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Crime Victims Direct Entry Billing Manual
Instructions for completing a Direct Entry bill to submit to the Crime Victims Compensation Program. Direct entry allows you to submit or adjust bills using a free online billing form through Provider Express Billing (PEB).

Manual
F800-118-000
 
Safety Comes Thru Job Training
A supervisor having a discussion with his crew. Get poster printing tips.

Cartel
FSP0-901-000
 
Ten Safe Handling Hints for Knives
Shows ten tips on handling a knife safely. Get poster printing tips.

Cartel
FSP0-903-000
 
Preventing Slips and Falls
Information on how to prevent slips and falls with your footwear, housekeeping and also some general awareness tips. Get poster printing tips.

Cartel
FSP0-904-000
 
Fryer Safety
Tips on deep frying safety. Get poster printing tips.

Cartel
FSP0-905-000
 
Ten Steps for Avoiding Burns
Tips on how to avoid burns while cooking. Get poster printing tips.

Cartel
FSP0-906-000
 
Job Site Safety: Wear Your Hard Hat
Poster: Visual reminder you can print for posting at appropriate job sites and use in safety training, crew or safety committee meetings.

Cartel
FSP0-907-000
 
Stay Clear of Suspended Loads
Pictures a guy under a suspended wooden carton. Get poster printing tips.

Cartel
FSP0-908-000
 
Standard Hand Signals for Cranes

Poster: Displays proper hand signals for directing crawler, locomotive and truck crane operators. Please order from L&I or print on 11" X 17" paper.



Cartel
FSP0-910-000
 
Poster - An Unprotected Trench is an Early Grave

Poster: Trench safety information for employers. Features tips to prevent cave-ins, and proper inspection proceedures. Get poster printing tips.



Cartel
FSP0-912-000
 
The Best Accident Insurance - To observe all safety regulations
Picture of a guy with Saftey Policy and Rules in his hand. Get poster printing tips.

Cartel
FSP0-915-000
 
Four Steps to Proper Lifting
Pictures of a person lifting a large box correctly along with tips on how to correctly lift a large item safely. Get poster printing tips.

Cartel
FSP0-918-000
 
Robberies and Abusive Customers: Tips for Preventing Injuries
Tips on handling cash and how to have a safer restaurant or retail environment. Get poster printing tips.

Cartel
FSP0-919-000
 
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.



Cartel
FSP0-919-999

Otro(s) idioma(s):
Ingl├ęs
 
Caution: Hard Hat Area
Visual reminder of the importance of wearing a hard hat. Get poster printing tips.

Cartel
FSP0-928-000

Otro(s) idioma(s):
Espa├▒ol
 
Precaución: Obligatorio Usar Casco
Picture of hard hats. Get poster printing tips.

Cartel
FSP0-928-999

Otro(s) idioma(s):
Ingl├ęs
 
Always Wear Eye Protection
Picture of a large eye with some content on when to use eye protection. Get poster printing tips.

Cartel
FSP0-940-000

Otro(s) idioma(s):
Espa├▒ol
 
Siempre Use Protección para los ojos
Picture of a large eye with some content on when to use eye protection. Get poster printing tips.

Cartel
FSP0-940-999

Otro(s) idioma(s):
Ingl├ęs
 
Ladder Safety
Picture of a ladder with safety tips on the rungs. Get poster printing tips.

Cartel
FSP0-951-000
 
Keys to Safety
Picture of two keys with the words 'Skills' and Knowledge' on them. Get poster printing tips.

Cartel
FSP0-954-000
 
Danger! Minimum Clearance for Counter Balance - Construction

Sticker: 30 inches long.



Calcoman├şa
FSP0-974-000
 
Safe Ways - Fork Lift Safety
Safety tips on using a fork lift. Get poster printing tips.

Cartel
FSP0-978-000
 
Report All Injuries Promptly
Large words: Report All Injuries Promptly. Get poster printing tips.

Cartel
FSP1-004-000

Otro(s) idioma(s):
Espa├▒ol
 
Reporte Todas las Lesiones Inmediatamente

Large words: Report All Injuries Promptly. Get poster printing tips.



Cartel
FSP1-004-999

Otro(s) idioma(s):
Ingl├ęs
 
Well...My Daddy Wears 'Em
Little boy wearing his daddy's hard hat, eye protection, gloves and boots. Get poster printing tips.

Cartel
FSP1-010-000
 
Danger, Workers Above
Picture of workers on a high rise. Get poster printing tips.

Cartel
FSP1-012-000

Otro(s) idioma(s):
Espa├▒ol
 
Danger, Workers Above-Spanish (Peligro - Trabajadores en el Nivel Superior)

Picture of workers on a high rise. Get poster printing tips.



