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A Guide to Workplace Safety and Health in Washington State

Pamphlet/booklet: Provides an overview of the Washington Industrial Safety and Health Act (WISHA), worker and employer rights and responsibilities, enforcement of WISHA rules, and consultation and education services L&I provides. Previously titled A Guide to WISHA



Publication
F416-132-000



Alt Language(s):
Español
 
Access Authorization for External Access to Apprenticeship Registration and Tracking System (ARTS)

Form must be filled out to request access to Apprenticeship Registration and Tracking System (ARTS).



Form
F100-535-000


 
Adolescentes en el trabajo: información para empleadores, padres y adolescentes

Folleto: Responde a preguntas que los empleadores, padres y adolescentes podrían tener cuando contratan trabajadores adolescentes (edades 14-17). Explica las reglas de trabajo no agrícolas, incluyendo los permisos necesarios, horas y condiciones de trabajo. Proporciona enlaces para otros recursos.



Publication
F700-022-999



Alt Language(s):
Inglés
 
Affidavit of Experience - Plumbers

This form is required to report plumber trainee's plumbing experience for credit towards journey level or specialty status.



Form
F627-004-000


 
Agricultural Employer Worksheet

Used by agricultural employers to assist them in determining if they are following the state Agricultural Employment Standards and the Minimum Wage Act for their employees.



Form
F700-125-000


 
Agricultural Employer Worksheet

Used by agricultural employers to assist them in determining if they are following the state Agricultural Employment Standards and the Minimum Wage Act for their employees.



Form
F700-125-000


 
Air Conditioner/Heat Pump Pre-Inspection Checklist

This checklist is designed to be generic in content and may not include all requirements for your particular installation.



Form
F622-014-000


 
Alteration Fire Safety Pre-Inspection Checklist

Checklist for homeowners on how to upgrade their pre-HUD homes to approach the HUD standards in the area of fire safety.



Form
F622-011-000



Alt Language(s):
Español
 
Alteration Polybutylene Re-Pipe Pre-Inspection Checklist

This checklist is used by the contractor when altering a polybutylene re-pipe. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-053-000


 
Alteration Polybutylene Re-Pipe Pre-Inspection Checklist

This checklist is used by the contractor when altering a polybutylene re-pipe. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-053-000


 
Alteration Re-Roofing for Low Slope Roofing

Checklist used by the contractor when altering a low slope roof.



Form
F622-039-000


 
An Employer's Intro to L&I

Info card: Provides information on the Employer's Intro to L&I workshop, including statewide schedule of workshops. Designed for employers and managers, the workshop covers a number of topics, including workers' compensation insurance, workplace safety, and overtime.



Publication
F101-101-000


 
Application for Farm Labor Contractor License

Used to apply or renew a license.



Form
F700-014-000


 
Application for Farm Labor Contractor License

Used to apply or renew a license.



Form
F700-014-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for House to House Sales Sales Employer Registration Certificiate

Used by employers to register as employing minors who will be engaged in house-to-house sales, as required by WAC 296-125-024, with Labor and Industries.



Form
F700-121-000


 
Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing Wage Rate

Employer Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing



Form
F700-122-000


 
Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing Wage Rate

Employer Application for Special Certificate to Employ A Vocationally Handicapped Worker at at Subprevailing



Form
F700-122-000


 
Application for Special Certificate to Employ at A Subminimum Wage Rate

Employer Application for Special Certificate to Employ at A Subminimum Wage Rate.



Form
F700-120-000


 
Application for Special Certificate to Employ at A Subminimum Wage Rate

Employer Application for Special Certificate to Employ at A Subminimum Wage Rate.



Form
F700-120-000


 
Authorization of Signature

This gives individuals other than the Secretary or Chairman authorization to sign ALL Papers or just Registration Cards. Must be signed by a quorum of the Apprenticeship Committee.



Form
F100-500-000


 
Autorización para proveer información de reclamos

Usado por el trabajador para designar a una persona(s) como representante(s) autorizado(s) del reclamo del trabajador.  Un representante autorizado puede obtener acceso a la información de reclamo.



Form
F101-010-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Beneficios de compensación para los trabajadores: una guía para los trabajadores lesionados

Folleto: Explica los derechos y responsabilidades de los trabajadores bajo la Ley de Seguro Industrial.  Describe beneficios y cómo presentar un reclamo.  Aviso: El documento fue anteriormnte titulado, Guía de beneficios del seguro industrial para los trabajadores.  



Publication
F242-104-999



Alt Language(s):
Inglés
 
Carta de intención de registro en una escuela

Utilizado por un estudiante de tiempo completo que tiene derecho a recibir beneficios de pensión.  El estudiante debe tener por lo menos 18 años de edad y no ser mayor de 23 años de edad.  Este formulario es para demostrar la intención del estudiante de registrarse en una escuela acreditada durante el próximo trimestre/semestre.



Form
F242-382-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Casas prefabricadas y móviles: lo que los dueños de casas y contratistas deben saber al modificar una vivienda

Folleto: Cubre asuntos que usted debe considerar al modificar su casa. Define lo que significa modificación, reparación y sustitución e incluye consejos para contratar contratistas registrados. También incluye información de comunicación para el Programa de L&I para Asistencia al Consumidor para dueños de casas prefabricadas /móviles.



Publication
F622-049-999



Alt Language(s):
Inglés
 
Certified Project Payroll

There are instructions in one PDF file, and a blank form that may be printed in the other PDF. The word document is saved in Microsoft 2003 format and is a fillable word form.



Form
F700-065-000


 
Cholinesterase Blood Testing Choice

Use this form to say whether or not you choose to have the Cholinesterase blood tests performed.



Form
F413-064-000



Alt Language(s):
Español
Español
 
Cholinesterase Monitoring Health Care Provider Recommendations

Filled out by the provider. This form gives the recommendations by the provider of what needs to be done based on the test results on the employee.



