Free F200-010-000 Reporting Injuries at Work - Washington

CUT ALONG DOTTED LINE

CUT ALONG DOTTED LINE

Have you been hurt on the job?
As a Washington worker, you are entitled to treatment from a qualified medical provider of your choice and other benefits if you are injured on the job. Under state law, you have a duty to immediately report your accident to your employer. Contact information for the person or the department you must notify at your workplace is on the back of this card. Please do this within 24 hours of being injured.
F200-010-000 [03-2006]

Have you been hurt on the job?
As a Washington worker, you are entitled to treatment from a qualified medical provider of your choice and other benefits if you are injured on the job. Under state law, you have a duty to immediately report your accident to your employer. Contact information for the person or the department you must notify at your workplace is on the back of this card. Please do this within 24 hours of being injured.
F200-010-000 [03-2006]

Have you been hurt on the job?
As a Washington worker, you are entitled to treatment from a qualified medical provider of your choice and other benefits if you are injured on the job. Under state law, you have a duty to immediately report your accident to your employer. Contact information for the person or the department you must notify at your workplace is on the back of this card. Please do this within 24 hours of being injured.
F200-010-000 [03-2006]
CUT ALONG DOTTED LINE

Have you been hurt on the job?
As a Washington worker, you are entitled to treatment from a qualified medical provider of your choice and other benefits if you are injured on the job. Under state law, you have a duty to immediately report your accident to your employer. Contact information for the person or the department you must notify at your workplace is on the back of this card. Please do this within 24 hours of being injured.
F200-010-000 [03-2006]
CUT ALONG DOTTED LINE

F200-010-000 [03-2006] Type your information in the green boxes, pressing "return" after each one. Information will automatically appear below. Then print this sheet and cut along dotted lines to create four cards. Fold and give to your employees.

Employee Wallet Cards

Reporting Injuries at Work

Phone:

Individual/ Department:

L&I Acct. No.

Company:

Phone:

Individual/ Department:

L&I Acct. No. Company: Phone: Individual/ Department:

Report on-the-job injuries/disease to:

Report on-the-job injuries/disease to:

FOLD OVER TO MAKE 2 SIDED

FOLD OVER TO MAKE 2 SIDED

L&I Acct. No.

Company:

Phone:

Individual/ Department:

L&I Acct. No. Company: Phone: Individual/ Department: L&I Acct. No. Company:

Report on-the-job injuries/disease to: Report on-the-job injuries/disease to:
FOLD OVER TO MAKE 2 SIDED FOLD OVER TO MAKE 2 SIDED