Formularios y publicaciones en español
También vea
| Título | Número |
|---|---|
| A Guide to Industrial Insurance Benefits for Employees of Self-insured Businesses - Spanish (Gua de beneficios de seguro industrial para los empleados de empresas autoaseguradas) Pamphlet/booklet: Explains to employees of self-insured businesses their rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim. |
F207-085-999 |
| A Guide to Workplace Safety and Health in Washington State-Spanish (Una gua de seguridad y salud del lugar de trabajo en el estado de Washington) Pamphlet/booklet: Provides an overview of the Washington Industrial Safety and Health Act (WISHA), worker and employer rights and responsibilities, enforcement of WISHA rules, and consultation and education services L&I provides. Previously titled A Guide to WISHA |
F416-132-999 |
| Accountability Agreement - Spanish (Acuerdo de Responsabilidad) This form must be signed by the worker and the VRC and sent in along with the retraining plan to L&I for approval. |
F280-016-999 |
| Address Change Request for Injured Workers - Spanish Solicitud para cambio de direccin
para trabajadores lesionados Completed and signed by a State Fund injured worker to notify L&I of a change in address. All address changes must be submitted in writing and signed by the injured worker. |
F242-388-999 |
| Address Change Request for Pensioners - Spanish Solicitud para cambio de
direccin para pensionados Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner. |
F242-107-999 |
| Adolescentes en el Trabajo: Los hechos para los empleadores, los padres y los adolescentes Pamphlet/booklet: Answers questions employers, parents and teens may have about employing teen workers (ages 14-17). Explains non-agriculture work rules, including the necessary permits, hours and work conditions. Provides links to other resources. |
F700-022-999 |
| Agreement - Farm Labor Contractors and Workers - Spanish - Acuerdo Entre Contratistas Agrícolas Y Trabajadores Employment wages and conditions agreement with Farm Labor Contractors and Workers |
F700-046-999 |
| Agricultural Employment Standards - Chapter 296-131 WAC Spanish ESTÁNDARES DE TRABAJO AGRÍCOLA Agricultural Employment Standards - Chapter 296-131 WAC Spanish EST脕NDARES DE TRABAJO AGR脥COLA |
F700-085-999 |
| Agricultural workers information line (English/Spanish) Card: Wallet card with a toll-free telephone number where agricultural workers can call to learn about their workplace rights. |
F700-103-909 |
| Alteration Fire Safety Pre-Inspection Checklist -Spanish Checklist for homeowners on how to upgrade their pre-HUD homes to approach the HUD standards in the area of fire safety. |
F622-011-999 |
| Application for Pension Benefits by Spouse or Children - Spanish Aplicación para beneficios de pensión presentado por el cónyuge o hijos Used by a spouse or dependent that was chosen by the deceased worker to receive a survivor benefit. At the time the worker was determined to be totally permanently disabled he/she made a decision to leave a survivor benefit to a spouse or dependent if the worker dies. |
F242-391-999 |
| Application to Reopen Claim - Spanish Aplicación Para Reabrir Un Reclamo Debido Al Empeoramiento De La Condición Benefits are limited to 50,000 per claim. if your claim has met or exceeded this cap, your reopening application will be denied and we will be unable to pay any further benefits. Used by victims of crime and medical or mental health providers to request a claim be reopened. |
F800-031-999 |
| Application to Reopen Claim due to Worsening Condition - Spanish APLICACIÓN PARA REABRIR UN RECLAMO Spanish version. Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days. The 12-2009 version has FAX numbers for Claims and Self Insurance. |
F242-079-999 |
| Applying for Your Washington Business License: A Step-by-Step Guide-Spanish (Aplicando para su Licencia de Negocio en Washington: Una guía detallada Pamphlet: Concise, easy-to-read pamphlet that explains the steps to apply for a business license and what to do if you plan to employ workers. Includes how to apply to be a registered construction contractor. |
F101-079-999 |
| Assessing Your Ability to Work: Your Rights and Responsibilities -- Spanish (Evaluando su capacidad para trabajar: sus derechos y responsabilidades, Servicios de rehabilitación vocacional)
Booklet: Explains the basics of the assessment phase of vocational services to injured workers. L&I sends this booklet to injured workers when they are referred for assessment services. |
F280-017-999 |
| Authorization for Deposit of Payments - English/Spanish AUTORIZACI脫N PARA