Form
F413-070-000



Alt Language(s):
Español
Español
 
Cholinesterase Monitoring Reimbursement Request

Employers use this form to request reimbursement for the reasonable costs of training, travel, recordkeeping, and medical expenses for Cholinesterase Monitoring.



Form
F413-062-000


 
Cholinesterase Monitoring Reimbursement Request

Employers use this form to request reimbursement for the reasonable costs of training, travel, recordkeeping, and medical expenses for Cholinesterase Monitoring.



Form
F413-062-000


 
Cholinesterase Monitoring Reimbursement Request

Employers use this form to request reimbursement for the reasonable costs of training, travel, recordkeeping, and medical expenses for Cholinesterase Monitoring.



Form
F413-062-000


 
Chronic Opioid Request Form

Use this form to request opioid coverage beyond 12 weeks from the date of injury or surgery, or every 90 days for chronic opioid therapy.



Form
F252-091-000


 
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Allow two weeks for a response. Accuracy and completeness speeds up the processing time.



Form
F621-001-000


 
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Allow two weeks for a response. Accuracy and completeness speeds up the processing time.



Form
F621-001-000


 
Copper Tubing Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing gas lines with copper tubing. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-046-000


 
Copper Tubing Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing gas lines with copper tubing. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-046-000


 
Court Form Granting Permission for Employment of Minors

Form from Court Granting Permission for Employment of Minors to the employer.



Form
F700-119-000


 
Court Form Granting Permission for Employment of Minors

Form from Court Granting Permission for Employment of Minors to the employer.



Form
F700-119-000


 
Crime Victims Compensation Program Initial Response and Assessment: Form II

Used by the clinical provider to request authorization to provide more than six sessions. This form must be submitted by the sixth session. (6 pages)



Form
F800-081-000


 
Crime Victims Compensation Program Treatment Report: Form V

Used by the clinical provider to get preauthorization for payment of additional sessions.



Form
F800-084-000


 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-070-000


 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Form
F800-070-000


 
Decertification of Manufactured and Mobile Homes

This document shows the steps to decertify a manufactured or mobile home.



Form
F622-063-000


 
Decertification of Manufactured and Mobile Homes

This document shows the steps to decertify a manufactured or mobile home.



Form
F622-063-000


 
Declaración para servicios misceláneos

Formulario:  Es utilizado por proveedores y trabajadores lesionados para cobrarle al Departamento por servicios tales como, cuidado dental; lentes; cuidado de enfermería en el hogar; equipo médico, servicios de intérprete; servicios que los trabajadores pagan por su cuenta y otros servicios.



Form
F245-072-999



Alt Language(s):
Inglés
 
Department of Employment Security Tax Compliance Certification

Form to gain Department of Employment Security Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-099-000


 
Department of Employment Security Tax Compliance Certification

Form to gain Department of Employment Security Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-099-000


 
Department of Revenue Tax Compliance Certification

Form to gain Department of Revenue Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-100-000


 
Department of Revenue Tax Compliance Certification

Form to gain Department of Revenue Tax Compliance Certification for registered Farm Labor Contractors.



Form
F700-100-000


 
Discriminación de seguridad y salud en el lugar de trabajo

Folleto: Los empleados tienen derecho a reportar sus inquietudes sobre seguridad y salud en sus lugares de trabajo.  Este folleto describe las “actividades protegidas": bajo la Ley de Seguridad y Salud Industrial de Washington (WISHA, por su sigla en inglés) y explica lo que debe hacer un empleado si él/ella es castigado o despedido por ejercer estos derechos.



Publication
F417-244-999



Alt Language(s):
Inglés
 
Elección para prueba de sangre de colinesterasa

Formulario:  Es utilizado para indicar si usted elije o no que se le hagan examenes de colinesterasa en la sangre.



Form
F413-064-999



Alt Language(s):
Inglés
Inglés
 
Elección para prueba de sangre de colinesterasa

Formulario:  Es utilizado para indicar si usted elije o no que se le hagan examenes de colinesterasa en la sangre.



Form
F413-064-999



Alt Language(s):
Inglés
Inglés
 
Electric / Gas Conversion Pre-Inspection Checklist

This checklist is generic in content and may not include all requirements for your particular installation. The manufacturer's installation instruction must be adhered to and available to the inspector at the time of the inspection.



Form
F622-013-000


 
Employer Petition to The Court for Minor Work Permit Under Age 14

Petition to The Court for Minor Work Permit Under Age 14 by Employer.



Form
F700-118-000


 
Employer Petition to The Court for Minor Work Permit Under Age 14

Petition to The Court for Minor Work Permit Under Age 14 by Employer.



Form
F700-118-000


 
Employer Rights - Wages Paid

Covers penalties for employer wage violations. Once stock runs out in warehouse, this form will be internet only.



Form
F700-058-000


 
Employer Rights - Wages Paid

Covers penalties for employer wage violations. Once stock runs out in warehouse, this form will be internet only.



Form
F700-058-000


 
Employing Children Under Age 14 in Non-Agricultural Jobs

Fact sheet: Explains when employers can and cannot employ minors under age 14 in non-agricultural jobs. Details the process for obtaining court permission when hiring minors under 14 is allowed.



Publication
F700-117-000


 
Employing teens under 18 in food service? - L&I’s fact sheet of permitted and prohibited work activities for youth ages 14 to 17 in food service

Fact sheet: Explains permitted and prohibited work activities for youth ages 14 to 17 in food service. Includes rules for driving, student-learner exemptions and work hours.



Publication
F700-167-000


 
Eye On Safety Card

Reference card: 8.5 X 5.5 card to promote L&I's EyeOnSafety.info website, where you can find video shorts, training videos, investigation stories and other visual resources.



Publication
F417-222-000


 
Factory Assembled Structures Alteration Application

Used by a homeowner or contactor to request a field inspection for an alteration to a manufactured or mobile home.

