Calendar: Features real Washington State businesses and employees handling typical workplace hazards with an emphasis on safety and health improvements over the past decades. It includes suggested weekly safety and health tips for different industries, including healthcare, logging, law enforcement, food processing and more.

Used by injured worker to report their employment history for the past three years and the wages at each job.

Used to provide your employment history for the past three years, including self-employment and volunteer work.

Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history.  If you were unemployed at any time, please explain why.  Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits?  Did you seek employment during the time period?  If no, why didn’t you seek employment?

Used by injured worker who has filed an occupational hearing loss claim to report their employment history and the nature of the noise exposure at each job. F262-013-111 is the continuation sheet.

Used by injured worker who has filed an occupational hearing loss claim to report their employment history and the nature of the noise exposure at each job. This form is a continuation of form F262-013-000.