Notice of Occupational Disease or Infection

Document Information
  How to complete a fillable form.
Title Notice of Occupational Disease or Infection

Used by medical providers to notify L&I that an occupational disease or infection has been diagnosed and that the worker has been advised that their condition may be work-related. This form can be used if the worker does not complete a Report of Accident or Occupational Disease (ROA) but should not be completed in place of an ROA.

Document number F242-243-000
How to get this document
Alt Language(s)
Valid dates 12/2012
Contact information Claims for Job Injuries

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.