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

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.

Cartel Requerido:  Describe partes importantes sobre la Ley de Salud y Seguridad Industrial (WISHA, por su sigla en inglés), la cual proporciona seguridad y salud en el trabajo para los empleados de Washington.  Aviso:  Los empleadores en el estado de Washington deben colocar este cartel donde los trabajadores puedan verlo.  Al ordenar la versión impresa, usted recibirá un cartel de 22 x 17 pulgadas que incluye ambos idiomas.

 Por favor solicítelo de L&I o imprímalo en un papel de 11"x 17".



Cartel
F416-081-909
 
Application for Permit to Operate Radio System in Designated Area

This form is used by the logging industry to apply for a permit to operate a radio signal system. What you type in the top form appears in the bottom one, so you have a copy.



Formulario
F416-087-000
 
A Guide to Workplace Safety and Health in Washington State

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



Publicación
F416-132-000

Otro(s) idioma(s):
Español
 
Una guía de seguridad y salud del lugar de trabajo en el estado de Washington

Folleto: Provee un resumen de la Ley de Seguridad y Salud Industrial de Washington (WISHA, por su sigla en inglés), derechos y responsabilidades del trabajador y del empleador, cumplimiento de las leyes de WISHA y los servicios de consultoría y educación que L&I proporciona. El título anterior era, Una guía de WISHA.



Publicación
F416-132-999

Otro(s) idioma(s):
Inglés
 
Overhead Crane Bridge, Monorail, Gantry Worksheet for Construction
Overhead Crane Bridge, Monorail, Gantry Worksheet for Construction.

Formulario
F416-141-000
 
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



Formulario
F417-014-000
 
Forklift Safety Guide
Book: Provides general information on kinds of forklifts, principles of physics that apply to forklifts, training requirements for forklift operators, basic operator safety rules, dangers of carbon monoxide, and safety while servicing a forklift.

Publicación
F417-031-000
 
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.



Publicación
F417-043-000
 
Quick Tips for Lifting/Consejos breves para levantar cargas (English/español)

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

Hoja de información:  Proporciona 10 consejos para levantar objetos con seguridad.  Contiene ilustraciones.

 



Publicación
F417-055-909
 
Actas de la reúnion de seguridad

Use este formulario para registrar las actas de sus reuniones de seguridad, estos registros deben mantenerse por un año a partir de la fecha de cada reunión.



Formulario
F417-087-999

Otro(s) idioma(s):
Inglés
 
Guidelines for Selecting Reserve Trees
Book: Provides technical guidance on retaining reserve trees in concert with safe work practices and forest and wildlife management goals. Produced cooperatively by state and federal agencies and industry groups.

Publicación
F417-092-000
 
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.



Formulario
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.



Checklist
F417-104-000
 
Workplace Violence: Awareness and Prevention for Employers and Employees
Book: Describes four types of workplace violence, outlines steps to minimize and prevent violent acts, and discusses potential risk factors and prevention techniques.

Publicación
F417-140-000
 
Safety and Health Discrimination in the Workplace / Discriminación de seguridad y salud en el lugar de trabajo (English/español)

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.

Cartel:  Los empleadores tienen derecho a reportar las inquietudes relacionadas con la seguridad y la salud en el lugar de trabajo.  Este cartel describe  las "actividades protegidas" bajo la Ley de Salud y Seguridad Industrial de Washington (WISHA, por su sigla en inglés) y explica lo que debe hacer un empleado si él/ella ha sido castigado o despedido por ejercer sus derechos.  Obtenga consejos para imprimir carteles.



Cartel
F417-188-909
 
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.



Publicación
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.



Publicación
F417-202-000
 
Borrower Agreement Form Safety and Health Video Library

Borrower Agreement Form - To open an account and borrow videos, please fill out this form.



Formulario
F417-205-000
 
Reservation Form Safety and Health Video Library

Use this form to make reservations of safety and health videos. There is both a fillable MS Word form that you can email in, and a fillable PDF that you can fill and print.



Formulario
F417-206-000
 
Personal Protective Equipment (PPE) Guide
Book: This guide helps employers comply with the WISHA Personal Protective Equipment rules. It covers general personal protective equipment and PPE requirements used to protect the head, eyes and face, hand and arm, foot and leg, and body (torso) in most work environments.

Publicación
F417-207-000
 
Fall Protection: Responding to Emergencies
Book: This guide is for employers and for employees who work from exposed, elevated surfaces. It covers the following: what to do to prevent fall-related emergencies and how to respond promptly if a fall-related emergency occurs. Includes illustrations of aided-rescue equipment systems.