Cartel
FSP1-012-999

Otro(s) idioma(s):
Ingl├ęs
 
Danger, Construction Area Authorized Personnel Only
Large words: Danger, Construction Area Authorized Personnel Only. Get poster printing tips.

Cartel
FSP1-013-000

Otro(s) idioma(s):
Espa├▒ol
 
Peligro - Área en Construcción - Solamente Personas Authorizadas

Large words: Peligro - Área en Construcción -  Solamente Personas Authorizadas. Get poster printing tips.



Cartel
FSP1-013-999

Otro(s) idioma(s):
Ingl├ęs
 
Danger
Large lettering: DANGER. Get poster printing tips.

Cartel
FSP1-030-000

Otro(s) idioma(s):
Espa├▒ol
 
Cartel - PELIGRO

Large lettering: PELIGRO



Cartel
FSP1-030-999

Otro(s) idioma(s):
Ingl├ęs
 
Walk, Don't Run
Timeless reminder to walk, don't run, showing a banana peel. Get poster printing tips.

Cartel
FSP1-051-000
 
Watch Where You Step
Large lettering: Watch Where You Step. Get poster printing tips.

Cartel
FSP1-055-000
 
Know Your Lockout Tagout Safety Procedures
Poster: Visual reminder you can print for posting in appropriate workplaces. Two options available for download and/or printing.

Cartel
FSP1-063-000
 
High Noise Area, Wear Hearing Protection
Cartoon of a guy plugging his ears with his fingers while his hearing protection is wrapped around his neck with the words 'High Noise Area' above his head. Get poster printing tips.

Cartel
FSP1-065-000
 
Apprentice Work Progress Record

Worksheets used to record the number of hours worked and Related Supplemental Instruction hours during a registered apprenticeship on a monthly basis. If used, a copy is usually given to the program monthly.



Formulario
F100-002-000
 
Program Equal Employment Opportunity Activity Documentation

Used to record individual equal employment opportunity activities conducted by Apprenticeship Programs.



Formulario
F100-012-000
 
The Apprenticeship Advantage: Earn While You Learn!
Fact sheet: Introduces apprenticeship to younger people. Explains the benefits of apprenticeship, a program of study where apprentices earn wages while learning a skilled profession. Includes contact information for L&I's apprenticeship coordinators around the state.

Publicaci├│n
F100-022-000
 
Application for Apprenticeship

EXAMPLE ONLY: Example of an application to apply for an apprenticeship. Registered Apprenticeship Programs use their own forms. NOT TO BE USED TO REQUEST PLUMBER or ELECTRICAL TRAINEE CARD.



Formulario
F100-033-000
 
Apprenticeship Applicant Register
Example: Used for tracking applicants for an apprenticeship program. Registered Apprenticeship Programs use their own forms.

Formulario
F100-045-000
 
Journey Level Wage Rate from which apprentices' wages rates are computed.

Used to submit the Journey-level wage rate from which the apprentices' wage rate is computed. Form must be submitteed at least annually or sooner if the rates change.



Formulario
F100-050-000
 
Related Supplemental Instruction Hours

Used by Apprenticeship programs to submit related instruction hours to L&I Apprenticeship section. It is preferred that programs use the combined RSI/OJT reporting form. RSI Hours must be reported quarterly.



Formulario
F100-228-000
 
Request for Cancellation of Program
Used for cancelling an apprenticeship program.

Formulario
F100-303-000
 
Request for Recognition of Apprenticeship Committee

Used to establish a new apprenticeship committee and list it's employer/employee representatives.



Formulario
F100-504-000
 
Apprenticeship Complaint (Not for Apprenticeship Appeals)

Used to file a complaint on a apprenticeship program, committee, training agent, etc. NOT be used by Apprentices appealing Committee Decisions.



Formulario
F100-505-000
 
Approved Training Agent

Used to allow an employer to train apprentices as part of a Registered Apprenticeship program.



Formulario
F100-508-000
 
Request for Cancellation of New Apprenticeship Committee
To request a cancellation of a new apprenticeship committee which never has a "Request for New Standards" approved by the WSATC

Formulario
F100-510-000
 
Employers’ Guide to Workers’ Compensation Insurance in Washington State

Book: Explains the Washington State's workers' compensation program. Suggests ways to protect workers' safety and health and describes L&I programs to help employers control premium costs.



Publicaci├│n
F101-002-000
 
Request for Public Records

To request public records from Washington State Dept. of Labor and Industries. You can order an earlier version from the LNI warehouse until stock is exhausted.