Allow 1-2 days for a response to alteration applications for Manufactured/Mobile Homes.

All other alteration applications, allow 2-3 weeks for a response. Accuracy and completeness speeds up the processing time.



Form
F622-036-000


 
Farm Labor Contractor Assignment of Account or Time Deposit

Farm Labor Contractor assignment of account or tme deposit for employee



Form
F700-060-000


 
Farm Labor Contractor Assignment of Account or Time Deposit

Farm Labor Contractor assignment of account or tme deposit for employee



Form
F700-060-000


 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-000



Alt Language(s):
Español
 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Form
F700-112-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Form
F700-109-000



Alt Language(s):
Español
 
Farm Labor Contractor Registration

Fact Sheet: Explains how to get a farm labor contractor license in order to operate legally as a farm labor contractor in Washington State.



Publication
F700-088-000



Alt Language(s):
Español
 
Farm Labor Contractors Bond

Notarized farm labor contractors bond coverage.



Form
F700-066-000


 
Farm Labor Contractors Bond

Notarized farm labor contractors bond coverage.



Form
F700-066-000


 
Flood Damaged Manufactured Home Checklist

Checklist on how to repair a flood damaged manufactured home. After the contractor has done all that is required by the checklist they call L&I for an inspection.



Form
F622-040-000


 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Form
F622-048-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
Gas Room Heaters Pre-Inspection Checklist

This checklist is used by the contractor when installing gas room heaters. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-045-000


 
HB 2253 Open Window Opportunity - Affidavit of Hours of Unsupervised Telecommunications Installation Experience

This form is not available until June 12.



Form
F500-127-000


 
Hearing Aid Repair Authorization Fax Request

Hearing Aid Repair Authorization Requests. If you need to purchase or replace a hearing aid, fax all of the information required by Medical Aid Rules and Fee Schedule (MARFS) including the Hearing Services Worker Information (F245-049-000) to 360-902-6252.



Form
F245-384-000


 
Hearing Aid Repair Authorization Fax Request

Hearing Aid Repair Authorization Requests. If you need to purchase or replace a hearing aid, fax all of the information required by Medical Aid Rules and Fee Schedule (MARFS) including the Hearing Services Worker Information (F245-049-000) to 360-902-6252.



Form
F245-384-000


 
Hiring a Plumber? Hire Smart!

Worksheet: Provides advice and step-by-step hiring tips for homeowners planning a remodel, repair or addition to their home that involves plumbing. Tells homeowners how to verify that a construction contractor is registered and a plumber is certified with the state.



Publication
F627-044-000


 
Hiring teens? / ¿Piensa contratar adolescentes? (English/español)

Fact sheet: Provides important information about hiring teens, including extra safety precautions, as well as legal requirements regarding minor work endorsement, hours and prohibited duties. Provides telephone, e-mail and Web contacts for more information.

Hoja de información:  Proporciona información importante sobre la contratación de adolescentes, incluyendo precauciones adicionales de seguridad, así como también los requisitos legales referentes al endoso de trabajo para menores, horas y tareas prohibidas.  Proporciona un teléfono, correo electrónico y contactos en la página Web para más información.

 



Publication
F700-142-909


 
Hoja para contratar un contratista con éxito

Lista de comprobación: Proporciona información para ayudar a seleccionar posibles contratistas para proyectos de construcción de casas o reparación/remodelación.  Presentado en un formato organizado y detallado.



Publication
F625-111-999



Alt Language(s):
Inglés
 
Home Modification for Workers with Catastrophic Injuries - Questions and Answers for Contractors

Fact sheet: Answers questions about the home modification benefit in Washington State's workers' compensation program and the bid process for contractors interested in this work.



Publication
F252-061-000


 
Homeowners Manufactured / Mobile Home Variance Request

This variance request applies only to the installations performed by a previous owner and does not apply to any home during the warranty period.



Form
F622-054-000


 
Homeowners Manufactured / Mobile Home Variance Request

This variance request applies only to the installations performed by a previous owner and does not apply to any home during the warranty period.



Form
F622-054-000


 
If Family Members Work for You, Know Your Obligations (English/Thai)

Fact sheet: Provides an overview and resources to know your obligations when you have family members working for you. Relatives, including children, must be treated as employees with the same rights as any other paid worker in the state of Washington.



Publication
F101-077-303



Alt Language(s):
English/中国的
English/한국의
English/русский
English/Español
English/Vi?t
 
If Family Members Work for You, Know Your Obligations / Conozca sus obligaciones cuando miembros de su familia trabajan para usted (English/español)

Fact sheet: Provides an overview and resources to know your obligations when you have family members working for you. Relatives, including children, must be treated as employees with the same rights as any other paid worker in the state of Washington.

Hoja de información:  Proporciona un resumen y recursos para conocer sus obligaciones cuando tiene miembros de la familia trabajando para usted.  Los familiares, incluyendo los niños, deben ser tratados como empleados con los mismos derechos que cualquier otro empleado pagado en el estado de Washington.



Publication
F101-077-909



Alt Language(s):
English/中国的
English/한국의
English/русский
English/Thai
English/Vi?t
 
Instrucciones para el registro de una queja sobre salario prevaleciente

Pídale a L&I que haga una investigación de un asunto relacionado con el salario prevaleciente que afecte a uno o más empleados.



Form
F700-146-999



Alt Language(s):
Inglés
 
Internal Revenue Service Tax Compliance Certification

Form to gain Internal Revenue Service Tax Compliance Certification for registered Farm Labor Contractors. Now includes IRS form 8821 Tax Information Authorization.



Form
F700-098-000


 
Internal Revenue Service Tax Compliance Certification

Form to gain Internal Revenue Service Tax Compliance Certification for registered Farm Labor Contractors. Now includes IRS form 8821 Tax Information Authorization.



Form
F700-098-000


 
Is it a Manufactured / Mobile Home?

