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Modificaciones de la vivienda para trabajadores con lesiones catastróficas

Hoja de información: Respuestas sobre el beneficio de la modificación de la vivienda del programa de compensación para los trabajadores del estado de Washington, quienes califican, lo que puede pagar L&I y donde obtener más información.



Publicación
F252-060-999

Otro(s) idioma(s):
Inglés
 
Home Modification for Workers with Catastrophic Injuries - Questions and Answers for Contractors

Fact sheet: Answers questions about the home modification benefit in Washington State's workers' compensation program and the bid process for contractors interested in this work.



Publicación
F252-061-000
 
Modificaciones de la vivienda para trabajadores con lesiones catastróficas – Preguntas y respuestas para contratistas

Hoja de información: Respuestas sobre el beneficio de la modificación de la vivienda del programa de compensación para los trabajadores del estado de Washington y el proceso de licitación para los contratistas interesados en el trabajo.



Publicación
F252-061-999

Otro(s) idioma(s):
Inglés
 
Vocational Provider Application

Complete this application and the StateWide Payee W-9 if you are applying for a firm Provider Number with L&I.



Formulario
F252-088-000
 
Industrial Insurance Discrimination Complaint

Employees who believe they have been discriminated against by their employer use this form to file a complaint.



Formulario
F262-009-000

Otro(s) idioma(s):
Español
 
Workers' Compensation Discrimination / Discriminación porque se lesionó en su trabajo (English/español)

Fact sheet: Explains workers' legal right to file a workplace injury claim and how to file a complaint if discrimination has occurred.

Hoja de información:  Explica el derecho legal de los trabajadores para presentar un reclamo de lesión en el lugar de trabajo y como presentar una queja si ocurre una discriminación.



Publicación
F262-249-909
 
Avoid Liability for Your Subcontractor's Unpaid Workers' Comp Premiums
Fact sheet: Tells construction contractors how to protect themselves from liability for their subcontractor's unpaid workers' compensation premiums.

Publicación
F262-262-000

Otro(s) idioma(s):
Español
 
Las primas de compensación para trabajadores no pagadas por su subcontratista podrían ser su responsabilidad

Hoja de información: Le informa a los contratistas de construcción cómo protegerse de la responsabilidad por las primas de compensación para los trabajadores no pagadas por su subcontratista.



Publicación
F262-262-999

Otro(s) idioma(s):
Inglés
 
Workers' Comp Fraud Hurts YOU
Pamphlet: Explains the impacts of workers' comp fraud and L&I's efforts to prevent and find fraud by workers, employers, contractors, and medical providers.

Publicación
F262-279-000
 
Plan Development Quality Assurance Review Form

For use internally by L&I Vocational Service Specialists (VSSs) to determine if all required components are included in the submitted plan. Can be used by VRCs as a tool. DO NOT SUBMIT TO L&I.



Formulario
F280-007-000
 
Assessment Eligible Quality Assurance Review Form

For use internally by L&I Vocational Service Specialists (VSSs) to determine if all required components are included in the submitted assessment.  Can be used by VRCs as a tool.  DO NOT SUBMIT TO L&I.



Formulario
F280-008-000
 
Plan Development Recommending Plan Approval Routing Sheet
Routing slip that accompanies the Vocational Services Closing Cover Sheet (F252-028-000) which is used to close vocational services to an injured worker only if you are recommending Plan Approval. For all other closing reports, use Vocational Closing Report Routing Sheet (F252-027-000).

Formulario
F280-013-000
 

Employer’s Guide to the Hazard Communication Rule  

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publicación
F413-012-000

Otro(s) idioma(s):
中国的
한국의
Español
Việt
 
Guide to the Hazard Communication Rule (Vietnamese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publicación
F413-012-555

Otro(s) idioma(s):
中国的
Inglés
한국의
Español
 
Employer's Guide to the Hazard Communication Rule (Korean)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publicación
F413-012-777

Otro(s) idioma(s):
中国的
Inglés
Español
Việt
 
Employer's Guide to the Hazard Communication Rule (Chinese)

Booklet: Washington State's new Hazard Communication rule became effective April 15, 2013. It is intended to improve understanding of hazard information found on product labels. The booklet includes training requirements, a Q&A about who is covered, pictograms, descriptions of hazards and everything employers need to know and do to be in compliance.

