Occupational Disease Employment History Hearing Loss

Document Information
  How to complete a fillable form.
Title Occupational Disease Employment History Hearing Loss
Description

Used by injured worker who has filed an occupational hearing loss claim to report their employment history and the nature of the noise exposure at each job.

Document number F262-013-000
How to get this document
Alt Language(s) Español
Valid dates 06/2015
Contact information Claims for Job Injuries
Related information
Documents

Occupational Hearing Loss Questionnaire


Websites

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.