If your home has any of the items in this document, it is a manufactured / mobile home and requires inspections for all alterations by L&I's Factory Assembled Structures Section.



Form
F622-043-000


 
Jorge's New Job: Cholinesterase Testing in Washington State / Un Nuevo Trabajo para Jorge(English/Spanish)

Pamphlet/booklet: Uses a story format with dialogue and photographs to explain the hazards of cholinesterase-inhibiting pesticides, the state's monitoring program and the importance of using proper safety equipment when working with pesticides.

Panfleto/folleto:  Utiliza un formato de cuento con diálogo y fotografías para explicar los peligros de la colinesterasa, el programa de monitoreo del estado y la importancia del uso adecuado del equipo de seguridad cuando se trabaja con pesticidas.



Publication
F417-213-909


 
Jorge's New Job: Cholinesterase Testing in Washington State / Un Nuevo Trabajo para Jorge(English/Spanish)

Pamphlet/booklet: Uses a story format with dialogue and photographs to explain the hazards of cholinesterase-inhibiting pesticides, the state's monitoring program and the importance of using proper safety equipment when working with pesticides.

Panfleto/folleto:  Utiliza un formato de cuento con diálogo y fotografías para explicar los peligros de la colinesterasa, el programa de monitoreo del estado y la importancia del uso adecuado del equipo de seguridad cuando se trabaja con pesticidas.



Publication
F417-213-909


 
Jorge's New Job: Cholinesterase Testing in Washington State / Un Nuevo Trabajo para Jorge(English/Spanish)

Pamphlet/booklet: Uses a story format with dialogue and photographs to explain the hazards of cholinesterase-inhibiting pesticides, the state's monitoring program and the importance of using proper safety equipment when working with pesticides.

Panfleto/folleto:  Utiliza un formato de cuento con diálogo y fotografías para explicar los peligros de la colinesterasa, el programa de monitoreo del estado y la importancia del uso adecuado del equipo de seguridad cuando se trabaja con pesticidas.



Publication
F417-213-909


 
Lista de comprobación para la preinspección de seguridad contra incendios

Lista de comprobación para dueños de casas sobre cómo mejorar sus casas antes de la preinspección del Departamento de Vivienda y Desarrollo Urbano (HUD, por su sigla en inglés) para alcanzar los estándares en el área de seguridad contra incendios.



Form
F622-011-999



Alt Language(s):
Inglés
 
Low Voltage Fire / Intrusion Alarm Checklist

This checklist is designed to be generic in content and may not include all requirements for your particular installation.



Form
F622-038-000


 
Manufactured Home Installer Certification Tag Order form

Manufactured Home Installer Certification Tag Order form



Form
F622-077-000


 
Manufactured Home Installer Certification Tag Transfer Request form

Manufactured Home Installer Certification Tag Transfer Request form



Form
F622-079-000


 
Manufactured Home Installer's Monthly Certification Tag Report

Manufactured Home Installer's Monthly Certification Tag Report



Form
F622-078-000


 
Maritime Coverage

Used by the employer as a quick reference guide to explain which maritime jobs may or may not be covered by L&I.



Form
F212-034-000


 
Maritime Coverage

Used by the employer as a quick reference guide to explain which maritime jobs may or may not be covered by L&I.



Publication
F212-034-000


 
Massage Therapy Treatment Authorization Fax Request

Used by a licensed massage practitioner/clinic to request authorization for outpatient massage therapy services for L&I claims.



Form
F248-357-000


 
Minimum Header Structural Requirements for Manufactured Home Alterations

For use on sidewalls only. Maximum of one new opening up to 11-6 wide per sidewall. Edge of opening to be no closer than 4 from end of sidewall.



Form
F622-080-000


 
Minimum Wage Law Exemptions

Covers exemptions to Washington state minimum wage law.



Publication
F700-051-000


 
Monitoreo de la colinesterasa - recomendaciones del proveedor médico (ejemplo)

El proveedor llena este formulario.  Este formulario da recomendaciones por parte del proveedor sobre lo que necesita hacerse basado en los resultados de las pruebas hechas al empleado.



Form
F413-070-999



Alt Language(s):
Inglés
Inglés
 
Monitoreo de la colinesterasa - recomendaciones del proveedor médico (ejemplo)

El proveedor llena este formulario.  Este formulario da recomendaciones por parte del proveedor sobre lo que necesita hacerse basado en los resultados de las pruebas hechas al empleado.



Form
F413-070-999



Alt Language(s):
Inglés
Inglés
 
Occupational or Physical Therapy Treatment Authorization Fax Request

Used by a therapy provider/clinic to request authorization for outpatient occupational or physical therapy services for L&I claims.



Form
F248-055-000


 
Office Locations Map

Fact sheet: Shows which L&I region serves which counties and the location of offices. Side Two lists the address and telephone number for each office.



Publication
F101-100-000


 
On-The-Job Training Work Hours

Used to report the work hours for an on-the-job training employee.



Form
F100-229-000


 
Parent / School Authorization for Employment of a Minor and Special Variance

For legal guardians and school officials to approve the hours and work activities for a minor employee to work according to terms listed by the employer. The Special Variance allows additional hours of work for 16- and 17-year-olds and is described on the form. All parties must sign to approve the hours of work for a minor regardless of the number of hours listed. This is NOT a work permit. Employers must obtain a minor work permit endorsement on their Master Business License where they employ workers under 18.

For hiring youth only during non-school weeks, you may use form F700-168-000 Parent Authorization Summer Work  



Form
F700-002-000


 
Parent / School Authorization for Employment of a Minor and Special Variance

For legal guardians and school officials to approve the hours and work activities for a minor employee to work according to terms listed by the employer. The Special Variance allows additional hours of work for 16- and 17-year-olds and is described on the form. All parties must sign to approve the hours of work for a minor regardless of the number of hours listed. This is NOT a work permit. Employers must obtain a minor work permit endorsement on their Master Business License where they employ workers under 18.