The changes are based on the International Globally Harmonized System of Classification and Labeling of Chemicals (GHS).



Publicación
F413-012-888

Otro(s) idioma(s):
Inglés
한국의
Español
Việt
 
Asbestos Abatement Project Notice of Intent and L&I DOSH Asbestos Program

Notice is not required for any asbestos project involving less than forty-eight (48) square feet of surface area, or less than ten (10) linear feet of pipe unless the surface area of the pipe is greater than forty-eight (48) square feet. Get instructions to complete the form.



Formulario
F413-025-000
 
Safety Standards for Possession, Handling, and Use of Explosives WAC 296-52

Explosives mean any chemical compound or mechanical mixture commonly intended or used for the purpose of producing an explosion.



Manual
F414-038-000
 
Chapter 296-807 WAC - Portable Power Tools

Portable power tools applies to hand-held power tools; circular saws, belt sanding machines, compressed air powered tools, powder actuated fastening systems designed to use the expanding gases from a powder load to propel a stud, pin, fastener, or other object into hard structural material, consumer and commercial power lawnmowers, portable hand- or power-operated hydraulic, mechanical ratchet and mechanical screw jacks.



Manual
F414-089-000
 
Safety and Health Discrimination Complaint

Use this form to file a complaint when you feel you've been discriminated against or discharged for reporting a workplace safety hazard.



Formulario
F416-011-000

Otro(s) idioma(s):
Español
 
Safety and Health Workshops

Pamphlet/Brochure: Introduces free workshops to help employers prevent workplace injuries and control workers' compensation costs. Includes course descriptions, and how to register.



Publicación
F416-036-000
 
Physical Exam - Charter Boat Operators License

This form is used by applicants applying for a charter boat operators license to have completed by a physician for an operators license



Formulario
F416-056-000
 
Charter Vessel Inspection

Form used for the applicant to complete a Certification of Inspection of a charter boat.



Formulario
F416-058-000
 
Forklift Safety Guide

Booklet: Contains general information about common forklifts and powered-industrial trucks, lifting and moving heavy loads safely, operator training, safety rules, carbon monoxide and service and maintenance. Included are many illustrations to help employers and workers understand the requirements.

This guide does not replace any of the requirements in the actual regulations and should only used as a companion to the actual regulations.



Publicación
F417-031-000
 
Competent Person Evaluation - Fall Restraint & Fall Arrest

The employer uses this checklist to determine the person they have designated as a competent person is competent within the description and intent of the fall restraint and fall arrest standard.



Formulario
F417-102-000
 
Competent Person Evaluation - Excavation & Trenching

The employer uses this checklist to determine the person they have designated as a competent person is competent within the description and intent of the excavation and trenching standards.



Checklist
F417-104-000
 
Personal Protective Equipment (PPE) Guide
Book: This guide helps employers comply with the WISHA Personal Protective Equipment rules. It covers general personal protective equipment and PPE requirements used to protect the head, eyes and face, hand and arm, foot and leg, and body (torso) in most work environments.

Publicación
F417-207-000
 
Voluntary Protection Program (VPP)
Fact sheet: Provides an overview of the VPP, a program that recognizes occupational safety and health excellence. Identifies benefits and includes testimonials from companies awarded VPP status.

Publicación
F417-221-000
 
Q&A: Hazard Communication Standard

Fact sheet: Provides information about changes to OSHA'S Federal Hazard Communication Standard, which triggers the need for changes to Washington State's standard. Rulemaking is under way in 2013. The changes are intended to improve comprehension of hazard information found in product labels to more effectively prevent injuries, illnesses and fatalities.



Publicación
F417-242-000

Otro(s) idioma(s):
Español
 
Agriculture Safety and Health Pocket Guide

This durable, compact pocket guide is an easy reference guide to safety and health hazards and accident prevention practices for many aspects of agricultural work. It is intended for use in the field by workers and employers in the state of Washington to help them work safely and be in compliance with state regulations.

This guide does not replace any of the requirements in the actual regulations and should only used as a companion to the actual regulations.