Publicación
F417-208-000
 
Keep Your Employees Safe and Working

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.



Publicación
F417-209-000

Otro(s) idioma(s):
Español
 
Mantenga a sus empleados seguros y trabajando

Folleto:  Describe los beneficios de las consultas gratis para  empleadores que ofrece la División de Seguridad y Salud Ocupacional (DOSH, por su sigla en inglés) de L&I.  Estos servicios incluyen consultas de seguridad y/o higiene industrial, asistencia de ergonomía y recomendaciones sobre el manejo de riesgos en el sitio de trabajo.



Publicación
F417-209-999

Otro(s) idioma(s):
Inglés
 
A Safe and Healthy Workplace Begins with You
Pamphlet: Provides an overview of employers' responsibilities for workplace safety and health in Washington State. Covers free L&I services, including workplace consultations, online training and prevention resources and required posters. Intended for new businesses or businesses hiring employees for the first time.

Publicación
F417-210-000
 
Jorge's New Job: Cholinesterase Testing in Washington State / 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.

Panfleto/folleto:  Utiliza un formato de cuento con diálogo y fotografías para explicar los peligros de la colinesterasa, el programa de monitoreo del estado y la importancia del uso adecuado del equipo de seguridad cuando se trabaja con pesticidas.



Publicación
F417-213-909
 
Protect Yourself and Your Family from Lead Poisoning
Pamphlet/booklet: Explains the risks of lead exposure for workers who work on outdoor steel structures, and harmful effects on workers and their families. It includes a poster about the importance of safe work practices and procedures.

Publicación
F417-214-000
 
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)

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.

Tarjeta: Identifica los efectos del agotamiento por el calor y la insolación en el cuerpo y lo que puede hacer si observa estos síntomas. Revisa los pasos para la prevención.  El archivo en PDF está configurado para que se impriman dos copias al mismo tiempo.



Publicación
F417-218-909
 
Voluntary Protection Program (VPP)
Fact sheet: Provides an overview of the VPP, a program that recognizes occupational safety and health excellence. Identifies benefits and includes testimonials from companies awarded VPP status.

Publicación
F417-221-000
 
Eye On Safety Card

Reference card: 8.5 X 5.5 card to promote L&I's EyeOnSafety.info website, where you can find video shorts, training videos, investigation stories and other visual resources.



Publicación
F417-222-000
 
Safety and Health Investment Projects (SHIP) Grant Program

Booklet: Introduces the SHIP Grant Program and application process. SHIP awards grants for innovative projects that (1) prevent workplace injuries, illnesses and deaths and (2) encourage injured workers to return to work early and reduce long-term disability.



Publicación
F417-224-000
 
Safety for Commercial Dive Teams
Fact sheet: Provides an overview of safety for commercial dive teams, summarizes the key requirements of commercial diving regulations (WAC 296-37), and includes contact information.

Publicación
F417-226-000
 
Safety and Health Program Assessment Worksheet

Safety and Health Program Assessment Worksheet



Formulario
F417-227-000
 
START Program (Safety through Achieving Recognition Together)
Fact sheet: Provides an overview of START, a program that recognizes occupational safety and health excellence in small businesses. Includes program requirements and benefits.

Publicación
F417-229-000
 
Nail Gun Safety: A Guide for Construction Contractors

Booklet: Gives information needed to prevent nail gun injuries for construction employers.



Publicación
F417-232-000
 
Ergonomics Consultation: Free, Confidential, Powerful Impact on Your Bottom Line

Pamphlet: Provides information to employers interested in a free ergonomics consultation for their business. Explains the importance of workplace ergonomics and how L&I can help to assess injury-causing tasks, and help develop an ergonomics program.



Publicación
F417-233-000
 
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.



Publicación
F417-234-000

Otro(s) idioma(s):
Español
 
Seguridad con los tractores: protección contra vuelcos y los cinturones de seguridad

Folleto: Resumen de las reglas de seguridad para la barra protectora contra vuelcos (ROPS, por su sigla en inglés) y los cinturones de seguridad en los tractores. También lista las exenciones y proporciona otra información sobre la operación segura de tractores.



Publicación
F417-234-999

Otro(s) idioma(s):
Inglés
 
Q&A: Stay of Abatement Date

Fact sheet: Explains how an employer requests a "stay of abatement date." Effective July 1, 2012, an employer must fix a hazard cited in a workplace inspection during appeal unless he or she has requested and been granted a stay of abatement date.



