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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


 
Electrical Telecommunication Principal Member Owner Update Request

Electrical Telecommunication Principal Member Owner Update Request



Form
F500-124-000


 
Financial Statement Businesses

Requesting Financial Information for Corporations, LLC and Partnerships.



Form
F215-040-000


 
Financial Statement Sole Proprietors and Individuals

Requesting Financial Information for Sole Proprietors and/or Individuals.



Form
F215-039-000


 
Labor and Industries Prosthetic Device Request Form

Labor and Industries Prosthetic Device Request



Form
F245-340-000


 
Request for Assistance in Obtaining Certified Payroll Records

Used to request copies of Certified Payrolls for prevailing wage projects.



Form
F700-141-000


 
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


 
Retrospective Rating Adjustment Protest

Used by employers to present L&I with a list of decisions they are protesting by adjustment period. The form requests all necessary elements needed for L&I to process a request for reconsideration.



Form
F250-024-000


 
Structural Inspection Request Questionnaire

Structural Inspection Request Questionnaire



Form
F622-075-000


 
Subacute Opioid Request Form

Use this form to request opioid coverage between 6 weeks to 12 weeks from the date of injury or surgery.



Form
F252-097-000


 
Crime Victims Compensation Subacute Opioid Request Form
Use this form for Crime Victims Compensation to request opioid coverage between 6 weeks and 12 weeks from date of injury or surgery.


F800-119-000


 





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