Forms and Publications

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Account Deposit for Contractor's or Miscellaneous Account Holder's

Used to deposit money into your L&I account (Electrical).



Form
F500-080-000


 
Application for a 0% Supervision Modified Electrical Training Certificate & Specialty Examination

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.



Form
F500-097-000


 
Application for Electrician Examination

Application and instructions for a Washington State electrician's certificate examination.



Form
F626-001-000


 
Application to Utilize Contractor Deposit (CD) Account

The contractor requests to set up an L&I Contractor Deposit Account (CD) which is established for businesses that are licensed by the department as elevator contractors.



Form
F621-094-000


 
Application to Utilize Contractor Deposit (CD) Account

The contractor requests to set up an L&I Contractor Deposit Account (CD) which is established for businesses that are licensed by the department as elevator contractors.



Form
F621-094-000


 
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 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


 
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


 
Conveyance Installation Approval by Building Official

Used by the installer to notify L&I that a conveyance is proposed for installation in a building.



Form
F621-056-000


 
Conveyance Installation Approval by Building Official

Used by the installer to notify L&I that a conveyance is proposed for installation in a building.



Form
F621-056-000


 
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
 
Elevator Five-Year Safety Test Report

This report is used by elevator company mechanics and left on the job site for review by elevator inspectors.



Form
F621-051-000


 
Elevator Five-Year Safety Test Report

This report is used by elevator company mechanics and left on the job site for review by elevator inspectors.



Form
F621-051-000


 
Elevator Installation Variance Application

Property owner or elevator company can apply for a variance to install an elevator. 4 pages.

Allow 4-6 weeks for a response.  Accuracy and completeness speeds up the processing time.



Form
F621-048-000


 
Elevator Installation Variance Application

Property owner or elevator company can apply for a variance to install an elevator. 4 pages.

Allow 4-6 weeks for a response.  Accuracy and completeness speeds up the processing time.



Form
F621-048-000


 
How to Protest a Department of Labor and Industries Decision / Cómo protestar una decisión en su reclamo del Departamento de Labor e Industrias (English/español)

Fact sheet: Explains how an injured worker can protest decisions on his/her claim and gives deadlines for taking action.

Hoja de información:  Explica como un trabajador lesionado puede protestar las decisiones en su reclamo e indica límites para tomar acción.



Publication
F242-363-909


 
Hydraulic Overpressure Test

To be submitted when a valve is changed or a seal is broken.



Form
F621-052-000


 
Hydraulic Overpressure Test

To be submitted when a valve is changed or a seal is broken.



Form
F621-052-000


 
Installation Application for Elevators

Used for installation application for elevators (new, renewals, and alterations).

Allow 30 business days for a response. Accuracy and completeness speeds up the processing time.
 
Residential Incline Chair Lifts: Allow one week for a response.



Form
F621-005-000


 
Installation Application for Elevators

Used for installation application for elevators (new, renewals, and alterations).

Allow 30 business days for a response. Accuracy and completeness speeds up the processing time.
 
Residential Incline Chair Lifts: Allow one week for a response.



Form
F621-005-000


 
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


 
Licensed Elevator Contractor (LC) Operation

Contractors who install, construct, repair, alter or maintain elevators need to be licensed by the Elevator Program through L&I and with L&I's contractor registration program.



Form
F621-069-000


 
Licensed Elevator Contractor (LC) Operation

Contractors who install, construct, repair, alter or maintain elevators need to be licensed by the Elevator Program through L&I and with L&I's contractor registration program.



Form
F621-069-000


 
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
 
New Elevator Installation Checklist

Checklist for the elevator company/contractor to complete before the call L&I for an elevator inspection. Includes December 2010 letter on ASME checklists.



Form
F621-057-000


 
New Elevator Installation Checklist

Checklist for the elevator company/contractor to complete before the call L&I for an elevator inspection. Includes December 2010 letter on ASME checklists.



Form
F621-057-000


 
Protesting Retro Adjustments

Fact sheet: Provides important information to employers and Retro groups about the process the department follows when considering an adjustment protest.



Publication
F250-027-000


 
Renewal of Contractor Elevator License

Used by Elevator Companies to renew their Contractor License.



Form
F621-082-000


 
Renewal of Contractor Elevator License

Used by Elevator Companies to renew their Contractor License.



Form
F621-082-000


 
Renewal of Elevator Mechanic License

Used by elevator mechanics to renew their license if they do not want to use the online "Get or Renew a License".



Form
F621-080-000


 
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


 
Test of Escalator Safety Devices

A licensed elevator mechanic shall perform this test once a year and mail a copy to L&I.



Form
F621-055-000


 
Test of Escalator Safety Devices

A licensed elevator mechanic shall perform this test once a year and mail a copy to L&I.



Form
F621-055-000


 





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