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


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.

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