Publicación
F417-255-000
 
Hazard Documentation Worksheet

Hazard Documentation Worksheet for use by L&I compliance staff to describe, measure and comment on workplace hazards.



Formulario
F418-031-000
 
Application for Certificate of Competency as an Inspector of Pressure Retaining Items

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.



Formulario
F620-040-000
 
Rental Boiler Operating Permit - Good at this Location Only

To request a permit to use a rental boiler at one location only.

Allow 24 hours for a response. Accuracy and completeness speeds up the processing time.



Formulario
F620-042-000
 
Chief Inspector Clarification and Interpretation Request Form

Form is used to ask the Chief Inspector to consider written requests for clarification and interpretation to the definitions, rules and regulations in WAC 296-104. Thsi form must be completed before F620-017-000 Board of Boiler Rules Interpretation and Revision Request form can be submitted.



Formulario
F620-056-000
 
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Allow two weeks for a response. Accuracy and completeness speeds up the processing time.



Formulario
F621-001-000
 
Elevator Permit Application

Used for installation application for elevators (new, renewals, and alterations).

For New Installations: Allow 30 business days for a response.

For Alterations: Allow 14 business days for a response.

Accuracy and completeness speeds up the processing time.

Residential Incline Chair Lifts: Allow one week for a response.



Formulario
F621-005-000
 
Elevator Installation Variance Application

Property owner or elevator company can apply for a variance to install an elevator. 4 pages.

Allow 4-6 weeks for a response.  Accuracy and completeness speeds up the processing time.



Formulario
F621-048-000
 
Elevator Five-Year Safety Test Report

This report is used by elevator company mechanics and left on the job site for review by elevator inspectors.



Formulario
F621-051-000
 
New Elevator Installation Checklist

Checklist for the elevator company/contractor to complete before the call L&I for an elevator inspection. Includes December 2010 letter on ASME checklists.



Formulario
F621-057-000
 
Renewal of Contractor Elevator License

Used by Elevator Companies to renew their Contractor License.



Formulario
F621-082-000
 
New/Update Elevator Company Primary Point of Contact

Used by the Elevator Section only to Change and/or Update the Primary Point of Contact for Elevator Companies



Formulario
F621-086-000
 
Lista de comprobación para la preinspección de seguridad contra incendios

Lista de comprobación para dueños de casas sobre cómo mejorar sus casas antes de la preinspección del Departamento de Vivienda y Desarrollo Urbano (HUD, por su sigla en inglés) para alcanzar los estándares en el área de seguridad contra incendios.



Formulario
F622-011-999

Otro(s) idioma(s):
Inglés
 
Factory Assembled Structures Alteration Application

Used by a homeowner or contactor to request a field inspection for an alteration to a manufactured or mobile home.

Allow 1-2 days for a response to alteration applications for Manufactured/Mobile Homes.

All other alteration applications, allow 2-3 weeks for a response. Accuracy and completeness speeds up the processing time.



Formulario
F622-036-000
 
Gas Piping Test Affidavit

You fill out, print and make a copy of this form on your company's letterhead. This affidavit must be available for the L&I inspector when the inspection is made.



Formulario
F622-048-000
 
Account Deposit for Factory Assembled Structures Account Holders

You must have a contractor license number or have completed an application for a miscellaneous account to use this form.



Formulario
F622-081-000
 
Application for Construction Contractor Registration

This is the form you would complete to register as a construction contractor.



Formulario
F625-001-000
 
Continuous Contractor's Surety Bond

This form is used for the surety bond for construction contractors and is required by the Contractor's Registration Act (RCW 18.27). The bond must be produced by a bonding company.



Formulario
F625-003-000
 
Contractor Complaint Form

Used by a home owner to file a complaint against a contractor.



Formulario
F625-033-000
 
What to Do if You Want to File Suit Against Your Construction Contractor

Fact sheet: Provides consumers with general information about the process for filing suit, and describes L&I's limited role in serving Summons & Complaint papers.



Publicación
F625-088-000
 
Washington Contractor's License Bond Name Change Rider

Used by the bond company to change the name of the contractor's business.



Formulario
F625-099-000
 
Washington Contractor's License Bond License Number Change Rider

Used by the bond company to change the contractor's business license number.