DEP脫SITOS DE PAGOS Used by pensioner to authorize L&I to deposit the pension payment to any designated financial institution. NOTE: F242-177-999 is the Direct Deposit Letter in Spanish |
F242-174-909 |
| Autorización Para Proveer Informaci贸n De Reclamos Used by the worker to designate a person(s) as an authorized representative for the worker's claim. An authorized representative can access claim information. |
F101-010-999 |
| Avoid Liability for Your Farm Labor Contractor's Unpaid Debits (English/Spanish) / Evite su obligación por las deudas no pagadas de su contratista de trabajadores agrícolas Fact sheet: Explains how employers could be liable for unpaid workers' compensation premiums, unpaid wages, damages and civil penalties when hiring a farm labor contractor. Outlines ways to protect against potential liability. |
F700-154-909 |
| Avoid Liability for Your Subcontractor's Unpaid Workers' Comp Premiums -Spanish (Las primas de compensaci贸n para trabajadores no pagadas por su subcontratista podr铆an ser su responsabilidad) Fact sheet: Tells construction contactors how to protect themselves from liability for their subcontractor's unpaid workers' compensation premiums. |
F262-262-999 |
| Cómo registrar un reclamo para la compensación del trabajador con empresas autoaseguradas Used by only self-insured employers to comply with WAC 296-15-400. The form provides information and instructions to employees of self-insured employers in case of an injury or development of an occupational disease. |
F207-155-999 |
| Carrying Out your Vocational Plan: Your Rights and Responsibilities During Plan Implementation -- Spanish (Llevando a cabo su Plan vocacional: Sus derechos y responsabilidades
durante el Plan de Implementaci贸n, Servicios de rehabilitaci贸n vocacional) Booklet: Explains the basics of the plan implementation phase of vocational services to injured workers. L&I sends this booklet to injured workers once the vocational plan they submitted is approved. Information about continuing with the vocational plan or selecting Option 2 to decline retraining is included. |
F280-019-999 |
| Case Transfer Card (Spanish) Tarjeta para transferencia de caso Used by injured worker to notify claim manager and request authorization to transfer care to a different doctor. |
F245-037-999 |
| Certificado de Cobertura - Ejemplo Sample of what the Certificate of Coverage looks like. You must order the forms you cannot download it off the internet. |
F211-141-999 |
| Claim for Pension by Spouse or Children - Spanish Reclamo para Pensión de Esposo(a) o Los Niños Used by a spouse or dependents of a deceased worker. The workers' fatal accident or occupational disease incurred in the course of their employment. This application is needed to determine if applicant(s) is/are entitled to a survivor benefit. |
F242-056-999 |
| Comentarios Sobre el Ex谩men M茅dico Independente Used by the injured worker to provide comments to L&I about their recent medical exam by an IME. |
F245-053-999 |
| Comunicación sobre Peligros Químicos: Información útil para los empleadores Book: Provides employers a checklist on the requirements of the chemical hazard communication rule. Contains an extensive question-and-answer section and information on starting an employee-training program. |
F413-012-999 |
| Construction Checklist - Safety - Spanish - Lista de verificación de seguridad en la construcción Construction Checklist - Safety - Spanish - Lista de verificaci贸n de seguridad en la construcci贸n |
F418-055-999 |
| Construction Contractors: Get the Facts, Get Registered - Spanish (Contratistas de Construcción:
Obtenga los datos, regístrese) Pamphlet/booklet: Explains the steps to register as a construction contractor in Washington State. |
F625-040-999 |
| Continuación del Historial de Trabajo Enfermedad Ocupacional Injured worker fills this out to document possible occupational disease and to show work history. |
F242-071-911 |
| Crime Victim Worker Verification - Spanish FORMULARIO DE VERIFICACIÓN DE EMPLEO Crime Victim Worker Verification - Spanish FORMULARIO DE VERIFICACI脫N DE EMPLEO |
F800-110-999 |
| Crime Victims Request for Pension by Dependents - Spanish Used by Spanish speaking dependents of deceased crime victims who are applying for pension benefits. |
F800-095-999 |
| Cuestionario Sobre Perdida Del Sentido Auditivo en el Trabajo Used by injured worker who has filed an occupational hearing loss claim to provide more specific information regarding how the hearing loss occurred. This is requested by the Claim Manager and sent to the Injured Worker. |
F262-016-999 |
