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Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.

Master Business Application

Link is to the Master Business License online form: Required for employers who hire minors and is obtained by completing the Master Business Application. Also available from L&I warehouse.

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.

Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

This form is not available to download. If you are an injured worker, ask your medical provider for a copy of this form or you can complete your portion of the Report of Accident (ROA) online at www.FileFast.Lni.wa.gov. Please note only medical providers may order this form from the Warehouse.

Our supply of paper ROAs is limited, but medical provider offices can file their Report of Accident (ROA) within 30 minutes online through FileFast at www.FileFast.Lni.wa.gov. Filing online gives you immediate claim confirmation and speeds claim processing by 5 days.  Provider offices also can get reimbursed $10 (billing code 1040M) for each ROA filed online.

We anticipate receiving additional ROAs in our Warehouse by February 9, 2015.

Power of Attorney for Electronic Remittance Advice

Providers complete this form to authorize a clearinghouse or third party to receive the EDI 835 Electronic Remittance Advice file from L&I's Provider Express Billing (PEB).

Employer Rights - Wages Paid

Covers penalties for employer wage violations. Once stock runs out in warehouse, this form will be internet only.

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.

Preventing Slips and Falls
Information on how to prevent slips and falls with your footwear, housekeeping and also some general awareness tips. Get poster printing tips.

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

Your Manufactured/Mobile Home

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.


Otro(s) idioma(s):
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.


Otro(s) idioma(s):

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