Formulario
F625-100-000
 
Washington Contractor's License Bond Date Change Rider

Used by the bond company to change the effective date of the contractor's bond.



Formulario
F625-101-000
 
Washington Contractor's License Bond Bond Amount Rider

Used by the bond company to amend the amount of the contractor's bond.



Formulario
F625-102-000
 
Washington Contractor's License Bond Entity Change Rider

Used by the bond company to show a change in the business structure of a contractor's business.



Formulario
F625-103-000
 
Washington Contractor's License Bond Address Change Rider

Used by the bond company to change the address of the contractor's business.



Formulario
F625-104-000
 
Hoja para contratar un contratista con éxito

Lista de comprobación: Proporciona información para ayudar a seleccionar posibles contratistas para proyectos de construcción de casas o reparación/remodelación.  Presentado en un formato organizado y detallado.



Publicación
F625-111-999

Otro(s) idioma(s):
Inglés
 
Construction Contractors - Steps for Success

Brochure: Provides tips to help construction contractors successfully start and maintain their business, and avoid common problems. Gives general overview of requirements for contractor registration, liability insurance, bonding, advertising, consumer disclosure, workers' compensation insurance, workplace safety, employee wages and hours, contractor training, prevailing wage and related topics. Includes resources for more details. Also includes sample "Model Disclosure Statement - Notice to Customer."



Publicación
F625-115-000
 
Affidavit of Wages Paid - Public Works Contract and Instructions

This form is a fillable Word document that is used by a contractor, company or agency to show the wages paid to employees on a public works project. The best way to use this document is to bookmark this page as a “Favorite” in your web browser. Then each time when you want to use the document, access the online version of the form. This will ensure you are always utilizing the most recently published form. (We recommend you not download the document and save the form for future use because we may make changes to the form that your downloaded version will not contain.) You must file the Affidavit of Wages Paid form when you have completed your portion of a public works job/project. Addendum A is form number F700-161-000, Addendum C is form number F700-162-000, and the EHB 2805 (RCW 39.04.370) Addendum is form number F700-164-000.



Formulario
F700-007-000
 
Statement of Intent to Pay Prevailing Wages - Public Works Contract

This form is a fillable Word document that is used by a contractor, company or agency upon accepting work on a public works project. The best way to use this use this document is to bookmark this page as a “Favorite” in your web browser. Then each time when you want to use the document, access the online version of the form. This will ensure you are always utilizing the most recently published form. (We recommend you not download the document and save it for future use because we may make changes to the form that your downloaded version will not contain.) You should file this form immediately after the contract is awarded and before you begin work. Form number F700-160-000 is addendum A and F700-163-000 is addendum C.



Formulario
F700-029-000
 
Washington State OverTime Law

Covers compensation for employees in Washington State working overime.



Publicación
F700-079-000
 
Internal Revenue Service Tax Compliance Certification

Form to gain Internal Revenue Service Tax Compliance Certification for registered Farm Labor Contractors. Now includes IRS form 8821 Tax Information Authorization.



Formulario
F700-098-000
 
Department of Employment Security Tax Compliance Certification

Form to gain Department of Employment Security Tax Compliance Certification for registered Farm Labor Contractors.



Formulario
F700-099-000
 
Department of Revenue Tax Compliance Certification

Form to gain Department of Revenue Tax Compliance Certification for registered Farm Labor Contractors.



Formulario
F700-100-000
 
Farm Labor Contractor Complaint Form

Used to file a complaint against a Farm Labor Contractor, landowner, employer, or other where a possible infraction is concerned.



Formulario
F700-109-000

Otro(s) idioma(s):
Español
 
Farm Labor Contractor Checklist

Farm Labor Contractor's Checklist to ensure compliance.



Formulario
F700-112-000

Otro(s) idioma(s):
Español
 
Lista de comprobacion para un contratista de trabajores agrícolas

Lista de comprobación para el contratista de trabajadores agrícola para asegurar el cumplimiento.



Formulario
F700-112-999

Otro(s) idioma(s):
Inglés
 
Interested Party Checklist for the Filing of Prevailing Wage Complaints

Checklist used for the filing of Prevailing Wage Complaints by "Interested parties" ONLY.