Formulario
F101-009-000
 
Authorization to Release Claim Information

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.



Formulario
F101-010-000

Otro(s) idioma(s):
Espa├▒ol
 
Request for Claim Information

Used by workers, workers' representatives, employers or employers' representatives to request claim information from L&I.



Formulario
F101-010-111
 
Autorización para Proveer Información 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.



Formulario
F101-010-999

Otro(s) idioma(s):
Ingl├ęs
 
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.

Publicaci├│n
F101-055-909
 
What Are Your Rights as a Worker?

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.



Publicaci├│n
F101-061-909

Otro(s) idioma(s):
Ingl├ęs/ß×Çßלßčĺß׾ß×╗ß×çß×Â
Ingl├ęs/ÝĽťŕÁşýŁś
Ingl├ęs/ĐÇĐâĐüĐüđ║đŞđ╣
Ingl├ęs/Viß╗çt
 
L&I Facility Use Application and Agreement for Government Agencies
Use this form if you are a government agency wanting to use the L&I facility located at 7273 Linderson Way SW; Tumwater, WA. (4 pages)

Formulario
F120-097-000
 
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries

Use to establish a factory assembled structure (FAS) deposit account. FAS deposit accounts are for businesses or other entities that are not currently licensed or registered with L&I as electrical or construction contractors but are legally required to purchase work permits from L&I. (3 pgs)



Formulario
F120-116-000
 
Getting Back to Work: It's Your Job and Your Future
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.

Publicaci├│n
F200-001-000

Otro(s) idioma(s):
Espa├▒ol
 
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.



Publicaci├│n
F200-001-999

Otro(s) idioma(s):
Ingl├ęs
 
Attending Provider's Return-to-Work Desk Reference
Book: Discusses best practices in occupational medicine that help return an injured worker to his/her job as soon as medically possible. Identifies resources available from L&I and explains how to bill for return-to-work services. Three hours of Category 1 CME credit are offered for completing an online self-assessment. Go to www.CMECredits.Lni.wa.gov.

Publicaci├│n
F200-002-000
 
Employer's Return-to-Work Guide

Pamphlet/booklet: Explains the benefits of 'return to work' from the employer's perspective, describes RTW options, and provides resource and contact information.



Publicaci├│n
F200-003-000
 
Application for Self-Insurance Certification

Used by employers to apply for self-insurance certification.



Formulario
F207-001-000
 
Self-Insurance Report of Occupational Injury or Disease (SIF-5)

Used by only self-insured employers or their representatives to report initial time loss payments or to request interlocutory, wage, overpayment or closure orders.



Formulario
F207-005-000
 
Quarterly Report for Self-Insured Business

Form used to submit Quarterly Report. If you need a copy of this form to complete your quarterly report, please contact Certification Services at 360-902-6867.



Formulario
F207-006-000
 
Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers

Used by self-insured employers to report their quarterly statement of supplemental benefits.



Formulario
F207-011-000
 
Quarterly Statement of Supplemental Benefits Instructions

Instructions for filling out the quarterly statement of supplemental benefits.



Formulario
F207-011-111
 
Special Escrow Agreement
Used by self-insured employer as a means to provide surety. This is an agreement between the self-insurer and the bank to hold these securities in trust as collateral for its self-insured program.

Formulario
F207-039-000
 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Used by an employer to apply for self-insurance.



Formulario
F207-040-000
 
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)

Used by certified self-insured companies when they are acquired by another organization. New parent organization guarantees the self-insured workers' compensation liabilities of its new subsidiary.



Formulario
F207-040-001
 
Assignment of Account Agreement
Used by a self-insured employer as an option to provide collateral for a total permanent disability claim.

Formulario
F207-058-000
 
Self-Insurer's Pension Bond

Used by self-insured employers as an option to provide collateral for a permanent total disability claim.



Formulario
F207-065-000
 
Self-Insurer's Bond - Existing Liabilities
Used to provide collateral for a self-insured program.

Formulario
F207-068-000
 
Self-Insured Employers' Time Loss Claim Closure Order and Notice

Used by only 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.



Formulario
F207-070-000

Otro(s) idioma(s):
Espa├▒ol
 
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses

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.



Publicaci├│n
F207-085-000

Otro(s) idioma(s):
Espa├▒ol
 
Protecting Yourself and Your Workers from Poison Oak and Ivy (English/Spanish)
Pamphlet/booklet: Discusses the effects of poison oak and ivy, where it is found in Washington State, how to control growth and protect workers from exposure.

Publicaci├│n
F413-047-000
 





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