Occupational Disease & Employment History


Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Occupational Disease & Employment History
Description

Injured worker fills this out to document possible occupational disease and to show work history.

Document number F242-071-000
How to get this document
Alt Language(s) Español
Valid dates 10/2005
Contact information Managing Injured Workers' Claims
Websites Workers' Comp Claims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.