Formulario
F700-129-000
 
Sports Teams and Youth Workers

Fact sheet: Explains the requirements for sports organizations that engage young people as volunteers or employees to referee, assist or work for the organizations. The focus is workers' compensation coverage and minor work rules.



Publicación
F700-130-000
 
Seasonal Group Variance Application

Used for Exceptions from the Hours of Work for Minors for Seasonal work.  Complete the form, print it, sign it and fax or mail it to the address at the top of the form. Variance Application forms may be faxed to (360) 902-5300. If you would like the approved Variance Certificate faxed back to your business, please state so on your cover sheet.



Formulario
F700-135-000
 
Protected Leave Complaint

For leave from work complaints: Download and complete a Protected Leave Complaint form (F700-144-000)



Formulario
F700-144-000

Otro(s) idioma(s):
Español
 
Queja sobre el permiso de ausencia protegida

Para quejas de ausencia del trabajo: Descargue y complete un Formulario de queja sobre permiso de ausencia protegida (Número F700-144-999)



Formulario
F700-144-999

Otro(s) idioma(s):
Inglés
 
Prevailing Wage Complaint and Instructions

Ask L&I to conduct an investigation into a prevailing wage violation that affects one or more employees. See box 30 on the form to see what types of complaints are covered.



Formulario
F700-146-000

Otro(s) idioma(s):
Español
 
Safety Steps for Supervisors and Employees in Restaurants
Fact Sheet: A useful summary of the responsibilities both employers and employees share for a safe workplace. This can be shared with new employees during their initial orientation.

Publicación
F700-139-000
 
Worker Rights Complaint Form

This is the Worker Rights Complaint Form. Both the 12-2011 and 10-2010 versions are valid.



Formulario
F700-148-000

Otro(s) idioma(s):
Español
 
What You Need to Know if You Don't Get Paid: A Worker's Guide to the Washington State Wage Payment Act / Lo que necesita saber si no recibe su pago: una guía para el trabajador de la ley del pago de salario del estado de Washington (English/español)

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.

Hoja de información:  Hace un resumen de los derechos y responsabilidades de los trabajadores referentes al salario mínimo, pago, horas trabajadas y horas extras y explica cómo presentar una queja de salario, incluye respuestas a varias preguntas frecuentes.



Publicación
F700-153-909
 
Keep Your Employees Safe and Working

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.



Publicación
F417-209-000

Otro(s) idioma(s):
Español
 
Mantenga a sus empleados seguros y trabajando

Folleto:  Describe los beneficios de las consultas gratis para  empleadores que ofrece la División de Seguridad y Salud Ocupacional (DOSH, por su sigla en inglés) de L&I.  Estos servicios incluyen consultas de seguridad y/o higiene industrial, asistencia de ergonomía y recomendaciones sobre el manejo de riesgos en el sitio de trabajo.



Publicación
F417-209-999

Otro(s) idioma(s):
Inglés
 
Avoid Liability for Your Farm Labor Contractor's Unpaid Debits / Evite su obligación por las deudas no pagadas de su contratista de trabajadores agrícolas (English/español)

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.

Hoja de información:  Explica cómo los empleadores pueden ser responsables por las primas de compensación para los trabajadores, salarios no pagados, daños y multas civiles al contratar un contratista agrícola.  Indica maneras para protegerse contra una posible responsabilidad.

 



Publicación
F700-154-909
 
Alleged Safety Or Health Hazards (DOSH Complaint Form)

Employees use this form to report work place conditions which jeopardize workers safety and health.



Formulario
F418-052-000

Otro(s) idioma(s):
Español
 
Presuntos riesgos de Salud y Seguridad (Formulario de queja de la División de Seguridad y Salud Ocupacional)

Los empleados usan este formulario de queja para reportar las condiciones de trabajo que ponen en peligro la seguridad y salud de los trabajadores.



Formulario
F418-052-999

Otro(s) idioma(s):
Inglés
 
Safety Comes Thru Job Training
A supervisor having a discussion with his crew. Get poster printing tips.

Cartel
FSP0-901-000
 
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
 
Farm Internship Agreement

Agreement form: Prior to hiring an intern, farms that have received a Farm Intern Program certificate must complete this agreement with the intern and submit it to the department.