Publicación
F417-235-000
 
Demounting and Mounting Procedures for Tubeless Truck and Bus Tires

Poster for tire and rim servicing. To be displayed with F417-237-000-B Demounting and Mounting Procedures for Tube-type Truck and Bus Tires and F417-237-000-C Multi-piece Rim Matching Chart. This poster must be printed at least 2'x3' in size.



Cartel
F417-237-000-A
 
Demounting and Mounting Procedures for Tube-type Truck and Bus Tires

Poster for tire and rim servicing. To be displayed with F417-237-000-A Demounting and Mounting Procedures for Tubeless Truck and Bus Tires and F417-237-000-C Multi-piece Rim Matching Chart. This poster must be printed at least 2'x3' in size.



Cartel
F417-237-000-B
 
Multi-piece Rim Matching Chart

Poster for tire and rim servicing. To be displayed with  F417-237-000-A Demounting and Mounting Procedures for Tubeless Truck and Bus Tires and F417-237-000-B Demounting and Mounting Procedures for Tube-type Truck and Bus Tires. This poster must be printed at least 2'x3' in size.



Cartel
F417-237-000-C
 
When a Loved One Dies at Work

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.



Publicación
F417-240-000

Otro(s) idioma(s):
Español
 
Cuando un ser querido fallece en el lugar de trabajo

Folleto: Proporciona información para los seres queridos de trabajadores que mueren de una lesión o enfermedad relacionada con el trabajo, incluyendo cómo solicitar beneficios de sobreviviente. Explica la investigación de L&I por una muerte y cómo los miembros de la familia pueden mantenerse informados sobre el estado de la investigación.



Publicación
F417-240-999

Otro(s) idioma(s):
Inglés
 
Workplace Safety and Health Pocket Guide

Pocket guide: Provides links to online information, including safety and health consultations, how to develop a safety program, reporting hazards and injuries, other safety training, and information for teen workers.



Publicación
F417-241-000
 
Q&A: Hazard Communication Standard

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.



Publicación
F417-242-000

Otro(s) idioma(s):
Español
 
Preguntas y Respuestas:Comunicación sobre los riesgos químicos

Hoja de información: Proporciona información sobre cambios a los reglamentos federales de comunicación de la Administración de Seguridad y Salud Ocupacional (OSHA, por su sigla en inglés), los cuales causan la necesidad para cambios en la norma del estado de Washington.  Se proyecta que los cambios mejoren el entendimiento de la información de peligro que se encuentra en las etiquetas de los productos para prevenir más efectivamente las lesiones, enfermedades y muertes.



Publicación
F417-242-999

Otro(s) idioma(s):
Inglés
 
Washington State Top 25 Hazardous Industries, 2006 to 2010

Booklet: Provides a summary of occupational injury and illness data, including safety and health violations cited, by the top 25 hazardous industries for the five-year period 2006 to 2010.



Publicación
F417-243-000
 
Safety and Health Discrimination in the Workplace

Brochure: Employees have the right to report concerns about safety and health in their workplace. This brochure 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.



Publicación
F417-244-000

Otro(s) idioma(s):
Español
 
Discriminación de seguridad y salud en el lugar de trabajo

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.



Publicación
F417-244-999

Otro(s) idioma(s):
Inglés
 
Q&A: Cranes, Rigging and Personnel Lifting Rule, Chapter 296-155 WAC, Part L

Q&A Factsheet: Answers to questions crane or derrik operators/owners might have regarding vehicle/operator certification and training required for cranes and derriks based on possible construction site scenerios.



Publicación
F417-245-000
 
Risk Management Consultation

Pamphlet/booklet: Describes the benefits of free risk management consultations. L&I’s Risk Managers can provide: data and analysis specific to your business that shows how claims can affect the premiums you pay; show you the cost/benefit of claim management strategies; identify return-to-work options and resources; and review best practices in hiring strategies and procedures.



Publicación
F417-246-000
 
2014 Workplace Safety and Health Calendar: Top 12 Hazards that Cause Injuries and Deaths

Calendar: Features real Washington State businesses and employees handling typical workplace hazards and spotlighting the top 12 hazards that cause injuries and deaths. It includes suggested weekly safety and health tips for different hazards, including slips trips and falls, struck by falling objects, burns and more.



Publicación
F417-248-000
 
Logger Safety Initiative Jobsite Notification

Members of the Logger Safety Initiative and landowners use this form to report their jobsite to L&I.