For hiring youth only during non-school weeks, you may use form F700-168-000 Parent Authorization Summer Work  



Form
F700-002-000


 
Parent / School Authorization for Employment of a Minor and Special Variance

For legal guardians and school officials to approve the hours and work activities for a minor employee to work according to terms listed by the employer. The Special Variance allows additional hours of work for 16- and 17-year-olds and is described on the form. All parties must sign to approve the hours of work for a minor regardless of the number of hours listed. This is NOT a work permit. Employers must obtain a minor work permit endorsement on their Master Business License where they employ workers under 18.

For hiring youth only during non-school weeks, you may use form F700-168-000 Parent Authorization Summer Work  



Form
F700-002-000


 
Payment of Wages - RCW 49.48.010 and 49.52.050

This is a copy of the law that pretains to the payment of wages to an employee when they stop working for an employer. The wages due to the employee for the pay period worked prior to leaving.



Form
F700-064-000


 
Payment of Wages - RCW 49.48.010 and 49.52.050

This is a copy of the law that pretains to the payment of wages to an employee when they stop working for an employer. The wages due to the employee for the pay period worked prior to leaving.



Form
F700-064-000


 
Plan Approval Request - Factory Built Structures and Commercial Coaches

A manufacturer of factory-built structures and/or commercial coaches uses this form to submit plans to L&I for review.



Form
F623-006-000


 
Pre-Inspection Checklist for Hot Water Heating or Hot Water Supply Boilers

Checklist which reflects the most common violations encountered by Field Inspectors. This checklist should be gone through prior to requesting inspection of Hot Water Heating or Hot Water Supply Boilers



Checklist
F620-050-000


 
Preauthorization Request for Services for State Fund Workers' Compensation Patients

This form can only be used for services that can be authorized by the claim manager and it should not be used for Utilization Review (Qualis), Provider Hotline or requests to the Occupational Nurse Consultant.  If you are unsure of what services need to be authorized see L&I fee lookup utility at www.Lni.wa.gov/apps/FeeSchedules/

For complete information on all authorization processes please see:  www.Lni.wa.gov/ClaimsIns/Providers/AuthRef/GetAuth.asp



Form
F242-397-000


 
Preauthorization Request for Services for State Fund Workers' Compensation Patients

This form can only be used for services that can be authorized by the claim manager and it should not be used for Utilization Review (Qualis), Provider Hotline or requests to the Occupational Nurse Consultant.  If you are unsure of what services need to be authorized see L&I fee lookup utility at www.Lni.wa.gov/apps/FeeSchedules/

For complete information on all authorization processes please see:  www.Lni.wa.gov/ClaimsIns/Providers/AuthRef/GetAuth.asp



Form
F242-397-000


 
Preauthorization Request for Services for State Fund Workers' Compensation Patients

This form can only be used for services that can be authorized by the claim manager and it should not be used for Utilization Review (Qualis), Provider Hotline or requests to the Occupational Nurse Consultant.  If you are unsure of what services need to be authorized see L&I fee lookup utility at www.Lni.wa.gov/apps/FeeSchedules/

For complete information on all authorization processes please see:  www.Lni.wa.gov/ClaimsIns/Providers/AuthRef/GetAuth.asp



Form
F242-397-000


 
Preauthorization Request for Services for State Fund Workers' Compensation Patients

This form can only be used for services that can be authorized by the claim manager and it should not be used for Utilization Review (Qualis), Provider Hotline or requests to the Occupational Nurse Consultant.  If you are unsure of what services need to be authorized see L&I fee lookup utility at www.Lni.wa.gov/apps/FeeSchedules/

For complete information on all authorization processes please see:  www.Lni.wa.gov/ClaimsIns/Providers/AuthRef/GetAuth.asp



Form
F242-397-000


 
Prevailing Wage Complaint and Instructions

Ask L&I to conduct an investigation into a prevailing wage violation that affects one or more employees. See box 30 on the form to see what types of complaints are covered.



Form
F700-146-000



Alt Language(s):
Español
 
Prevailing Wage Complaint and Instructions

Ask L&I to conduct an investigation into a prevailing wage violation that affects one or more employees. See box 30 on the form to see what types of complaints are covered.



Form
F700-146-000



Alt Language(s):
Español
 
Protect My Home Hire Smart Worksheet

Checklist: Provides information to help screen potential contractors for home construction or repair/remodel projects. Presented in an organized, step-by-step format.



Publication
F625-111-000


 
Record Keeping Provisions - Employment Standards

This form is for employers to use to keep records on every employee.



Form
F700-009-000


 
Record Keeping Provisions - Employment Standards

This form is for employers to use to keep records on every employee.



Form
F700-009-000


 
Registered Contractor Card

This is a fillable version of the Registered Contractor Card



Form
F625-069-000


 
Request for Survivor Counseling Benefits / Solicitud para beneficios de apoyo para los sobrevivientes (English/español)  

Used by immediate family members of homicide victims to request mental health counseling.

Utilizado por miembros de la familia inmediatos de víctimas de homicidio para solicitar asesoría de salud mental.



Form
F800-057-909


 
Safety and Health Workshops

Pamphlet/Brochure: Introduces free workshops to help employers prevent workplace injuries and control workers' compensation costs. Includes course descriptions, and how to register.



Publication
F416-036-000


 
Se ha lesionado en el trabajo?

Tarjeta para billetera:  Explica cómo presentar un reclamo de compensación para los trabajadores por teléfono.



Publication
F242-404-999


 
Seasonal Group Variance Application

Used for Exceptions from the Hours of Work for Minors for Seasonal work.  Complete the form, print it, sign it and fax or mail it to the address at the top of the form. Variance Application forms may be faxed to (360) 902-5300. If you would like the approved Variance Certificate faxed back to your business, please state so on your cover sheet.