Formulario
F700-157-000
 
Caution: Hard Hat Area / Precaución: obligatorio usar un casco (English/español)

Picture of hard hats. Get poster printing tips.

Fotografía de cascos.  Obtenga información sobre cómo imprimir carteles.



Cartel
FSP0-928-999

Otro(s) idioma(s):
Inglés
 
Application for Farm Internship

Application form: Small farm owners wishing to participate in the pilot small farm internship program must complete this form and submit it to the department. The information requested on the form is required to process an application for approval in order to issue a certificate of participation.



Formulario
F700-158-000
 
Siempre use protección para los ojos (English/español)

Fotografía de un ojo grande con contenido sobre cuando debe usar protección de los ojos. Obtenga información sobre cómo imprimir carteles.



Cartel
FSP0-940-999

Otro(s) idioma(s):
Inglés
 
Affidavit of Wages Paid EHB 2805 Addendum

F700-164-000 is an addendum to your Affidavit of Wages Paid Form. RCW 39.04.370 requires you to complete form F700-164-000 if the prime contract is at a cost of over one million dollars ($1,000,000). If you fail to properly provide the requested information more than one time between September 1, 2010 and December 31, 2013, pursuant to RCW 39.04.350(1)(f) you will not be considered a responsible bidder qualified to be awarded a public works project. Use as many of these forms as you need in order to provide the requested information for all relevant project items. This is an addendum to form F700-007-000.



Formulario
F700-164-000
 
Always Wear Eye Protection

Sticker: 7.25 inches x 4.25 inches.

This sticker is to remind workers to wear eye protection when grinding, milling, sanding, sawing, welding, chipping, chiseling, etc.



Calcomanía
FSP0-941-000

Otro(s) idioma(s):
Español
 
Farm Labor Contractor Application/Renewal Packet

This is the packet you would complete to register as a farm labor contractor.



Formulario
F700-170-000
 
Danger! Minimum Clearance for Counter Balance - Construction

Sticker: 8.25 inches x 6 inches.

This sticker is required for construction. There is a minimum counter balance clearance of 30 inches.



Calcomanía
FSP0-974-000
 
Farm Internship Project Complaint Form

Complaint form for public to complete and submit



Formulario
F700-172-000
 
Put this Guard Back - 8.5 x 3.5 inches

This sticker is for employers to place on their equipment to inform workers that if they must remove the guard for service or maintenance to be sure to put it back immediately.



Calcomanía
FSP0-993-000

Otro(s) idioma(s):
Español
 
Put this Guard Back - 5 1/2 x 2 1/8 inches

Sticker: 5 1/2 inches X 2 1/8 inches



Calcomanía
FSP0-993-001

Otro(s) idioma(s):
Español
 
Help for Victims of Crime / Ayuda para víctimas de crimen (English/español)

Pamphlet/booklet: Answers questions about Washington State's Crime Victims Compensation Program, who may be eligible for benefits and how to apply.

Folleto: Responde preguntas sobre el Programa de Compensación para Víctimas de Crimen del estado de  Washington, quienes podrían tener derecho a recibir beneficios y cómo pueden aplicar. 

 



Publicación
F800-006-909
 
Si usted TIENE que remover este resguardo 8.5 x 5.5

Etiqueta adhesiva: 8.5 pulgadas x 3.5 pulgadas. Esta etiqueta adhesiva es para que los empleadores la coloquen en su equipo para informarles a los trabajadores que si necesitan quitar el resguardo de seguridad o mantenimiento deben asegurarse de volver a colocarlo inmediatamente.



Calcomanía
FSP0-993-999

Otro(s) idioma(s):
Inglés
 
Grinding Wheel - Prevent Accidents

Sticker: 4 inches x 3 inches.

This sticker is required for grinder wheel equipment. This sticker reminds workers of the maximum distance between the grinding wheel and tongue guard and the maximum distance between the grinding wheel and the work rest.



Calcomanía
FSP1-000-000
 
Statement for Crime Victims Mental Health Services

Used by the Crime Victims Compensation Program providers for reimbursement of Mental Health Services.