Formulario
F417-249-000
 
Bicycle Safety: Delivery, couriers, and messengers

Fact Sheet: Provides a summary of requirements and tips to ensure the safety of bicycle couriers, bicycle messengers and bicycle delivery riders. Includes a safety checklist.



Publicación
F417-250-000
 
2015 Workplace Safety and Health Calendar: Preventing Sprains and Strains - Washington’s Leading Workplace Injury

Calendar: Features real Washington State businesses and employees in jobs where sprains and strains are most common. The calendar includes suggested weekly safety and health tips for preventing sprains and strains to the neck, shoulders, back, hands/wrists, knees, and elbows.



Publicación
F417-251-000
 
Fall Hazards: Standing Walls - Highlights of Fall Protection Requirements

Safety Topic fact sheet: Describes the fall hazards workers are exposed to while framing, erecting and raising walls without using fall protection. Includes photos, safety requirements and different methods of fall restraints and fall arrest systems.



Publicación
F417-252-000
 
Rigging Safety: Construction Rigging Requirements

Safety Topic fact sheet: Provides information on how to correctly and safety rig loads on construction job sites to prevent falling material, property damage and equipment failure or tip over. Includes a summary chart of requirements material handling and cranes and derricks.



Publicación
F417-253-000
 
Employee Misconduct: Information for Employers

Fact Sheet: This publication is intended to help employers understand how the Department of Labor & Industries (L&I) and Employment Security Department (ESD) take employee misconduct into account when making decisions about workplace safety and health violations or unemployment benefits.

Contact:
L&I: Terry Walley
360-902-4758, Terry.Walley@Lni.wa.gov
ESD: Unemployment Benefits Employer Hotline
1-877-504-5607



Publicación
F417-254-000
 
Q&A: Emergency Washing Requirements for Pesticide Handlers

Fact Sheet: Produced in collaboration with the Washington State Department of Agriculture, this fact sheet answers questions about emergency washing requirements for pesticide handlers. It includes information about when emergency washing is required, how much water is necessary, emergency eyewash, access to water in remote areas and more.



Publicación
F417-257-000
 
Washington State Top 25 Hazardous Industries, 2008 to 2012

Booklet: Provides a summary of occupational injury and illness data, including safety and health violations cited, by the top 25 hazardous industries for the five-year period 2008 to 2012.



Publicación
F417-258-000
 
Application for Copies of Citation and Notice

Used by an employee to apply for copies of citation and notices issued to their employer.



Formulario
F418-023-000
 
Hazard Documentation Worksheet

Hazard Documentation Worksheet for use by L&I compliance staff to describe, measure and comment on workplace hazards.



Formulario
F418-031-000
 
Alleged Safety Or Health Hazards (DOSH Complaint Form)

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



Formulario
F418-052-000

Otro(s) idioma(s):
Español
 
Presuntos riesgos de Salud y Seguridad (Formulario de queja de la División de Seguridad y Salud Ocupacional)

Los empleados usan este formulario de queja para reportar las condiciones de trabajo que ponen en peligro la seguridad y salud de los trabajadores.



Formulario
F418-052-999

Otro(s) idioma(s):
Inglés
 
Construction Checklist - Safety

Safety checklist for fall protection, ramps, stairways, ladders, trenches, excavations, scaffolds, personal protective equipment (PPE), electrical and chemical.



Checklist
F418-055-000
 
Application for Amusement Ride or Air Supported Structure Operating Permit

To apply for a decal for an amusement ride or air supported structure.



Formulario
F500-010-000
 
Application for Electrical Contractors License

Application used to get an electrical contractors license



Formulario
F500-018-000
 
Electrical/Telecommunications Contractor Assignment of Savings Account

This is used to assign ownership interest to a savings account that is held by L&I for one year after a contractor's license has expired or after the contractor ceases business in Washington State.



Formulario
F500-020-000
 
Agency Requested Inspection

Used by non-L&I agencies and jurisdictional authorities to request an inspection on an electrical hazard.



Formulario
F500-025-000
 
Request for Duplicate or Replacement License or Certificate

To request a duplicate or replacement of your Washington state electrical license or certificate.



Formulario
F500-032-000
 
Chapter 19.28 RCW - Electricians and Electrical Installations

Simplified version of the Chapter 19.28 RCW - Electricians and Electrical Installations Rules



Manual
F500-039-111
 
Electrical Safety Standards,Administration, and Installation WAC 296-46B

Electrical Safety Standards,Administration, and Installation WAC 296-46B



Manual
F500-039-222
 
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.