Form
F700-135-000


 
Sports Teams and Youth Workers

Fact sheet: Explains the requirements for sports organizations that engage young people as volunteers or employees to referee, assist or work for the organizations. The focus is workers' compensation coverage and minor work rules.



Publication
F700-130-000


 
Standard Hand Signals for Cranes

Poster: Displays proper hand signals for directing crawler, locomotive and truck crane operators. Please order from L&I or print on 11" X 17" paper.



Poster
FSP0-910-000


 
Statement for Home Nursing Services

Used to bill L&I for reimbursement of home nursing services.



Form
F248-160-000


 
Statement for Home Nursing Services

Used to bill L&I for reimbursement of home nursing services.



Form
F248-160-000


 
Statement for Home Nursing Services

Used to bill L&I for reimbursement of home nursing services.



Form
F248-160-000


 
Statement for Miscellaneous Services

This bill form is used by providers and injured workers to bill the department for services such as dental care; glasses; medical equipment; nursing home services; interpreter services; services workers pay for out of pocket; and other services. Information on how to bill the department can be found in the General Provider Billing Manual [F248-100-000].

 



Form
F245-072-000



Alt Language(s):
Español
 
Statement for Miscellaneous Services

This bill form is used by providers and injured workers to bill the department for services such as dental care; glasses; medical equipment; nursing home services; interpreter services; services workers pay for out of pocket; and other services. Information on how to bill the department can be found in the General Provider Billing Manual [F248-100-000].

 



Form
F245-072-000



Alt Language(s):
Español
 
Steel or Wrought-Iron Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing steel or wrought-iron gas line. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-044-000


 
Steel or Wrought-Iron Gas Line Pre-Inspection Checklist

This checklist is used by the contractor when installing steel or wrought-iron gas line. Be sure you can answer YES to all questions before calling L&I for an inspection.



Form
F622-044-000


 
Structural Inspection Request Questionnaire

Structural Inspection Request Questionnaire



Form
F622-075-000


 
Student Learner Variance Application

Employer uses this application form for requesting a variance to employment regulations for minors enrolled in a work-based learning placement. It can be used for individual or multiple minors for the same employer.



Form
F700-166-000


 
Summary of Agricultural Employment Regulations and Farm Contractor Requirements

This summary is on employment laws relating to the agricultural industry.



Publication
F700-124-000


 
Teens at Work: Facts for Employers, Parents and Teens

Pamphlet/booklet: Answers questions employers, parents and teens may have about employing teen workers (ages 14-17). Explains non-agriculture work rules, including the necessary permits, hours and work conditions. Provides links to other resources.



Publication
F700-022-000



Alt Language(s):
Español
 
UB04 HCFA 1450

Used by hospitals to bill L&I for inpatient/outpatient services. This version includes NPI number.



Form
F245-367-000


 
Una guía de seguridad y salud del lugar de trabajo en el estado de Washington

Folleto: Provee un resumen de la Ley de Seguridad y Salud Industrial de Washington (WISHA, por su sigla en inglés), derechos y responsabilidades del trabajador y del empleador, cumplimiento de las leyes de WISHA y los servicios de consultoría y educación que L&I proporciona. El título anterior era, Una guía de WISHA.



Publication
F416-132-999



Alt Language(s):
Inglés
 
Variance Application - Employment Standards

Employer application request for a variance from employment standards for non minor employees.



Form
F700-089-000


 
Variance Application - Employment Standards

Employer application request for a variance from employment standards for non minor employees.



Form
F700-089-000


 
Variance Application - For exceptions from specific rules governing employment of minors.

Employer uses this application for requesting a variance to employment regulations for minors.



Form
F700-076-000


 
Variance Application - For exceptions from specific rules governing employment of minors.

Employer uses this application for requesting a variance to employment regulations for minors.



Form
F700-076-000


 
Wage Transcription and Computation Sheet

Employer uses this to show time worked and wages earned for an employee.



Form
F700-024-000


 
Wage Transcription and Computation Sheet

Employer uses this to show time worked and wages earned for an employee.



Form
F700-024-000


 
Wage-and-Hour Questions Employers Often Ask

Fact sheet: Provides answers to questions related to pay requirements, deductions from pay, hiring a teen worker, employee uniforms and access to personnel file. Includes contact information if an employer needs assistance with a specific situation.



Publication
F700-150-000


 
Washington State Deduction Laws

Deductions for current & terminated employees and employer liability for paying less than required.



Form
F700-097-000


 
Washington State Deduction Laws

Deductions for current & terminated employees and employer liability for paying less than required.



Form
F700-097-000


 
Washington State OverTime Law

Covers compensation for employees in Washington State working overime.



Publication
F700-079-000


 
Washington State Prevailing Wage Law

Booklet: Contains the prevailing wage laws (RCWs) and rules (WACs) as well as plain language descriptions and contact information.



Publication
F700-032-000


 
What Are Your Rights as a Worker? / ¿Cuáles son sus derechos como trabajador? (English/español)

Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits.

Hoja de información: Proporciona un resumen de los derechos de los trabajadores administrados por el Departamento de Labor e Industrias. Estos incluyen algunos derechos relacionados con el empleo y derechos con la seguridad en el lugar de trabajo y beneficios de compensación para los trabajadores. 



Publication
F101-061-909



Alt Language(s):
English/កម្ពុជា
English/한국의
English/русский
English/Vi?t
 
What Are Your Rights as a Worker? / ¿Cuáles son sus derechos como trabajador? (English/español)

Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits.

Hoja de información: Proporciona un resumen de los derechos de los trabajadores administrados por el Departamento de Labor e Industrias. Estos incluyen algunos derechos relacionados con el empleo y derechos con la seguridad en el lugar de trabajo y beneficios de compensación para los trabajadores. 



Publication
F101-061-909



Alt Language(s):
English/កម្ពុជា
English/한국의
English/русский
English/Vi?t
 
What Are Your Rights as a Worker? / ¿Cuáles son sus derechos como trabajador? (English/español)

Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits.

