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

Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease - (Forms/Publications)
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Title Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease
Description

This form is not available online. 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 https://secure.Lni.wa.gov/home.

Medical providers can order the ROA and the worker instruction in Spanish from the L&I Warehouse by using the link below.
http://www.Lni.wa.gov/ClaimsIns/Providers/FormPub/ROA/OrderROA.asp

Detail
Form number F242-130-000
Availability
Order it
Keywords accident report, claim information, claims, coverage, diseases, espanol, industrial insurance, medical forms, occupational diseases, occupational injuries, report of injury or occupational disease, reporting accidents, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 10-2012
Contact information
Web pages Workers' Comp Claims

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