Formulario
F800-025-000
 
Report All Injuries Promptly
Large words: Report All Injuries Promptly. Get poster printing tips.

Cartel
FSP1-004-000

Otro(s) idioma(s):
Español
 
Help for Crime Victims (large poster)

Poster (11" X 17"): Highlights the Crime Victims Compensation Program and provides contact information. Intended for display in health-care, criminal-justice and social-service organizations. Can be downloaded and printed, or ordered from L&I. Smaller version is also available (8.5" X 11"). Get 11" X 17" poster printing tips.



Cartel
F800-041-000

Otro(s) idioma(s):
Español
 
Report All Injuries Promptly / Reporte todas las lesiones inmediatamente (English / español)

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

Palabras en tamaño grande: Reporte todas las lesiones inmediatamente.  Obtenga información sobre cómo imprimir carteles.



Cartel
FSP1-004-999

Otro(s) idioma(s):
Inglés
 
Ayuda para víctimas de crimen (cartel grande)

Cartel:  Documento con las medidas 11 X 17 pulgadas. Resalta el Programa de Compensación para Víctimas de Crimen y proporciona información para comunicarse con el programa. La intención es ponerlo a la vista en clínicas, organizaciones judiciales y de servicios sociales. Puede descargarse e imprimirse o solicitarse de L&I.  Hay una versión disponible más pequeña (8.5 X 11 pulgadas).



Cartel
F800-041-999

Otro(s) idioma(s):
Inglés
 
First Aid

Sticker: 5 inches x 6 inches.

This sticker is used to mark the location of first aid equipment.



Calcomanía
FSP1-005-000
 
Application for Benefits - Crime Victims

This application is used by victims of crime in Washington State to apply for benefits such as compensation for time lost from work; loss of financial support; and medical or mental health treatment.

The application for Homicide Claims is available online by searching for form number F800-120-000.



Formulario
F800-042-000

Otro(s) idioma(s):
Español
 
Danger, Workers Above
Picture of workers on a high rise. Get poster printing tips.

Cartel
FSP1-012-000

Otro(s) idioma(s):
Español
 
Danger, Workers Above / Peligro - Trabajadores en el nivel superior (English/español)

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

Fotografía: Trabajadores en una superficie alta.  Obtenga instrucciones sobre cómo imprimir los carteles.



Cartel
FSP1-012-999

Otro(s) idioma(s):
Inglés
 
Crime Victims Statement for Pharmacy Services

Used by Crime Victims Compensation Program providers to bill for pharmacy services. Crime Victims Compensation Program providers are required to bill using this form.



Formulario
F800-058-000
 
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):
Español
 
Crime Victims' Statement for Compound Prescription

Bill form for use by pharmacies and home infusion companies to submit compound drug charges for Crime Victims Compensation. This form is for drug charges only and is filled out by the pharmacist.



Formulario
F800-067-000
 
Peligro - área en construcción - solamente personas authorizadas

En letras grandes: Peligro - área en construcción -  solamente personas autorizadas. Obtenga instrucciones sobre cómo imprimir los carteles.



Cartel
FSP1-013-999

Otro(s) idioma(s):
Inglés
 
Crime Victims Statement for Home Nursing Services

Used by the Crime Victims Compensation Program providers for reimbursement of home nursing services. Crime Victims Compensation Program providers are required to bill using this form.



Formulario
F800-070-000
 
Danger
Large lettering: DANGER. Get poster printing tips.

Cartel
FSP1-030-000

Otro(s) idioma(s):
Español
 
Danger / PELIGRO (English/español)

Large lettering: DANGER. Get poster printing tips.

Cartel: En letras grandes: PELIGRO. Obtenga instrucciones sobre cómo imprimir los carteles.



Cartel
FSP1-030-999

Otro(s) idioma(s):
Inglés
 
Know What to Expect: How Recoveries and Settlements May Impact Your Crime Victim Claim

Pamphlet and form: Explains third-party liability, recoveries and settlements. A crime victim or the Crime Victims Compensation Program may pursue monetary restitution from someone who caused or contributed to a crime victim's injury. Explains the purpose of the form and why individuals who file a crime victims claim are required to complete it.