Formulario
F500-043-000
 
Request for Change of Address

Used by electrical licensee to notify L&I of an address change.



Formulario
F500-044-000
 
Administrator / Electrician / Master Electrician Certificate Renewal

To renew your electrical certificate. Fee varies depending on renewal type.



Formulario
F500-045-000
 
Application to Establish an Account and Access to L&I's Electrical Permit & Inspection System (EPIS) with L&I's Miscellaneous Accounts

To request access to L&I's EPIS - Miscellaneous Accounts



Formulario
F500-054-000
 
Application to Access L&I's Electrical Permit and Inspection System (EPIS) from SecureAccess Washington and Utilize Contractor Deposit Account via the Internet

To establish a contractor deposit account by an electrical contactor or registered construction contractors who are legally required to purchase electrical work permits from L&I.



Formulario
F500-055-000
 
Electrical Installation Variance Application

To apply for a variance which is an allowable deviation from specific requirements of a National Electrical Code section, or the WAC 296-46B where the proposed alternate methods will maintain equivalent safety.



Formulario
F500-063-000
 
Application for Amusement Ride Inspector Certification

Application to be certified as an amusement ride inspector.



Formulario
F500-065-000
 
Affidavit for Amusement Rides

Affidavit of experience to apply for cetification as a Amusement Ride Inspector.



Formulario
F500-066-000
 
Electrical Education Course Application

Used to get approval of a course as an electrical continuing education class. This application must be received by L&I at least 30 days before the course is offered.



Formulario
F500-068-000
 
Reassignment of Savings Account or Time Deposit - Electrical Contractor

A reassignment is permitted only when (1) the Electrical Contractor (assignor) changes the name of the business; (2) the Electrical Contractor transfers the funds to a new account; or (3) the financial institution changes the account number.



Formulario
F500-072-000
 
Investigation Report

To notify L&I on any electrical work that you think is illegal.



Formulario
F500-076-000
 
Electrical / Telecommunication Contractor's License Renewal Notice

This form is used to notify you that your license will expire and for you to use to renew your license.



Formulario
F500-077-000
 
Electrical Work on Residential Property: What You Should Know Before Work Begins
Fact Sheet: Explains to property owners the importance of electrical permits, inspections and approvals. An electrical permit is required for most new, remodel and maintenance electrical work.

Publicación
F500-078-000
 
Account Deposit for Contractor's or Miscellaneous Account Holder's

Used to deposit money into your L&I account (Electrical).



Formulario
F500-080-000
 
Electrical Inspection Witness Statement

Used to gather information from a person who was a witness to electrical work that is being investigated by L&I.



Formulario
F500-087-000
 
Application for Master Electrician Certification Examination

Use this form to apply for the master electrician exam.



Formulario
F500-088-000
 
Electrical Continuing Education Instructor Application

An application to receive approval from L&I to instruct electrical continuing education courses.



Formulario
F500-090-000
 
Contractor Electrical Work Permit Application

This application is used to apply for a valid electrical permit from L&I. 4 pages.



Formulario
F500-093-000
 
Property Owner Electrical Work Permit Application

This application is used to apply for a valid electrical permit. 5 pages.



Formulario
F500-094-000
 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Formulario
F500-097-000
 
Application for Specialty Electrician Certificate

Application and instructions for the specialty electrician certificate for 03A, 06B, 07A, 07B, 07C, 07D, 07E and 10. Eligibility granted through modified supervision requirements of RCW 19.28.191(1)(g)(ii)



Formulario
F500-098-000
 
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.



Formulario
F500-101-000
 
Application for Pump Installer Combination General Contractor Registration and Electrical Contractor License

Used for creating combination electrical and plumbing contractors license



Formulario
F500-104-000
 
Electrical Work on Commercial Property: What You Should Know Before Work Begins
Fact Sheet: Explains to commercial property owners the importance of electrical permits, inspections and approvals. An electrical permit is required for most new, remodel and maintenance electrical work.

Publicación
F500-109-000
 
Questions and Answers about Electrical Safety
Fact Sheet: Answers questions about training and certification/licensing requirements for those who perform electrical installations, and electrical work that requires a permit and inspection.

Publicación
F500-110-000
 
Before Electrical Sign Work Begins: What Electrical Sign Contractors and Electricians Should Know
Fact Sheet: Explains work that is allowed and not allowed under (04) Sign Scope of Work and what electrical sign contractors and electricians should know before doing sign work. Also covers electrical Class B labels and electrical permits, inspections and fees.