| Danger, Workers Above-Spanish (Peligro, Trabajadores en el nivel superior) Picture of workers on a high rise. Get poster printing tips. |
FSP1-012-999 |
| Declaración De Derechos Para Dependiente Del Trabajador Fallecido Bajo El Programa De Compensación Y Beneficios Para Trabajadores Used by a dependent of a worker whose death was related to an on the job injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits. |
F242-173-933 |
| Declaración De Derechos Para Padres O Tutor Bajo El Programa De Compensación Y Beneficios Para Trabajadores Used by a guardian or other person having custody of the minor or disabled children or dependents of a deceased worker to declare their entitlement to receive the pension benefits for those children/dependents in their care and custody. |
F242-173-922 |
| Declaración De Derechos Para Trabajador Totalmente Discapacitado Bajo El Programa De Compensación Y Beneficios Para Trabajadores Used by a totally permanently disabled worker. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits. |
F242-173-944 |
| Declaración De Derechos Para Viuda(O) Bajo El Programa De Compensación Y Beneficios Para Trabajadores Used by the widow/widower whose spouse died of a work related injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of your benefits. |
F242-173-911 |
| Depósito Directo Used by the pensioner to learn about direct deposit. It accompanies the Authorization for Deposit of Payments- Spanish (F242-174-909) form. |
F242-177-999 |
| Elección para Prueba de Sangre de Colinesterasa Use this form to say whether or not you choose to have the Cholinesterase blood tests performed. |
F413-064-999 |
| Employee Discrimination Protection (English/Spanish)/ Protección Para Empleados Contra La Discriminación Poster: Employees have the right to report concerns about safety and health in their workplace. This poster describes "protected activities" under the Washington Industrial Safety and Health Act (WISHA) and explains what an employee should do if he/she has been punished or fired for exercising these rights. Get poster printing tips. |
F417-188-909 |
| F242-208-909 Loss of Earning Power medical - English/Spanish SOLICITUD PARA COMPENSACI脫N POR REDUCCI脫N DE INGRESOS (M脡DICO) Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager. |
F242-208-909 |
| F242-208-999 Application for LEP compensation medical - Spanish SOLICITUD PARA COMPENSACI脫N POR REDUCCI脫N DE INGRESOS (M脡DICO) Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager. |
F242-208-999 |
| F242-209-909 Application for LEP Vocational English/Spanish SOLICITUD PARA COMPENSACI脫N POR REDUCCI脫N DE INGRESOS (VOCACIONAL) Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager. |
F242-209-909 |
| F242-209-999 application for LEP - Voc Spanish APLICACI脫N PARA COMPENSACI脫N POR REDUCCI脫N DE INGRESOS (VOCACIONAL) Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager. |
F242-209-999 |
| F242-395-999 Affidavit_for_Time_Loss_Compensation_Benefits spanish DECLARACIÓN FIRMADA PARA COMPENSACIÓN DE TIEMPO PERDIDO F242-395-999 Affidavit_for_Time_Loss_Compensation_Benefits spanish DECLARACI脫N FIRMADA PARA COMPENSACI脫N DE TIEMPO PERDIDO Completed by injured workers contending eligibility for payment of back time loss benefits for a period that exceeds six months or $25,000. Injured workers requesting benefits for current time missed from work due to a work-related injury should use the F242-052-999 Worker Verification Form. |
F242-395-999 |
| Formulario De Queja En Contra De Un Contratista De Trabajores Agricolas (Farm Labor Contractor Complaint) Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned. |
F700-109-999 |
| Formulario de Verificación de Empleo Completed by the injured worker if they are unable to work due to a workplace injury AND their employer is not paying their full wages. |
F242-052-999 |
| Getting Back to Work: It's Your Job and Your Future-Spanish (Regresando a trabajar es su trabajo y su futuro) Pamphlet/booklet: Briefly explains steps to return to work quickly and minimize the economic impact of time-loss. Also provides helpful resources. Intended for injured workers. |
F200-001-999 |
| Guía para contratar Contratistas Independientes en el Estado de Washington Pamphlet/booklet: Designed to help employers determine if their workers are employees or independents under Washington's workers' compensation, workplace safety, wage and hour and unemployment tax laws. Includes a short "test" and helpful references. |
F101-063-999 |
