Get a Form or Publication: closure
Your search for "closure" returned 23 documents.
See also
| Title | Type | Number |
|---|---|---|
| Application to Reopen Claim due to Worsening Condition - Spanish Aplicación para Reabrir un Reclamo Debido al Empeoramiento de la Condición
Also available in: English, English/Spanish Spanish version. Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days. |
Form | F242-079-999 |
| Model Disclosure Statement Notice to Customer
This disclosure statement is given to the consumer (customer) from the contractor showing they are registered in the state of Washington. The consumer (customer) signs this form as acknowledgement of receipt. |
Form | F625-030-000 |
| Notificación de Decisión de Cierre para Reclamos Únicamente Médicos para Empleadores Autoasegurados
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-999 |
| Request for Public Records
To request public records from Washington State Dept. of Labor and Industries. You can order an earlier version from the LNI warehouse until stock is exhausted. |
Form | F101-009-000 |
| Affidavit to Release Public Records
This form is to request L&I to release public records in the contractors registration section. |
Form | F625-066-000 |
| Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-NTL
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-999 |
| Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-TL
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-999 |
| Notificación de Decisión de Cierre para reclamos de Tiempo Perdido para Empleadores Autoasegurados
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-999 |
| Request for Archive Records - Contractor Registration
This form is to request L&I to release archive records in the contractors registration section. |
Form | F625-094-000 |
| Self-Insurance Report of Occupational Injury or Disease (SIF-5)
Used by only self-insured employers or their representatives to report initial time loss payments or to request interlocutory, wage, overpayment or closure orders. |
Form | F207-005-000 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-111 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice - Cambodian
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-666 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice - Korean
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-777 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-000 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL - Korean
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-777 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL -Cambodian
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-666 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-000 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL - Cambodian
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-666 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL -Korean
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-777 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice
Also available in: Cambodian, Korean, Spanish Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-000 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice - Korean
Also available in: English Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-777 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice -Cambodian
Also available in: English Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-666 |
| Your Privacy Is Important to Us (English/Spanish)
Fact sheet: Serves as L&I's official privacy notice. States how L&I may use and share the pesonal information it collects. It also informs the public how they can file a complaint if they believe L&I has misused or inappropriately disclosed their personal information. |
Publication | F101-055-909 |
We value your feedback!
Please take this survey to help improve the L&I website.
Take survey
(About 3 minutes)
© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.