Publicación
F800-074-000
 
Crime Victims Compensation Program Initial Response and Assessment: Form I
Used by the clinical provider to get approval to see a victim for six sessions or less. If more than six sessions, please complete Form II (F800-081-000).

Formulario
F800-080-000
 
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
 
Crime Victim Compensation Program Sexual Assault Exam Report

A form used by physicians, hospitals and clinics to provide information and reporting to the Crime Victims Compensation Program.



Formulario
F800-098-000
 
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
 
Billing Guidelines for Sexual Assault Examinations: Crime Victims Compensation Program

Provides information health-care providers need to bill the Crime Victims Compensation Program for medical services.



Manual
F800-100-000
 
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
 
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
 
Helping Providers Understand the Crime Victims Compensation Program
Fact sheet: Answers questions doctors and mental health counselors may have about the Crime Victims Compensation Program and billing for services. Also suggests steps these providers can take to speed up reimbursement.

Publicación
F800-102-000
 
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):
Español
 
Safe Ways - Fork Lift Safety
Safety tips on using a fork lift. Get poster printing tips.

Cartel
FSP0-978-000
 
Help for Crime Victims (small poster)

Poster (8.5" X 11"): Highlights the Crime Victims Compensation Program and provides contact information. Intended for display in health-care, criminal-justice, and social-service organizations. Can be downloaded and printed, or ordered from L&I. Larger version is also available (11" X 17").



Cartel
F800-104-000

Otro(s) idioma(s):
Español
 
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
 
Ayuda para víctimas de crimen

Cartel:  Documento con las medidas 8.5 X 11 pulgadas.  Resalta el programa de compensación para víctimas de crimen y proporciona información para comunicarse con el programa. La intención es ponerlo a la vista en clínicas, organizaciones judiciales y de servicios sociales.  Puede descargarse e imprirse o solicitarse de L&I. Hay una versión disponible más grande (11 X 17 pulgadas).



Cartel
F800-104-999

Otro(s) idioma(s):
Inglés
 
Watch Where You Step
Large lettering: Watch Where You Step. Get poster printing tips.

Cartel
FSP1-055-000
 
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
 
Mental Health Fee Schedule and Billing Guidelines

Manual: This manual is for providers who bill the Crime Victims Compensation Program for mental health services for crime victims.



Manual
F800-105-000
 
Si usted TIENE que remover este resguardo 5 1/2 x 2 1/8

Etiqueta adhesiva: Tamaño 5.5 pulgadas x 2.15 pulgadas. Esta etiqueta adhesiva es para que los empleadores la coloquen en su equipo para informarles a los trabajadores que si necesitan quitar el resguardo de seguridad o mantenimiento deben asegurarse de volver a colocarlo inmediatamente.



Calcomanía
FSP0-993-991

Otro(s) idioma(s):
Inglés
 
Victim Verification Form

For use by crime victims requesting wage replacement compensation



Formulario
F800-110-000

Otro(s) idioma(s):
Español
 
Robos y clientes abusivos: consejos para prevenir lesiones

Consejos sobre cómo manejar el dinero en efectivo y cómo tener un restaurante o un entorno minorista más seguro.  Obtenga información sobre cómo imprimir carteles.



Cartel
FSP0-919-999

Otro(s) idioma(s):
Inglés
 
Formulario de verificación de empleo

Para ser utilizado por las víctimas de crimen que están solicitando compensación de reemplazo de salario.



Formulario
F800-110-999

Otro(s) idioma(s):
Inglés
 
A Safe and Healthy Workplace Begins with You
Pamphlet: Provides an overview of employers' responsibilities for workplace safety and health in Washington State. Covers free L&I services, including workplace consultations, online training and prevention resources and required posters. Intended for new businesses or businesses hiring employees for the first time.

Publicación
F417-210-000
 
Safety and Health Discrimination in the Workplace

Brochure: Employees have the right to report concerns about safety and health in their workplace. This brochure 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.



Publicación
F417-244-000

Otro(s) idioma(s):
Español
 
CVCP Opioid Progress Report Chronic, Non-Cancer Pain and Treatment Agreement.

Crime Victims Compensation Opioid Progress Report Chronic, Non-Cancer Pain and Treatment Agreement.



Formulario
F800-116-000
 





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