| Heat-related Illness Education Card/Tarjeta de educación sobre enfermedades relacionadas con el calor (English/Spanish) Identifies the effects of heat exhaustion and heat stroke on the body and what to do if you observe symptoms. Reviews prevention steps. PDF file is set up for two copies to print at one time. |
F417-218-909 |
| Help for Crime Victims (English/Spanish) - Ayuda para Victimas de Crimen Pamphlet/booklet: Answers questions about Washington State's Crime Victims Compensation Program, who may be eligible for benefits and how to apply. |
F800-006-909 |
| Help for Crime Victims (large poster) - Spanish (Ayuda para Victimas de Crimen) Poster: Provides contact information for the Crime Victims Compensation Program. Intended for display in health-care, criminal-justice and social-service organizations that assist crime victims. The size is 11" X 17" if ordered from the Crime Victims Compensation Program. If you print from the Web, the poster will be 8.5" X 11". |
F800-041-999 |
| Help for Crime Victims (small poster) - Spanish (Ayuda para Victimas de Crimen) Poster: Provides contact information for the Crime Victims Compensation Program. Intended for display in health-care, criminal-justice and social-service organizations that assist crime victims. This poster is 8.5" X 11." |
F800-104-999 |
| Help for Injured Workers of Self-Insured Businesses-Spanish (Ayuda para trabajadores lesionados de empresas autoaseguradas) Information card: Introduces the Office of the Ombudsman for Self-Insured Injured Workers. The ombudsman is appointed by the Governor to serve as an independent advocate for the rights of injured workers of self-insured employers. |
F207-201-999 |
| Hiring a Contractor or Remodeler? What You Should Know-Spanish (驴Piensa contratar a un contratista de construcción o remodelador?) Fact sheet: Provides a checklist for consumers considering hiring a general or specialty construction contractor, reviews the permitting process, and suggests ways to avoid lien problems. Washington State law requires construction contractors to register with L&I. |
F625-084-999 |
| Hiring Teens this Summer? - Spanish (驴Piensa contratar adolescentes este verano?) Flier: Provides important information about hiring teens, including extra safety precautions, as well as legal requirements regarding minor work endorsement, hours and prohibited duties. Provides telephone, e-mail and Web contacts for more information. |
F700-142-999 |
| Hiring Teens this Summer?-Spanish (驴Piensa contratar adolescentes este verano?) Flier: Provides important information about hiring teens, including extra safety precautions, as well as legal requirements begarding minor work endorsement, hours and prohibited duties. Provides telephone, e-mail and Web contacts for more information. |
F700-142-999 |
| Historial de Empleo Used by injured worker to report their employment history for the past three years and the wages at each job. |
F242-109-999 |
| Historial de Trabajo (Enfermedad Ocupacional) Injuried worker fills out this document to show more work history. This form goes with Occupational Disease & Employment History (F242-071-000). |
F242-071-999 |
| How to Protest a Department of Labor and Industries Decision (English/Spanish) Fact sheet: Explains how an injured worker can protest decisions on his/her claim and gives deadlines for taking action. |
F242-363-909 |
| If Family Members Work for You, Know Your Obligations (English/Spanish) - Conozca sus obligaciones cuando miembros de su familia trabajan para usted Fact sheet: Provides an overview and resources to know your obligations when you have family members working for you. Relatives, including children, must be treated as employees with the same rights as any other paid worker in the state of Washington. |
F101-077-909 |
| Injured by a Third Party? You Have Legal Options - Spanish (驴Lesionado por
un tercero? Usted tiene opciones legales) Pamphlet/booklet: Summarizes what action to take when a workplace injury is caused by a defective product or defective machine or by a person who is not a co-worker. |
F249-008-999 |
| Instrucciones para: Solicitud para beneficios para víctimas de crimen - Instructions in Spanish for completing the Application for Crime Victims Benefits in English Instructions in Spanish to complete the English form F800-042-000 Application for Crime Victim benefits. The form is used by victims of a crime in Washington State to receive benefits for time lost from work, loss of financial support, medical or mental health treatment. This 12-10 version is internet only. |
F800-042-999 |
| Instructions in Spanish for completing the form F245-072-000 Statement for Miscellaneous Services Instructions in Spanish for completing the form F245-072-000 Statement for Miscellaneous Services |