Publicación
F500-111-000
 
Class B Labels: What You Should Know

Fact Sheet: Explains Class B label electrical work, scope and limitations, and provides general instructions for using Class B labels.



Publicación
F500-112-000
 
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.

Publicación
F500-113-000
 
Electrical Program Contacts

Fact Sheet: Provides information for requesting electrical inspections, including telephone numbers and locations of L&I offices that handle electrical inspections.



Publicación
F500-114-000
 
Electrical Safety Tips for Your Home: Protect Your Family and Your Property
Pamphlet/Booklet: Provides information to help consumers properly handle electrical equipment and appliances, know the required permits and inspections for electrical work, and verify licenses and certifications before having electrical work performed.

Publicación
F500-115-000
 
Green Power Generation System Installation: What You Should Know Before Doing Any Electrical Work
Fact sheet: Explains that an electrical permit and inspection are required for most new, remodel, and maintenance electrical work. Provides information specific to the installation of green power generation systems.

Publicación
F500-116-000
 
How to Become a Certified Electrician: What You Need to Know about Certification in Washington State
Fact sheet: Provides information about getting a trainee card and outlines the electrical training and experience required to be certified as an electrician in Washington State.

Publicación
F500-117-000
 
An Annual Electrical Permits Saves Time and Money. Would it Work for You?

Flier: Describes when facility operators/owners qualify for an annual electrical permit.



Publicación
F500-123-000
 
Electrical Telecommunication Principal Member Owner Update Request

Electrical Telecommunication Principal Member Owner Update Request



Formulario
F500-124-000
 
HB 2253 Open Window Opportunity - Affidavit of Hours of Unsupervised Telecommunications Installation Experience

This form is not available until June 12.



Formulario
F500-127-000
 
Request for Letter of Good Standing

This form is used by electricians to request the agency send a letter of good standing for all electrical hours/experience from Washington State.



Formulario
F500-128-000
 
Application for Telecommunications Contractor's License

Application used to get an telecommunications contractors license.



Formulario
F503-008-000
 
Non-Compliance Report - Boiler & Pressure Vessel Inspection

Used by L&I inspectors when a boiler or pressure vessel does not pass inspection. You can only mail or fax this form to L&I. E-mailed forms are NOT accepted.



Formulario
F620-012-000
 
Board of Boiler Rules Interpretation and Revision Request Form

Used to submit written requests for interpretations and revisions to the definitions, rules and regulations found in WAC 296-104. These must be submitted 45 days prior to the Board of Boiler Rules Meeting date. F620-056-000 Chief Inspector Clarification and Interpretation Request Form must be submitted before using this form.



Formulario
F620-017-000
 
Operating Boilers Safely
Fact sheet: Explains what you need to know to keep your boilers and pressure vessels operating safety. Provides an overview of inspection requirements, frequency and fees.

Publicación
F620-025-000
 
Shop and Field Inspection Report

Used by L&I inspectors when they inspect boilers.



Formulario
F620-027-000
 
Boiler / Pressure Vessel Water Heater Installation or Reinstallation Permit
This form is filled out by the installer, contractor and/or owner who wants to install or reinstall a boiler.

Formulario
F620-032-000
 
Application for Certificate of Competency as an Inspector of Pressure Retaining Items

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.



Formulario
F620-040-000
 
Boiler/Pressure Vessel Clearance Variance Request

To request a clearance variance on a boiler or pressure vessel. You can only mail or fax this form to L&I. E-mailed forms are not accepted.



Formulario
F620-041-000
 
Rental Boiler Operating Permit - Good at this Location Only

To request a permit to use a rental boiler at one location only.

Allow 24 hours for a response. Accuracy and completeness speeds up the processing time.



Formulario
F620-042-000
 
Historical Boilers Inspection Guideline

Inspection sheet for boiler inspectors. 4 pages.



Formulario
F620-043-000
 
Incident Report Boiler or Pressure Vessel

Used for the reporting of incident with boilers or a pressure vessels.



Formulario
F620-044-000
 
Keep Your Water Heater Safe
Pamphlet/booklet: Describes the process for conducting an annual safety test of a residential water heater. Includes illustrations.

