Report of Industrial Injury or Occupational Disease (Accident Report ) (ROA)


Report of Industrial Injury or Occupational Disease (Accident Report ) (ROA)

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Title	Report of Industrial Injury or Occupational Disease (Accident Report ) (ROA)
Description	Used by injured workers, doctors, and employers to report an industrial injury or occupational disease. This report is not available online. Order by the number of copies you need. Do not order by box or case. If you are an injured worker, ask your doctor for a copy of this form.
Detail
Form number	F242-130-000
Availability	Order it
Keywords	accident, accident report, claim information, claims, coverage, diseases, espanol, industrial, industrial insurance, injury, insurance, medical, medical forms, occupational, occupational diseases, occupational injuries, report, report injury, report of accident, report of injury or occupational disease, reporting accidents, spanish, worker's compensation, workers compensation, workers' compensation
Languages	English , Spanish
Valid dates	05-2008
Contact information	Managing Injured Workers' Claims
Web pages	Workers' Comp Claims