F245-072-999 |
| Job Safety and Health Law-English/Spanish (Ley de seguridad y salud en el trabajo) Required poster: Describes important parts of the Washington Industrial Safety and Health Act (WISHA), which provides for job safety and health of Washington employees. Note: Employers in Washington State must display this poster where workers can see it. When ordering the printed version, you will receive one 22" X 17" poster that includes both languages. Get poster printing tips. |
F416-081-909 |
| Jorge's New Job: Cholinesterase Testing in Washington State (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. |
F417-213-909 |
| Letter of Intent for School Enrollment - Spanish CARTA DE INTENCIÓN DE
REGISTRO EN UNA ESCUELA Letter of Intent for School Enrollment - Spanish CARTA DE INTENCI脫N DE REGISTRO EN UNA ESCUELA |
F242-382-999 |
| Lista De Comprobacion Para Un Contratista De Trabajores Agricolas (Farm Labor Contactor Checklist) Farm Labor Contractor's Checklist to ensure compliance. |
F700-112-999 |
| Making the Best Treatment Choice for Your Chronic Low-back Pain-Spanish (Como hacer la mejor elección de tratamiento para el dolor crónico en la parte inferior de su espalda) Fact sheet: Reviews the options that an injured worker with low-back pain should consider in determining the best treatment choice. |
F252-081-999 |
| Monitoreo de la Colinesterasa Recomendaciones del Proveedor Medico formulario muestra 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. |
F413-070-999 |
| Need a Doctor? - Spanish (驴Necesita un doctor?) Information card: Provides contact information for injured workers needing assistance in finding a health-care provider who will treat their occupational injury or disease. This PDF will print out an 8.5" X 11" sheet that has 12 copies of the card. Note: Disclaimer information on Page 2 may not line up accurately in two-sided printing. |
F160-006-999 |
| Notice to Employees -- If a Job Injury Occurs (English/Spanish) Required poster: Outlines the steps a worker should take if a job-related injury or illness occurs. Also briefly describes the benefits available through Washington's workers' compensation system. Note: 'Employers who receive industrial insurance coverage from L&I must display this poster where workers can see it. English and Spanish online versions will print separately. Get poster printing tips. |
F242-191-909 |
| Notice to Employees -- Self-Insurance (English/Spanish) Required poster for self-insured businesses: Outlines what a worker employed by a self-insured business should do if a work-related injury or illness occurs. Note: Self-insured employers must display this poster where workers can see it. Get poster printing tips. |
F207-037-909 |
| Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-NTL Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
F207-165-999 |
| Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-TL Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
F207-164-999 |
| Notificación de Decisión de Cierre para reclamos Únicamente Médicos para Empleadores Autoasegurados Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
F207-020-999 |
| Notificación de Decisión de Cierre para reclamos de Tiempo Perdido para Empleadores Autoasegurados Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
F207-070-999 |
| Occupational Disease Employment History of Hearing Loss and Continuation Sheet - Spanish - HISTORIA DE TRABAJO PÉRDIDA DE AUDICIÓN History of Hearing Loss and Continuation Sheet - Spanish - HISTORIA DE TRABAJO P脡RDIDA DE AUDICI脫N |
F262-013-999 |
| OJT Accountability Agreement ACUERDO DE RESPONSABILIDAD DE LA CAPACITACIN DURANTE EL TRANSCURSO DEL TRABAJO (Para planes presentados desde 7/01/11 - 6/30/12 OJT Accountability Agreement in Spanish |
F280-029-999 |
| Option 2 Vocational Benefits Training Enrollment Application and Verification/APLICACI脫N Y VERIFICACIÓN DEL REGISTRO PARA CAPACITACIÓN DE BENEFICIOS VOCACIONALES OPCIÓN 2 State fund workers who have selected Option 2 and closed their claim can use this form to apply for access to their Option 2 training funds. To seek reimbursement, use form F245-030-000 Statement for Retraining and Job Modification Services. |
F280-024-909 |
| Peligro Large lettering: PELIGRO |
FSP1-030-999 |
| Peligro Área en Construcci贸n Solamente Personas Authorizadas Large words: Peligro 脕rea en Construcci贸n Solamente Personas Authorizadas. Get poster printing tips. |
FSP1-013-999 |
| Pension and Survivor Benefits in Washington State's Workers' Compensation Program--English/Spanish (Beneficios de pensión y para sobrevivientes del programa de compensación