Publicación
F620-048-000
 
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



Checklist
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



Checklist
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



Formulario
F620-052-000
 
Apprenticeship Related Supplemental Instruction (RSI) Plan Review Glossary of Terms

Glossary of terms used with Apprenticeship Related Supplemental Instruction (RSI) Plan Review form and RSI Plan.



Formulario
F100-519-000
 
Apprenticeship Related Supplemental Instruction (RSI) Plan Review

Used by apprenticeship programs/sponsors as part of the process of getting new programs/standards/occupations approved.



Formulario
F100-520-000
 
Apprenticeship Related Supplemental Instruction (RSI) Plan Revew Review Criteria

Describes the process for getting approval of new or revised RSI for new apprenticeship programs/standards/occupations.



Formulario
F100-521-000
 
Statement for Home Nursing Services

Used to bill L&I for reimbursement of home nursing services.



Formulario
F248-160-000
 
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.



Checklist
F622-013-000
 
Plan Approval Request - Conversion Vendor / Medical Units

Used in requesting a plan approval for Conversion Vendor or Medical Unit factory-assembled structures.



Formulario
F622-035-000
 
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.



Formulario
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.

Formulario
F622-073-000
 
Application for Insignia Conversion Vendor/Medical Units

Used to apply for an official insignia for conversion vendor or medical unit factory-assembled structures. See sample form for instructions about how to fill out the form correctly.



Formulario
F623-021-000
 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Formulario
F800-070-000
 
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 March 2015 printed edition.



Publicación
F100-041-000
 
Related Supplemental Instruction Hours

Used by Apprenticeship programs to submit related instruction hours to L&I Apprenticeship section. It is preferred that programs use the combined RSI/OJT reporting form. RSI Hours must be reported quarterly.



Formulario
F100-228-000
 
Instructor's Report of Accident / Incident

This form must be submitted to L&I's Apprenticeship Section by the Instructor at the time of the incident and the appropriate Apprenticeship Program within 5 days of an accident/incident of an apprentice/trainee during Related Supplemental Instruction (RSI).



Formulario
F100-509-000
 
Comparing Career Pathways

Fact sheet: Assists high school students and their parents by comparing the benefits of registered apprenticeship to a traditional university or college program. Compares wages, costs, and length of study.



Publicación
F100-531-000
 
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.



Formulario
F101-009-000
 
Provider's Initial Report (PIR)

Used by medical providers when reporting initial treatment for an industrial injury or occupational disease for a self-insured claim.

Medical providers treating self-insured workers, self-insured businesses, or their third party claims administrators can access this form one of two ways:

  1. Download the Microsoft (MS) Word form and the PDF file with instructions:

           The first file is the PDF instructions.

           The second file is an Office 2003 MSWord document ending in .doc.

           The third file is an Office 2007/2010 version, ending in .docx.

2.  Order paper copies of this form by clicking the “order it” button.



Formulario
F207-028-000
 
Pre-Audit Questionnaire

Pre-Audit Questionnaire. The fillable MSWord version is saved in the 2003 format. The EXCEL file is saved in ExCEL 2007 format. There is also a fillable PDF version.



Formulario
F213-177-000
 
Notice to Employees -- If a Job Injury Occurs/Aviso a los empleados--si ocurre una lesión en el trabajo (English/español)

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.

Cartel requerido:  Describe los pasos que un trabajador debe tomar si le ocurre una lesión o enfermedad relacionada con el trabajo.  También describe brevemente los beneficios disponibles a través del sistema de compensación para los trabajadores de Washington.  Aviso:  Los empleadores que reciben cobertura de seguro industrial de L&I deben colocar este cartel donde los trabajadores puedan verlo.  Las versiones en línea en ingés y español se imprimirán por separado.



Cartel
F242-191-909
 
Cuestionario de exposición a sustancias químicas

Formulario: Contiene el  Cuestionario de exposición a sustancias químicas F242-409-999, la Autorización para proveer información  F262-005-999 y la versión en inglés solamente de un formulario del Seguro Social que contiene la información apropiada de L&I.



Formulario
F242-409-999

Otro(s) idioma(s):
Inglés
 
Statement for Miscellaneous Services

This bill form is used by providers and injured workers to bill the department for services such as dental care; glasses; medical equipment; nursing home services; interpreter services; services workers pay for out of pocket; and other services. Information on how to bill the department can be found in the General Provider Billing Manual [F248-100-000].

 



Formulario
F245-072-000

Otro(s) idioma(s):
Español
 
UB04 HCFA 1450

Used by hospitals to bill L&I for inpatient/outpatient services. This version includes NPI number.



