Your search for "record" returned 41 documents.
| Title | Type | Number |
|---|---|---|
| Affidavit of Experience
This affidavit is used to record the hours of a trainee's electrical experience with direct supervision under a Washington certified journeyman, master or specialty electrician. |
Form | F500-043-000 |
| 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 |
| Employer's Job Description
Used by employer of record to prepare a written job description for a light-duty job, transitional, modified duty job, or alternative job when an injured worker is unable to work due to an industrial injury or occupational disease. The form includes a description of the job tasks, machinery, tools, equipment and personal protective equipment used, and the physical demands of the job. After completing the employer's job description form, the employer gives it to the injured worker's doctor for review and approval. |
Form | F252-040-000 |
| Employment History Form
Also available in: Spanish Used to provide your employment history for the past three years, including self-employment and volunteer work. Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history. If you were unemployed at any time, please explain why. Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits? Did you seek employment during the time period? If no, why didn’t you seek employment? |
Form | F242-109-000 |
| 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 |
| Interpretive Services Appointment Record
Used when an interpreter is appointed to interpret for an injured worker during their medical visits. |
Form | F245-056-000 |
| 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 |
| Training Plan Cost Encumbrance
To record the training costs. For use only with plans approved after 1/1/2008. |
Form | F245-374-000 |
| Transportation Cost Encumbrance
To record the costs for transportation. For use only with plans approved after 1/1/2008. |
Form | F245-375-000 |
| Worker's Compensation Insurance Manual Chapter 296-17 WAC General Reporting Rules, Audit, and Recordkeeping
This chapter applies to employer reporting requirements for workers compensation insurance. |
Manual | F213-170-000 |
| 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 |
| Apprentice Work Progress Record
Worksheets used to record the number of hours worked and Related Supplemental Instruction hours during a registered apprenticeship on a monthly basis. If used, a copy is usually given to the program monthly. |
Form | F100-002-000 |
| 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 |
| 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 |
| Corporate Officers
Quick reference card: Explains the criteria to allow a corporate officer to be exempt from industrial insurance (workers' compensation) coverage. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides. |
Publication | F214-010-000 |
| 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 |
| Employers' Guide to Self-Insurance in Washington State
Book: Explains the process for employers to provide their own industrial insurance (workers’ compensation) coverage in Washington State. Also reviews surety requirements for self-insurance, reporting and recordkeeping requirements, claims processing, and compliance and legal issues. |
Publication | F207-079-000 |
| Excluded and Exempt Employments
Quick reference card: Provides a list of employments excluded from workers' compensation coverage, including those eligible for optional coverage. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides. |
Publication | F214-013-000 |
| Guide to Crew Safety Meetings
Pamphlet/booklet: Provides a succinct guide to conducting crew safety meetings for general industry and the construction industry. Includes a format for recording meeting minutes. |
Publication | F417-043-000 |
| Housing and Board Cost Encumbrance
To record the costs for housing and board. For use only with plans approved after 1/1/2008. |
Form | F245-372-000 |
| Independent Contractors
Quick reference card: Provides information to help determine whether a "subcontractor" working for you meets the legal requirements to be an independent contractor, or whether he/she is actually a covered worker for workers' compensation (industrial insurance) purposes. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides. |
Publication | F214-012-000 |
| Limited Liability Companies (LLC)
Quick reference card: Reviews the requirements for members or managers of limited liability companies to be exempt from workers' compensation (industrial insurance) coverage. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides. |
Publication | F214-021-000 |
| Log of Good Faith Effort Documentation
This is for Registered Apprenticeship Programs to record Good Faith Effort activities in accordance with their Registered Apprenticeship Standards (Equal Employment Opportunity Plan) |
Form | F100-515-000 |
| Logging Emergency Medical Plan (Logging Safety and Health Meetings)
Use this two part form for employers to record work locations and emergency rescue info and for holding safety meetings for each new jobsite |
Form | F417-014-000 |
| Minutes of Apprenticeship Committee Meeting
Example of how the minutes for an Apprenticeship Committee meeting should be recorded. Submit this to L&I Apprenticeship section within 30 days of the meeting. |
Form | F100-029-000 |
| Plan Time Encumbrance
To record the work plan time. For use only with plans approved after 1/1/2008. |
Form | F245-376-000 |
| Program Equal Employment Opportunity Activity Documentation
Used to record individual equal employment opportunity activities conducted by Apprenticeship Programs. |
Form | F100-012-000 |
| Record Keeping
Quick reference card: Identifies the type of records employers, including construction contractors, need to keep to allow L&I to compute premiums. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides. |
Publication | F214-011-000 |
| Record Keeping Provisions - Employment Standards
This form is for employers to use to keep records on every employee. |
Form, Publication | F700-009-000 |
| 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 |
| Request for Assistance in Obtaining Certified Payroll Records
Used to request copies of Certified Payrolls for prevailing wage projects. |
Form | F700-141-000 |
| Safety Meeting Minutes
Also available in: Spanish Use this form to record the minutes from your safety meetings - these records must be retained for one year from the date of each meeting |
Form | F417-087-000 |
| Safety Meeting Minutes - Spanish - Actas De La Reúnion de Seguridad
Also available in: English Use this form to record the minutes from your safety meetings - these records must be retained for one year from the date of each meeting |
Form | F417-087-999 |
| Standard Exception Classification
Quick reference card: Provides basic information about standard exception classifications, which can be separately rated from the basic business classification for determining industrial insurance (workers' compensation) premiums. This information is part of the publication, Workers’ Compensation Record Keeping and Report Guides. |
Publication | F214-016-000 |
| Stay at Work Expense Reimbursement Application for Employers Tools, Clothing, Training.
Employer of record can request reimbursement for tools, clothing, or training expenses required to enable an injured worker to return to light duty or transitional work. After completing the form, the employer submits it, along with supporting documentation, to the Stay at Work program for review and approval. For wage reimbursements see F243-001-000. |
Form | F243-003-000 |
| Stay at Work Wage Reimbursement Application for Employers
Employer of record can request reimbursement for wages paid to an injured worker during light duty or transitional work. After completing the form, the employer submits it, along with supporting documentation, to the Stay at Work program for review and approval. For expense reimbursements see F243-003-000. |
Form | F243-001-000 |
| Wage Transcription and Computation Sheet
Employer uses this to show time worked and wages earned for an employee. |
Form | F700-024-000 |
| Workers' Compensation Record Keeping and Reporting Guides
Packet: Contains eight quick reference cards covering topics related to workers' compensation record keeping and reporting. Topics include: computering worker hours, standard exception classifications, excluded employments and corporate officers. |
Publication | F212-222-000 |
| Your Daily Record of Hours Worked (English/Spanish) / Su Registro de Horas Trabajadas
Pamphlet/booklet: A pocket-sized bilingual booklet to encourage agricultural workers to keep track of their daily work hours and earnings. |
Publication | F700-105-909 |
| 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 |
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