Hoja de información: Proporciona un resumen de los derechos de los trabajadores administrados por el Departamento de Labor e Industrias. Estos incluyen algunos derechos relacionados con el empleo y derechos con la seguridad en el lugar de trabajo y beneficios de compensación para los trabajadores. 



Publication
F101-061-909



Alt Language(s):
English/កម្ពុជា
English/한국의
English/русский
English/Vi?t
 
What Are Your Rights as a Worker? / ¿Cuáles son sus derechos como trabajador? (English/español)

Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits.

Hoja de información: Proporciona un resumen de los derechos de los trabajadores administrados por el Departamento de Labor e Industrias. Estos incluyen algunos derechos relacionados con el empleo y derechos con la seguridad en el lugar de trabajo y beneficios de compensación para los trabajadores. 



Publication
F101-061-909



Alt Language(s):
English/កម្ពុជា
English/한국의
English/русский
English/Vi?t
 
What Are Your Rights as a Worker? / ¿Cuáles son sus derechos como trabajador? (English/español)

Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits.

Hoja de información: Proporciona un resumen de los derechos de los trabajadores administrados por el Departamento de Labor e Industrias. Estos incluyen algunos derechos relacionados con el empleo y derechos con la seguridad en el lugar de trabajo y beneficios de compensación para los trabajadores. 



Publication
F101-061-909



Alt Language(s):
English/កម្ពុជា
English/한국의
English/русский
English/Vi?t
 
What Are Your Rights when You Work for a Farm Labor Contractor? (English/Spanish) / ¿Cúales son sus derechos cuando trabaja para un contratista de trabajadores agrícolas?

Fact sheet: Provides an overview of rights workers have when they are employed by a farm labor contractor. Several topics are covered, including regular wages, workplace safety, and help if injured on the job.



Publication
F700-067-000


 
What to Do if You Want to File Suit Against Your Construction Contractor

Fact sheet: Provides consumers with general information about the process for filing suit, and describes L&I's limited role in serving Summons & Complaint papers.



Publication
F625-088-000


 
What You Need to Know if You Don't Get Paid: A Worker's Guide to the Washington State Wage Payment Act / Lo que necesita saber si no recibe su pago: una guía para el trabajador de la ley del pago de salario del estado de Washington (English/español)

Fact sheet: Summarizes workers' rights and responsibilities regarding minimum wage, pay, work hours and overtime and explains how to file a wage complaint. Includes answers to several commonly asked questions.

Hoja de información:  Hace un resumen de los derechos y responsabilidades de los trabajadores referentes al salario mínimo, pago, horas trabajadas y horas extras y explica cómo presentar una queja de salario, incluye respuestas a varias preguntas frecuentes.



Publication
F700-153-909


 
What You Should Know About Hiring a Contractor, Remodeler, or Handyman

Pamphlet/booklet: Provides a checklist for consumers considering hiring a general or specialty construction contractor, reviews the permitting process, and suggests ways to avoid lien problems. Washington State law requires contractors to register with L&I.



Publication
F625-084-000



Alt Language(s):
Español
 
Wood / Pellet Stove / Fireplace Pre-Inspection Checklist

This checklist is designed to be generic in content and may not include all requirements for your particular installation.



Form
F622-015-000


 
Worker Rights Complaint Form

This is the Worker Rights Complaint Form. Both the 12-2011 and 10-2010 versions are valid.



Form
F700-148-000



Alt Language(s):
Español
 
Worker Rights Complaint Form

This is the Worker Rights Complaint Form. Both the 12-2011 and 10-2010 versions are valid.



Form
F700-148-000



Alt Language(s):
Español
 
Your Daily Record of Hours and Units Worked - For Agricultural Workers / Su registro diario de horas y unidades trabajadas - para trabajadores agrícolas (English/español)

Booklet: A pocket-sized bilingual guide to encourage agricultural workers to keep track of their daily work hours, units and earnings.

Folleto: Una guía de bolsillo bilingüe para animar a los trabajadores agrícolas a mantener un registro de sus horas de trabajo diarias, unidades e ingresos.



Publication
F700-169-909


 
Your Daily Record of Hours Worked / Su registro de horas trabajadas (English/español)

Pamphlet/booklet: A pocket-sized bilingual booklet to encourage workers to keep track of their daily work hours and earnings.

Folleto: Un librito bilingüe de tamaño bolsillo para animar a los trabajadores a mantener un registro de sus horas de trabajo diarias y de sus ingresos.



Publication
F700-105-909


 
Your Daily Record of Hours Worked / Su registro de horas trabajadas (English/español)

Pamphlet/booklet: A pocket-sized bilingual booklet to encourage workers to keep track of their daily work hours and earnings.

Folleto: Un librito bilingüe de tamaño bolsillo para animar a los trabajadores a mantener un registro de sus horas de trabajo diarias y de sus ingresos.



Publication
F700-105-909


 
Your Manufactured/Mobile Home

Pamphlet/booklet: Covers things you should consider when altering your home. Defines what is meant by alteration, repair and replacement and includes tips for hiring a registered contractor. It also includes contact information for L&I Consumer Assistance Program for owners of new manufactured/mobile homes.



Publication
F622-049-000



Alt Language(s):
Español
 
Your Manufactured/Mobile Home

Pamphlet/booklet: Covers things you should consider when altering your home. Defines what is meant by alteration, repair and replacement and includes tips for hiring a registered contractor. It also includes contact information for L&I Consumer Assistance Program for owners of new manufactured/mobile homes.



Publication
F622-049-000



Alt Language(s):
Español
 
Your Manufactured/Mobile Home

Pamphlet/booklet: Covers things you should consider when altering your home. Defines what is meant by alteration, repair and replacement and includes tips for hiring a registered contractor. It also includes contact information for L&I Consumer Assistance Program for owners of new manufactured/mobile homes.



