Industrial Insurance Discrimination Complaint

Industrial Insurance Discrimination Complaint - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Industrial Insurance Discrimination Complaint (A fillable form - 142 KB PDF)
Description Employees who believe they have been discriminated against by their employer use this form to file a complaint.
Detail
Form number F262-009-000
Availability
Online only. See document above to download.
Keywords discrimination, employer, Retaliation, worker
Languages English , Spanish
Valid dates 05-2012
Contact information Workers' Comp Fraud Investigation
Web pages Fraud & Complaints

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.