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  Type   Title Owner Modified Date Size Actions
  Document 2017 Fillable Accident Incident Form

Form to declare an accident at work

10557 06/30/17 59 KB
  Document Activity Prescription Form.pdf 07736 01/05/16 168 KB
  Document Administrator Packet.pdf

For Administrator Use: Please use this packet of information to guide you through reporting a bloodborne pathogen exposure

05492 05/07/24 227 KB
  Document Employee Exposure Packet.pdf

Please use this packet of information to guide you through reporting a bloodborne pathogen exposure

05492 04/19/24 382 KB
  Document Filing an online Claim Information Document_Everett.pdf

Instructions to file L&I claim online

07736 01/05/16 302 KB
  Document Fillable Activity Prescription Form

APF

10557 08/19/16 301 KB
  Document Fillable Physicians Initial Report

PIR

10557 08/19/16 106 KB
  Document OLD - DNU - Exposure Packet -- Updated 08.2016.pdf 07736 04/10/24 876 KB
  Document Physicians Initial Report Form

First L & I Visit Form

07736 01/05/16 68 KB
  Document Work Injury Flow Chart - Employee PDF.pdf 08813 02/13/20 135 KB