Publication
F622-049-000



Alt Language(s):
Español
 
Your Manufactured/Mobile Home

Pamphlet/booklet: Covers things you should consider when altering your home. Defines what is meant by alteration, repair and replacement and includes tips for hiring a registered contractor. It also includes contact information for L&I Consumer Assistance Program for owners of new manufactured/mobile homes.



Publication
F622-049-000



Alt Language(s):
Español
 
Your Rights as a Worker in Washington State/ Sus derechos como trabajador en el estado de Washington (English/español)

Required poster: Reviews workers' rights under Washington's wage-and-hour laws. Topics include minimum wage, overtime, meal and rest breaks, pay periods, deductions, and employment of teens under age 18. Also reviews family leave provisions under federal and state law, and leave for spouses of deploying military personnel and victims of domestic violence. Note: Employers in both agricultural and non-agricultural industries in Washington State must display this poster where workers can see it.

Please order from L&I or print on 11" x 17" paper.

Get poster printing tips.

Cartel requerido: Da un resumen de los derechos de los trabajadores bajo las leyes de salario y horas de Washington.  Los temas incluyen el salario mínimo, horas extras, comida y períodos de descanso, deducciones y empleo de adolescentes menores de 18 años de edad.  También cubre las disposiciones de ausencia familiar bajo la ley federal y estatal y la ausencia para los cónyuges del personal militar y las víctimas de violencia doméstica.  Aviso:  Los empleadores tanto en la industria de la agricultura y otros sectores en el estado de Washington deben colocar este cartel donde los trabajadores puedan verlo.

Por favor solicítelo de L&I o imprímalo en papel de tamaño 11x17 pulgadas.

Obtenga consejos para imprimir carteles. 

 

 

 



Poster
F700-074-909


 
Your Rights as a Worker in Washington State/ Sus derechos como trabajador en el estado de Washington (English/español)

Required poster: Reviews workers' rights under Washington's wage-and-hour laws. Topics include minimum wage, overtime, meal and rest breaks, pay periods, deductions, and employment of teens under age 18. Also reviews family leave provisions under federal and state law, and leave for spouses of deploying military personnel and victims of domestic violence. Note: Employers in both agricultural and non-agricultural industries in Washington State must display this poster where workers can see it.

Please order from L&I or print on 11" x 17" paper.

Get poster printing tips.

Cartel requerido: Da un resumen de los derechos de los trabajadores bajo las leyes de salario y horas de Washington.  Los temas incluyen el salario mínimo, horas extras, comida y períodos de descanso, deducciones y empleo de adolescentes menores de 18 años de edad.  También cubre las disposiciones de ausencia familiar bajo la ley federal y estatal y la ausencia para los cónyuges del personal militar y las víctimas de violencia doméstica.  Aviso:  Los empleadores tanto en la industria de la agricultura y otros sectores en el estado de Washington deben colocar este cartel donde los trabajadores puedan verlo.

Por favor solicítelo de L&I o imprímalo en papel de tamaño 11x17 pulgadas.

Obtenga consejos para imprimir carteles. 

 

 

 



Publication
F700-074-909


 
Computing Worker Hours

Quick reference card: Shows employers how to figure workers' compensation premiums for different types of employees: hourly employees, salaried employees, commissioned personnel or employees paid for piecework. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides.



Publication
F214-014-000


 
Crime Victims Compensation Program Initial Response and Assessment: Form I
Used by the clinical provider to get approval to see a victim for six sessions or less. If more than six sessions, please complete Form II (F800-081-000).

Form
F800-080-000


 
Crime Victims Compensation Program Initial Response and Assessment: Form I
Used by the clinical provider to get approval to see a victim for six sessions or less. If more than six sessions, please complete Form II (F800-081-000).

Form
F800-080-000


 
Electrical Work on Residential Property: What You Should Know Before Work Begins
Fact Sheet: Explains to property owners the importance of electrical permits, inspections and approvals. An electrical permit is required for most new, remodel and maintenance electrical work.

Publication
F500-078-000


 
Electrical Work on Residential Property: What You Should Know Before Work Begins
Fact Sheet: Explains to property owners the importance of electrical permits, inspections and approvals. An electrical permit is required for most new, remodel and maintenance electrical work.

Publication
F500-078-000


 
F245-392-000 Resource Utilization Group (RUG) Residential Care Services for L&I Injured Workers (In place of MDS 3.0 beginning October 1, 2010.)
Filled out by the provider when they treat an injured worker. See web links below for: Latest payment amounts, Updates and corrections, and Review payment policy. For use in place of Minimum Data Set (MDS) 3.0 beginning October 1, 2010.

Form
F245-392-000


 
FileFast postcard handout for workers
Handout (4.25 x 6): Explains to workers why and how to file an accident report online or by phone following an injury; also reminds them to stay in contact with employer and L&I.

Publication
F242-398-000


 
FileFast poster for workers
Poster (8.5 x 11): Explains to workers why and how to file an accident report online or by phone following an injury and reminds them to stay in contact with employer and L&I.

Poster
F242-399-000


 
FileFast wallet card for workers
Wallet card (3.5 x 2): Reminds workers of FileFast web address and number for call center.

Publication
F242-400-000


 
Home Modification for Workers with Catastrophic Injuries

Fact sheet: Answers questions about the home modification benefit in Washington State's workers' compensation program, who qualifies, what L&I can pay, and where to get more information.



Publication
F252-060-000


 
Keep Your Water Heater Safe
Pamphlet/booklet: Describes the process for conducting an annual safety test of a residential water heater. Includes illustrations.

Publication
F620-048-000


 
Keep Your Water Heater Safe
Pamphlet/booklet: Describes the process for conducting an annual safety test of a residential water heater. Includes illustrations.

Publication
F620-048-000


 
Keep Your Water Heater Safe
Pamphlet/booklet: Describes the process for conducting an annual safety test of a residential water heater. Includes illustrations.

Publication
F620-048-000


 





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