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Employers' Guide to Workers' Compensation Insurance in Washington State


Publicación
F101-002-000

Otro(s) idioma(s):
Español
 
Application for Self-Insurance Certification


Formulario
F207-001-000
 
Self-Insurance Report of Occupational Injury or Disease (SIF-5)


Formulario
F207-005-000
 
Notice to Employees -- Self-Insurance / Aviso a los empleados -- Seguro industrial propio (English/español)


Cartel
F207-037-909
 
Employers' Guide to Self-Insurance in Washington State


Publicación
F207-079-000
 
Self-Insured Employer Certificate of Excess Insurance


Formulario
F207-095-000
 
Preparing for Your Self-Insurance Audit


Publicación
F207-110-000
 
Self-Insurance Vocational Services Closing Cover Sheet


Formulario
F207-171-000
 
Self-Insurance Certification Questionnaire


Formulario
F207-176-000
 
Self-Insurance Vocational Reporting Form


Formulario
F207-190-000
 
Self Insurance Continuing Education Report of Course Completion


Formulario
F207-191-000
 
Self Insurance Continuing Education Sponsor/Instructor Application for Course Approval


Formulario
F207-192-000
 
Self-Insurance Electronic Data Reporting System (SIEDRS) Enrollment Form


Formulario
F207-193-000
 
Self-Insurance Electronic Data Reporting System (SIEDRS): Enrollment Package 2.0


Publicación
F207-194-000
 
SIEDRS (Self-Insurance Electronic Data Reporting System) Data Change Request


Formulario
F207-197-000
 
Self-Insurance Continuing Education Application for Course Approval and Attendance


Formulario
F207-206-000
 
Self-Insurance Medical Provider Billing Dispute Form


Formulario
F207-207-000
 
Temporary Services Guide to Workers' Compensation Insurance


Manual
F213-019-000
 
Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance


Formulario
F242-422-000

Otro(s) idioma(s):
Español
 
Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance


Formulario
F242-423-000

Otro(s) idioma(s):
Español
 
Application for Group Membership & Authorization for Release of Insurance Data


Formulario
F250-016-000
 
Industrial Insurance Discrimination Complaint


Formulario
F262-009-000

Otro(s) idioma(s):
Español
 
Assignment of Account or Time Deposit for Insurance - Bodily Injury - WA State Banks Only


Formulario
F625-082-000
 
Assignment of Account or Time Deposit for Insurance - Property Damage - WA State Banks Only


Formulario
F625-083-000
 
Application for Agent On-Line Insurance Entry Account


Formulario
F625-110-000
 
The Best Accident Insurance - To observe all safety regulations


Cartel
FSP0-915-000
 
An Employer's Intro to L&I


Publicación
F101-101-000
 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification


Formulario
F207-040-000
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses


Publicación
F207-085-000

Otro(s) idioma(s):
Español
 
Memorandum of Understanding Irrevocable Standby Letter of Credit


Formulario
F207-113-000
 
Overpayment Reimbursement Fund Request Coversheet


Formulario
F207-212-000
 
Sports Teams Coverage Agreement


Formulario
F212-196-000
 
Mechanized Logging Supplemental Quarterly Report


Formulario
F212-223-000
 
Construction Industry Classification Guide


Publicación
F213-008-000
 
Corporate Officers


Publicación
F214-010-000
 
Independent Contractors


Publicación
F214-012-000
 
Standard Exception Classification


Publicación
F214-016-000
 
Limited Liability Companies (LLC)


Publicación
F214-021-000
 
Workers' Compensation Benefits: A Guide for Injured Workers


Publicación
F242-104-000

Otro(s) idioma(s):
Español
 
Notice to Employees -- If a Job Injury Occurs/Aviso a los empleados--si ocurre una lesión en el trabajo (English/español)


Cartel
F242-191-909
 
Application for Limited Elective Coverage for Licensed Pony Riders


Formulario
F250-026-000
 
Quick Tips for Lifting / Consejos rápidos para levantar objetos (English/español)


Publicación
F417-055-909
 
Reassignment of Savings Account or Time Deposit - Construction Contractors


Formulario
F625-011-000
 
Construction Contractors - Steps for Success


Publicación
F625-115-000

Otro(s) idioma(s):
Español
 
Authorization to Release Claim Information


Formulario
F101-010-000

Otro(s) idioma(s):
Español
 
Request for Claim Information


Formulario
F101-010-111
 
Autorización para proveer información de reclamos


Formulario
F101-010-999

Otro(s) idioma(s):
Inglés
 
Quarterly Report for Self-Insured Business


Formulario
F207-006-000
 
Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers


Formulario
F207-011-000
 
Special Escrow Agreement


Formulario
F207-039-000
 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)


Formulario
F207-040-001
 
Assignment of Account Agreement


Formulario
F207-058-000
 
Self-Insurer's Pension Bond


Formulario
F207-065-000
 
Self-Insurer's Bond - Existing Liabilities


Formulario
F207-068-000
 
Self-Insured Employers' Time Loss Claim Closure Order and Notice


Formulario
F207-070-000

Otro(s) idioma(s):
Español
 
Irrevocable Standby Letter of Credit


Formulario
F207-112-000
 
Amendment of Irrevocable Standby Letter of Credit


Formulario
F207-112-111
 
Pension Bond Rider


Formulario
F207-120-000
 
Annual Supplemental Surety Information


Formulario
F207-125-000
 
Memorandum of Understanding


Formulario
F207-129-000
 
Surety Rider


Formulario
F207-134-000
 
Special Escrow Account - Amendment Agreement


Formulario
F207-137-000
 
Acknowledgement of Security Interest


Formulario
F207-143-000
 
SIF-5A Cover Sheet: Wage Calculations


Formulario
F207-156-000
 
Workers' Compensation Filing Information


Formulario
F207-155-000

Otro(s) idioma(s):
Español
 
Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL


Formulario
F207-164-000

Otro(s) idioma(s):
Español
 
Work Status Form (formerly Worker Verification Form)


Formulario
F242-052-000

Otro(s) idioma(s):
Español
 
Cómo Registrar un Reclamo para la Compensación del Trabajador con Empresas Autoaseguradas


Formulario
F207-155-999

Otro(s) idioma(s):
Inglés
 
Self-Insured Employers' Medical Only Claim Closure Order and Notice


Formulario
F207-020-111

Otro(s) idioma(s):
Español
 
Notificación de decisión de cierre para reclamos únicamente médicos para empleadores autoasegurados


Formulario
F207-020-999

Otro(s) idioma(s):
Inglés
 
Notificación de decisión de cierre para reclamos de tiempo perdido para empleadores autoasegurados


Formulario
F207-070-999

Otro(s) idioma(s):
Inglés
 
Notificación de decisión de cierre con discapacidad parcial permanente para empleadores autoasegurados -DISCAPACIDAD PARCIAL PERMANENTE (PPD) - CON TIEMPO PERDIDO (NTL)


Formulario
F207-164-999

Otro(s) idioma(s):
Inglés
 
Address Change Request for Injured Workers


Formulario
F242-388-000

Otro(s) idioma(s):
Español
 
Solicitud para cambio de dirección para trabajadores lesionados


Formulario
F242-388-999

Otro(s) idioma(s):
Inglés
 
Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL


Formulario
F207-165-000

Otro(s) idioma(s):
Español
 





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