Washington Workers Insured Out-of-State: Employer’s Supplemental Quarterly Report for Workers’ Compensation


Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Washington Workers Insured Out-of-State: Employer’s Supplemental Quarterly Report for Workers’ Compensation
Description The purpose of 212-233-000 Supplemental reporting form is to allow employers to report out-of-state wages and hours as per the requirement in WAC 296-17-25203(8).
Document number F212-233-000
How to get this document
  • Download (309 KB Fillable PDF) 
  • Call Public Affairs, 360-902-5400. Please provide the document number so we can process your request quickly. The title is also helpful.
Alt Language(s)
Valid dates 11/2008
Contact information
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.