para trabajadores de Washington)
Pamphlet/booket: Answers the most common questions about pension and survivor benefits under Washington's workers' compensation program. |
F242-352-909 |
| Pension Benefits for Washington's Workers' Compensation Program - Spanish (Beneficios de Pensión para el Programa de Compensación para Trabajadores de Washington)
Pamphlet/booklet: Answers the most common questions about pension benefits under Washington鈥檚 workers鈥 compensation system. |
F242-352-999 |
| Pension Benefits Questionnaire - Spanish CUESTIONARIO PARA BENEFICIOS DE PENSIN
Used by an injured worker who receives an order that states he or she is totally permanently disabled. This questionnaire must be completed in full and all necessary documents attached before his or her pension benefit options can be calculated. |
F242-393-999 |
| Plain Talk Summary of Prevailing Wage Laws: Understand Your Responsibilities and Rights When Performing Public Work (Resumen de las leyes de salario prevaleciente en lenguaje sencillo
Entienda sus responsabilidades y derechos al hacer trabajos publicos) 8.5" X 11" sheets: Provides a summary of prevailing wage laws and rules in Spanish. This publication is only available in Spanish. For similar information in English, read the Washington State Prevailing Wage Law booklet. |
F700-152-999 |
| Plan Development: What Are My Rights & Responsibilities -- Spanish (Plan de desarrollo: 驴Cuáles son mis derechos y responsabilidades? Servicios de rehabilitación vocacional)
Booklet: Explains the basics of the plan development phase of vocational services to injured workers. L&I sends this booklet to injured workers when they are referred for plan development services. The assigned vocational rehabilitation counselor is required to review this booklet with the worker at their initial face-to-face meeting. |
F280-018-999 |
| Precaución: Obligatorio Usar Casco Picture of hard hats. Get poster printing tips. |
FSP0-928-999 |
| Preferred Worker Program-Spanish (Programa con incentivos para reemplear trabajadores lesionados) Pamphlet/booklet: Describes the Preferred Worker Program and the benefits employers receive when hiring a preferred workers. In general, these are workers whose work-related injury or occupational disease prevents them from returning to their old job. |
F280-021-999 |
| Presuntos Riesgos de Salud y Seguridad - Alleged Safety Or Health Hazards (DOSH Complaint Form) - Spanish Employees use this complaint form to report work place conditions which jeopardize workers safety and health. |
F418-052-999 |
| Prevailing Wage Complaint and Instructions - Spanish - QUEJA SOBRE SALARIO PREVALECIENTE Ask L&I to conduct an investigation into a prevailing wage-related that affects one or more employees. |
F700-146-999 |
| Protected Leave Complaint Form - Spanish - Queja sobre permiso de ausencia protegida Para quejas de ausencia del trabajo: Descargue y complete un formulario de Queja sobre permiso de ausencia protegida (F700-144-999) |
F700-144-999 |
| Protegiendo a los trabajadores de Washington (Protecting Washington Workers) DVD: An innovative tool to teach Spanish-speaking workers about workplace rights while introducing English terminology. |
F130-004-909 |
| Provider Application and Notice for Spanish Speaking Providers Outside the United States- English/Spanish This form is to be used by Spanish speaking Medical Providers out side the United States. This form now includes both English and Spanish versions of the Provider form and letters. File includes W8ECI form from IRS and instructions for the form. Both IRS form and instructions are in English. Instructions in Spansih for the W8ECI have been added. This version is not the same as the English version, which is intended for use by Providers in the United States |
F248-361-909 |
| Put this Guard Back (Spanish) Sticker: 5.5 inches X 2.15 inches |
FSP0-993-991 |
| Put this Guard Back (Spanish) Sticker: 8.5 inches X 3.5 inches |
FSP0-993-999 |
| Queja De Discriminacion Sobre Salud Y Seguridad En El Lugar De Trabajo Si Usted piensa que ha sido discriminado o despedido por reportar los peligros existentes en su lugar de trabajo, utilice este formulario para presentar una queja. |
F416-011-999 |
| Queja Por Discriminaci贸n Used by employees who believe they have been discriminated against by their employer may use this form to file a complaint. |
F262-009-999 |
| Queja por Suprimir un Reclamo - Spanish - Claim Suppression Complaint An injured worker may submit this form if their employer has suppressed their right to file an injury claim. |
