Notice of Occupational Disease or Infection

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

Notice of Occupational Disease or Infection

(96 KB PDF)
Descripción

Used by medical providers to notify L&I that an occupational disease or infection has been diagnosed and that the worker has been advised that their condition may be work-related. This form can be used if the worker does not complete a Report of Accident or Occupational Disease (ROA) but should not be completed in place of an ROA.

Detalle
Número del formulario F242-243-000
Disponibilidad Online only
Palabras claves claims, diseases, industrial insurance, worker's compensation, workers compensation, workers' compensation
Idiomas English
Fechas válidas 12-2012
Contacto Claims for Job Injuries

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.