Order L&I Report of Industrial Injury or Occupational Disease (ROA) forms

Order your updated Report of Accident forms here – It's required

(Also referred to as Report of Industrial Injury or Occupational Disease or ROA. The health care provider and the injured worker completes this from when filing a workers compensation claim.)

  • Use the new forms as soon as they arrive: 
    Discard your old Report of Accident forms and use only this updated version.
  • Read the new law requiring this change – Registered Domestic Partners 
    This new form incorporates changes required by a new Washington law that, beginning Dec. 3, 2009, gives state Registered Domestic Partners the same rights and benefits as married spouses.

Order now:

Submit your online order

Or

Use this form to FAX your order

Note:  Please order a three-month supply, at the most. Our warehouse reserves the right to mail a smaller order if supplies run low.  

Check other changes we made to this form

  • Clearer, simplified instructions and new look
  • Time-saving tips for our health care providers
  • Better information for injured workers
  • Clearer instructions for doctors recommending light-duty

Online Filing of the ROA

L&I offers a financial incentive to providers who file the Report of Accident on our website at www.FileFast.Lni.wa.gov.

Learn more about FileFast.

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.