Occupational Disease & Employment History

Document Information
  How to complete a fillable form.
Title Occupational Disease & Employment History

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
  • Order it from our Warehouse
  • Alt Language(s) Español
    Valid dates 10/2005
    Contact information Managing Injured Workers' Claims
    Websites Workers' Comp Claims

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