Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

Información del documento
  Obtenga ayuda para descargar e imprimir archivos. Cómo completar formularios electrónicos.

This form is not available to download. If you are an injured worker, ask your medical provider for a copy of this form or you can complete your portion of the Report of Accident (ROA) online at Please note only medical providers may order this form from the Warehouse.

Our supply of paper ROAs is currently out of stock, but medical provider offices can file their Report of Accident (ROA) within 30 minutes online through FileFast at Filing online gives you immediate claim confirmation and speeds claim processing by 5 days.  Provider offices also can get reimbursed $10 (billing code 1040M) for each ROA filed online. If you have questions or concerns about using FileFast, please call 360-902-6393.

We anticipate receiving additional ROAs in our Warehouse by February 9, 2015.

Número del formulario F242-130-000
Disponibilidad solicítelo
Palabras claves accident report, claim information, claims, coverage, diseases, espanol, industrial insurance, medical forms, occupational diseases, occupational injuries, report of injury or occupational disease, reporting accidents, worker's compensation, workers compensation, workers' compensation
Idiomas English
Fechas válidas 10-2012
Páginas de Internet Workers' Comp Claims

End of main content, page footer follows.

Access Washington en Español

© Depto. de Labor e Industrias del Estado de Washington. El uso de éste sitio del Internet está sujeto a las leyes del Estado de Washington.