F262-024-999 |
| Quick Tips for Lifting-English/Spanish (Consejos breves para levantar cargas) Fact sheet: Provides 10 tips for safer lifting. Contains illustrations. |
F417-055-909 |
| Reclamo for Pensión por Dependientes Used by dependents of a deceased worker to file a claim for benefits. |
F242-062-999 |
| Report of Accident Instructions in Spanish - Instrucciones para: Reporte de Accidente o enfermedad ocupacional This information provides instructions in Spanish for completing the F242-130-000 Report of Industrial Injury or Occupational Disease version dated 11-09. The F242-130-000 form is in English. The form is not available in Spanish. These are the instructions In Spanish for completing the English version of the form. Please print off of the internet for now and use this link to order the instructions from the warehouse. http://www.lni.wa.gov/ClaimsIns/Providers/FormPub/ROA/OrderROA.asp |
F242-130-999 |
| Reporte Todas Las Lesiones Inmediatamente Large words: Report All Injuries Promptly. Get poster printing tips. |
FSP1-004-999 |
| Reporte Trimestral Para La Industria De Tabla De Yeso Used by drywall employers as a guide to completing quarterly and supplemental reports. This includes filled out samples of F212-050-000 and F212-051-000. |
F212-224-999 |
| Reporting Injuries at Work, Employee Wallet Cards (Spanish) Used by employers to teach their employees about the legal requirement to report accidents at work and who to notify if they have an accident at work. After completing the Employee Wallet Card form, the employer gives a wallet card to each employee. |
F200-010-999 |
| Request for Survivor Counseling Benefits (English/Spanish) Used by immediate family members of homicide victims to request mental health counseling. |
F800-057-909 |
| Robberies and Abusive Customers: Tips for Preventing Injuries-Spanish ( Robos y clientes abusivos: Consejos para prevenir lesiones) Tips on handling cash and how to have a safer restaurant or retail environment. Get poster printing tips. |
FSP0-919-999 |
| Sample Job Offer Letter - Spanish Sample Job Offer Letter - Spanish |
F252-035-999 |
| Say Yes! To a Safe Workplace, to a Free Consultation-Spanish (隆Diga Sí! A un lugar de trabajo seguro, a una consulta gratis) Pamphlet/booklet: Describes the benefits of free employer consultations offered by L&I's Division of Occupational Safety and Health (DOSH). These services include on-site safety and/or industrial hygiene consultations, ergonomics assistance and risk management advice. |
F417-209-999 |
| Siempre Use Protección para los ojos Picture of a large eye with some content on when to use eye protection. Get poster printing tips. |
FSP0-940-999 |
| Su cuerpo, su empleo: Prevención del Síndrome del Túnel Carpiano y otras lesiones músculo esqueléticas de las extremidades superiores Pamphlet/booklet: Reviews the symptoms and risk factors for carpal tunnel syndrome and several other musculoskeletal disorders that affect the shoulder, arm and elbow. Discusses prevention approaches and where to get more information. |
F413-024-999 |
| Sus Pulmones Su trabajo Su vida: Lo que debería saber acerca del asma ocupacional Pamphlet/booklet: Briefly reviews the symptoms and causes of work-related asthma and explains prevention and treatment approaches. |
F413-060-999 |
| Travel Reimbursement Request Spanish (Solicitud para el reembolso de gastos de viaje) Injured workers use this form to request reimbursement for travel expenses used to receive treatment, retraining and/or vocational services. |
F245-145-999 |
| Use su equipo de protección (Spanish) - Use Your Safety Equipment Man working on a roof with fall protection, eye protection, work boots and the ladder is tied off. With words: Just Making Sure I Get Home Safely! Get poster printing tips. |
FSP1-075-999 |
| Verificiation of School Enrollment - Spanish VERIFICACIÓN DE
REGISTRO EN LA ESCUELA Verificiation of School Enrollment - Spanish VERIFICACI脫N DE REGISTRO EN LA ESCUELA |
F242-055-999 |
| Vocational Questionnaire/Work History - Spansih CUESTIONARIO VOCACIONAL/HISTORIA DE TRABAJO Vocational Questionnaire/Work History for use by Vocational Providers serving injured workers |
F280-038-999 |
| Washington Minimum Wage Poster (English and Spanish) - Cartel del Salario M铆nimo de Washington Poster: Lists the minimum wage and basic facts about minimum wage. Get poster printing tips. |
F700-102-909 |
| What Are Your Rights as a Worker? (English/Spanish) Fact sheet: Provides a brief overview of the worker rights administered by the Department of Labor and Industries. These include certain employment-related rights and rights pertaining to workplace safety and workers' compensation benefits. |
