18. Also reviews family leave provisions under federal and state law, and leave for spouses of deploying military personnel and victims of domestic violence. Note: Employers in both agricultural and non-agricultural industries in Washington State must display this poster where workers can see it.

Please order from L&I or print on 11" x 17" paper.

Get poster printing tips.

F700-074-909
¿Lesionado por un tercero? Usted tiene opciones legales - English (Injured by a Third Party? You Have Legal Options)
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.
F249-008-999
Agricultural workers information line (English/Spanish)
Card: Wallet card with a toll-free telephone number where agricultural workers can call to learn about their workplace rights.
F700-103-909
Carrying Out your Vocational Plan: Your Rights and Responsibilities During Plan Implementation -- Spanish (Llevando a cabo su Plan vocacional: Sus derechos y responsabilidades durante el Plan de Implementación, Servicios de rehabilitación vocacional)
Booklet: Explains the basics of the plan implementation phase of vocational services to injured workers. L&I sends this booklet to injured workers once the vocational plan they submitted is approved. Information about continuing with the vocational plan or selecting Option 2 to decline retraining is included.
F280-019-999
Certificado de Cobertura - Ejemplo
Sample of what the Certificate of Coverage looks like. You must order the form, you cannot download it off the internet.
F211-141-999
Comentarios Sobre el Exámen Médico Independente
Used by the injured worker to provide comments to L&I about their recent medical exam by an IME.
F245-053-999
Help for Crime Victims (large poster) - Spanish (Ayuda para Victimas de Crimen)
Poster: Provides contact information for the Crime Victims Compensation Program. Intended for display in health-care, criminal-justice and social-service organizations that assist crime victims. The size is 11" X 17" if ordered from the Crime Victims Compensation Program. If you print from the Web, the poster will be 8.5" X 11".
F800-041-999
Help for Crime Victims (small poster) - Spanish (Ayuda para Victimas de Crimen)
Poster: Provides contact information for the Crime Victims Compensation Program. Intended for display in health-care, criminal-justice and social-service organizations that assist crime victims. This poster is 8.5" X 11."
F800-104-999
Hiring Teens this Summer? - Spanish (¿Piensa contratar adolescentes este verano?)
Flier: 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.
F700-142-999
Need a Doctor? - Spanish (¿Necesita un doctor?)
Information card: Provides contact information for injured workers needing assistance in finding a health-care provider who will treat their occupational injury or disease. This PDF will print out an 8.5" X 11" sheet that has 12 copies of the card. Note: Disclaimer information on Page 2 may not line up accurately in two-sided printing.
F160-006-999
Precaución: Obligatorio Usar Casco
Picture of hard hats. Get poster printing tips.
FSP0-928-999
Protegiendo a los trabajadores de Washington (Protecting Washington Workers)
DVD: An innovative tool to teach Spanish-speaking workers about workplace rights while introducing English terminology.
F130-004-909
Queja por Suprimir un Reclamo - Spanish - Claim Suppression Complaint
An injured worker may submit this form if their employer has suppressed their right to file an injury claim.
F262-024-999
Siempre Use Protección para los ojos
Picture of a large eye with some content on when to use eye protection. Get poster printing tips.
FSP0-940-999
Su cuerpo, su empleo: Prevención del Síndrome del Túnel Carpiano y otras lesiones músculo esqueléticas...

Pamphlet/booklet: Reviews the symptoms and risk factors for carpal tunnel syndrome and several other musculoskeletal disorders that affect the shoulder, arm and elbow. Discusses prevention approaches and where to get more information.

F413-024-999
Sus Pulmones Su trabajo Su vida: Lo que debería saber acerca del asma ocupacional
Pamphlet/booklet: Briefly reviews the symptoms and causes of work-related asthma and explains prevention and treatment approaches.
F413-060-999
Teens at Work: Facts for Employers, Parents and Teens /Adolescentes en el trabajo (Spanish)

Pamphlet/booklet: Answers questions employers, parents and teens may have about employing teen workers (ages 14-17). Explains non-agriculture work rules, including the necessary permits, hours and work conditions. Provides links to other resources.

F700-022-999
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.
F417-234-999
Verification of School Enrollment/Verificación de registro en la escuela (Spanish)

Use by the student and a school official each quarter to verify school enrollment.

F242-055-999
What Are Your Rights When You Work for a Farm Labor Contractor? (English/Spanish) / ¿Cúales son sus derechos cuando trabaja para un contratista de trabajadores agrícolas?
Fact sheet: Explains workers' rights when they are employed by a farm labor contractor. Topics covered include workplace safety, rest and meal breaks, and help if injured on the job.
F700-067-909
What You Need to Know if You Don't Get Paid: A Worker's Guide to the Washington State Wage Payment Act-English/Spanish (Lo que necesita saber si no recibe su pago: Una guía para el trabajador de la ley del pago de salario del) estado de Washington
Fact sheet: Summarizes workers' rights and responsibilities regarding minimum wage, pay, work hours and overtime and explains how to file a wage complaint. Includes answers to several commonly asked questions.
F700-153-909
Workers' Compensation Discrimination-English/Spanish (Discriminación porque se lesionó en su trabajo)
Fact sheet: Explains workers' legal right to file a workplace injury claim and how to file a complaint if discrimination has occurred.
F262-249-909
Workers' Guide to Hazardous Chemicals: Understanding the Right-to-Know Law-English/Spanish (Gua del trabajador para el uso de qumicos peligrosos: Comprendiendo la Ley del derecho a saber)
Pamphlet/booklet: Explains Washington's chemical hazard communication standard, which requires employers to inform their employees about hazardous chemicals in the workplace and to train them in their proper use.
F413-014-909
Young Workers in Agriculture/Trabajadores jóvenes en la agricultura (English/Spanish)

Pamphlet/booklet: Answers many questions employers and minor workers have about employing minors. Covers agriculture work rules, including the necessary permits, hours and work conditions for workers 12-17 years of age.

F700-096-909
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.
F700-105-909
Your Independent Medical Exam: For Employees of Self-Insured Businesses - Spanish (Su Examen Médico Independiente: Para empleadores de negocios autoasegurados)
Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers.
F207-202-999
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.
F101-055-909
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.
F700-145-909

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