Notice of Occupational Disease or Infection

Notice of Occupational Disease or Infection - (Forms/Publications)
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Title   Notice of Occupational Disease or Infection (96 KB PDF)

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.

Form number F242-243-000
Online only. See document above to download.
Keywords claims, diseases, industrial insurance, worker's compensation, workers compensation, workers' compensation
Languages English
Valid dates 12-2012
Contact information Claims for Job Injuries

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