Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease


Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease
Description

This form is not available to download. If you are an injured worker, ask your medical provider for a copy of this form or you can complete your portion of the Report of Accident (ROA) online at https://secure.Lni.wa.gov/home

Document number F242-130-000
How to get this document
Keywords accident report, claim information, claims, coverage, diseases, espanol, industrial insurance, medical forms, occupational diseases, occupational injuries, report of injury or occupational disease, reporting accidents, worker's compensation, workers compensation, workers' compensation
Alt Language(s) Español
Valid dates 10/2012
Contact information
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.