Formulario
F245-367-000
 
Registered Contractor Card

This is a fillable version of the Registered Contractor Card



Formulario
F625-069-000
 
Affidavit of Wages Paid - Public Works Contract and Instructions

This form is a fillable Word document that is used by a contractor, company or agency to show the wages paid to employees on a public works project. The best way to use this document is to bookmark this page as a “Favorite” in your web browser. Then each time when you want to use the document, access the online version of the form. This will ensure you are always utilizing the most recently published form. (We recommend you not download the document and save the form for future use because we may make changes to the form that your downloaded version will not contain.) You must file the Affidavit of Wages Paid form when you have completed your portion of a public works job/project. Addendum A is form number F700-161-000, Addendum C is form number F700-162-000, and the EHB 2805 (RCW 39.04.370) Addendum is form number F700-164-000.



Formulario
F700-007-000
 
Statement of Intent to Pay Prevailing Wages - Public Works Contract

This form is a fillable Word document that is used by a contractor, company or agency upon accepting work on a public works project. The best way to use this use this document is to bookmark this page as a “Favorite” in your web browser. Then each time when you want to use the document, access the online version of the form. This will ensure you are always utilizing the most recently published form. (We recommend you not download the document and save it for future use because we may make changes to the form that your downloaded version will not contain.) You should file this form immediately after the contract is awarded and before you begin work. Form number F700-160-000 is addendum A and F700-163-000 is addendum C.



Formulario
F700-029-000
 
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.



Formulario
F700-143-000
 
Worker Rights Complaint Form

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



Formulario
F700-148-000

Otro(s) idioma(s):
Español
 
Formulario de queja sobre los derechos laborales

Formulario: queja sobre los derechos laborales.  Las versiones de octubre de 2010 y de diciembre 2011 son válidas.



Formulario
F700-148-999

Otro(s) idioma(s):
Inglés
 
Help for Crime Victims (large poster)

Poster (11" X 17"): Highlights the Crime Victims Compensation Program and provides contact information. Intended for display in health-care, criminal-justice and social-service organizations. Can be downloaded and printed, or ordered from L&I. Smaller version is also available (8.5" X 11"). Get 11" X 17" poster printing tips.



Cartel
F800-041-000

Otro(s) idioma(s):
Español
 
Ayuda para víctimas de crimen (cartel grande)

Cartel:  Documento con las medidas 11 X 17 pulgadas. Resalta el Programa de Compensación para Víctimas de Crimen y proporciona información para comunicarse con el programa. La intención es ponerlo a la vista en clínicas, organizaciones judiciales y de servicios sociales. Puede descargarse e imprimirse o solicitarse de L&I.  Hay una versión disponible más pequeña (8.5 X 11 pulgadas).



Cartel
F800-041-999

Otro(s) idioma(s):
Inglés
 
Statement for Crime Victim Miscellaneous Services

Used by the provider or supplier for reimbursement of the following services - dental, glasses, home health, nursing home serivces, medical equipment, prosthetics-orthotics, transportation, vocational, retraining and other.



Formulario
F800-076-000
 
Help for Crime Victims (small poster)

Poster (8.5" X 11"): Highlights the Crime Victims Compensation Program and provides contact information. Intended for display in health-care, criminal-justice, and social-service organizations. Can be downloaded and printed, or ordered from L&I. Larger version is also available (11" X 17").



Cartel
F800-104-000

Otro(s) idioma(s):
Español
 
Ayuda para víctimas de crimen

Cartel:  Documento con las medidas 8.5 X 11 pulgadas.  Resalta el programa de compensación para víctimas de crimen y proporciona información para comunicarse con el programa. La intención es ponerlo a la vista en clínicas, organizaciones judiciales y de servicios sociales.  Puede descargarse e imprirse o solicitarse de L&I. Hay una versión disponible más grande (11 X 17 pulgadas).



Cartel
F800-104-999

Otro(s) idioma(s):
Inglés
 
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.



Formulario
F100-002-000
 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Formulario
F120-116-000
 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Formulario
F207-040-000
 
F245-392-000 Resource Utilization Group (RUG) Residential Care Services for L&I Injured Workers (In place of MDS 3.0 beginning October 1, 2010.)
Filled out by the provider when they treat an injured worker. See web links below for: Latest payment amounts, Updates and corrections, and Review payment policy. For use in place of Minimum Data Set (MDS) 3.0 beginning October 1, 2010.

Formulario
F245-392-000
 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Formulario
F622-081-000
 





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