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Pply: 1) Complete and sign this section of this form. 2) Take form to your employer and vocational counselor to complete. 3) Mail this paperwork to the above address. Questions? Contact your claim manager. Worker s Section At the time of injury, I was working: I am currently working: hours per day hours per day days per week. days per week. My gross earnings, before deductions, for the work period: to were $ On the date o.

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Contact support

If your employer does not pay you the correct minimum wage, you can contact the Washington State Department of Labor and Industries' (L&I) employment standards office at (360) 902-5316 or toll-free at 1 (866) 219-7321 to report your employer or file a complaint. Interpreter services are available.

General information. Contact the Washington State Department of Labor & Industries for information about agency programs and services in your language at 1-800-547-8367.

Provider Hotline: 1-800-848-0811.

Contact the IS Service Desk at 360-902-5000 or ISHelpDesk@Lni.wa.gov for setup assistance.

L&I strives to make filing a claim as easy as possible, and you have options: Online via our FileFast tool. By phone: 1-877-561-FILE (3453)

(800) 541-2894.

You can also file a claim form online at http://.lni.wa.gov/ORLI/ECS/FileFast.asp or by phone at 1-877-561-FILE (3453).

When reporting, you can: Call 1-800-423-7233. Fill out a DOSH Complaint Form and: Submit the form to our secure file upload. You can also use this link to send us photos, videos, documents, and all other supporting information along with your form. or. Mail or Fax it to your local L&I office.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232