F101-061-909 |
| What Are Your Rights When You Work for a Farm Labor Contractor? (English/Spanish) / 驴Cúales son sus derechos cuando trabaja para un contratista de trabajadores agrícolas? Fact sheet: Explains workers' rights when they are employed by a farm labor contractor. Topics covered include workplace safety, rest and meal breaks, and help if injured on the job. |
F700-067-909 |
| What You Need to Know if You Don't Get Paid: A Worker's Guide to the Washington State Wage Payment Act-English/Spanish (Lo que necesita saber si no recibe su pago: Una gu铆a para el trabajador de la ley del pago de salario del)
estado de Washington Fact sheet: Summarizes workers' rights and responsibilities regarding minimum wage, pay, work hours and overtime and explains how to file a wage complaint. Includes answers to several commonly asked questions. |
F700-153-909 |
| Worker Rights Complaint Form - Spanish formulario de queja sobre los derechos laborales Worker Rights Complaint Form - Spanish formulario de queja sobre los derechos laborales. Please print the 10-2010 version off of the internet for now. It will be available in the L&I warehouse around December 17. |
F700-148-999 |
| Workers' Compensation Discrimination-English/Spanish (Discriminación porque se lesionó en su trabajo) Fact sheet: Explains workers' legal right to file a workplace injury claim and how to file a complaint if discrimination has occurred. |
F262-249-909 |
| Workers' Guide to Hazardous Chemicals: Understanding the Right-to-Know Law-English/Spanish (Gua del trabajador para el uso de qumicos peligrosos: Comprendiendo la Ley del derecho a saber) Pamphlet/booklet: Explains Washington's chemical hazard communication standard, which requires employers to inform their employees about hazardous chemicals in the workplace and to train them in their proper use. |
F413-014-909 |
| Workers' Guide to Industrial Insurance Benefits - Spanish (Gua de los trabajadores para beneficios del seguro industrial) Pamphlet/booklet: Explains a worker's rights and responsibilities under industrial insurance law. Describes benefits and how to file a claim. |
F242-104-999 |
| Young Workers in Agriculture (English/Spanish) - Trabajadores jóvenes en la agricultura Pamphlet/booklet: Answers many questions employers and minor workers have about employing minors. Covers agriculture work rules, including the necessary permits, hours and work conditions for workers 12-17 years of age. |
F700-096-909 |
| 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. |
F700-105-909 |
| Your Independent Medical Exam - Spanish (Su Exámen M茅dico Independiente) Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form. |
F245-224-999 |
| Your Independent Medical Exam: For Employees of Self-Insured Businesses-Spanish (Su Examen M茅dico Independiente: Para empleadores de negocios autoasegurados) Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers. |
F207-202-999 |
| Your Manufactured/Mobile Home-Spanish (Casas prefabricadas y mviles:
Lo que los dueos de casas y contratistas deben saber al modificar una vivienda)
Pamphlet/booklet: Covers things you should consider when altering your home. Defines what is meant by alteration, repair and replacement and includes tips for hiring a registered contractor. It also includes contact information for L&I Consumer Assistance Program for owners of new manufactured/mobile homes. |
F622-049-999 |
| 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. |
F101-055-909 |
| Your Rights as a Worker in Washington State (English/Spanish) / Sus derechos como trabajador en el estado de Washington Required poster: Reviews workers' rights under Washington's wage-and-hour laws. Topics include minimum wage, overtime, meal and rest breaks, pay periods, deductions, and employment of teens under age 18. Also reviews family leave provisions under federal and state law, and leave for spouses of deploying military personnel and victims of domestic violence. Note: Employers in both agricultural and non-agricultural industries in Washington State must display this poster where workers can see it. Get poster printing tips. |
F700-074-909 |
| Youth in Construction - English/Spanish (Adolescentes en construcción) Booklet/pamphlet: Explains the limits on work teens under age 18 can perform in the construction industry, discusses the importance of training and emphasizes safety. Includes a checklist of "do's" and "don'ts" for employers, plus other resources. |
F700-145-909 |
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