Get a Form or Publication: activity

Your search for "activity" returned 4 documents.

Title Type Number
Insurer Activity Prescription Form - Spanish Formulario de Restricciones Laborales del Asegurador
Also available in: English

Used by Spanish speaking health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans.

Utilizado por proveedores de cuidado de la salud que hablan español para indicar la condición actual del trabajador lesionado, restricciones físicas, certificación de tiempo perdido y planes de tratamiento.

Form F242-385-909
Insurer Activity Prescription Form
Also available in: English/Spanish

Used by health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans. To print an APF, click on the title of the form in the box above.

Form F242-385-000
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities

Used by both workers and bidding contractors to read, sign and submit to L&I to verify that they have read, understand and accept their respective responsibilities in the home modification process.

Form F247-003-000
Program Equal Employment Opportunity Activity Documentation

Used to record individual equal employment opportunity activities conducted by Apprenticeship Programs.

Form F100-012-000



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