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Washington Form Center


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,000 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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CLAIMS FORMS
(address) Address Change Request - 6/07
(appelective) Assessment Closing Report - 1/08
(reopen) Application to Reopen Claim - 8/07
(release01) Authorization to Release Claim Information - 4/06
(release92) Authorization to Release Information - 4/92
(deposit) Authorization for Deposit of Payments - 12/07
(transfer) Case Transfer Card - 4/08
(assumption) Employers Job Description - 6/06
(history) Employment History Form - 1/06
(TLCC) Employers Time Loss Closure - N/D
(hearingloss1) Occupational Disease Employment History Hearing Loss - 3/02
(hearingloss2) Occupational Disease Employment History Hearing Loss (Continuation) - 3/02
(hearingloss-q) Occupational Hearing Loss Questionnaire - 7/02
(req-medforms) Medical Forms Request - 1/05
(disease1) Occupational Disease & Employment History - 10/05
(disease2) Occupational Disease & Employment History (Continuation) - 5/02
(req-info) Request for Claim Information - 2/00
(worker) Worker Verification Form - 12/04
(dependents) Claim for Pension by Dependents - 10/01
(spouse-children) Claim for Pension by Spouse or Children - 3/08
(entitlement) Declaration of Entitlement - for Dependent of Deceased Worker Benefits under Industrial Insurance - 10/07
(guardian) Declaration of Entitlement - for Guardian Benefits under Industrial Insurance - 10/07
(disabled) Declaration of Entitlement - for Totally Disabled Worker Benefits under Industrial Insurance - 10/07
(widow) Declaration of Entitlement - for Widow or Widower Benefits under Industrial Insurance - 10/07
(school) Letter Of Intent For School Enrollment - 5/07
(calculation) Third Party Recovery Worksheet with calculations - 5/00
(travel) Travel Reimbursement Request - 7/08
MEDICAL/VOCATIONAL FORMS
(OT PTrequest) Occupational Or Physical Therapy Treatment Authorization Fax Request - 7/08
(pre-job) Pre-Job AccommodationTherapy Treatment Authorization Fax Request - 11/07 Assistance Application - 1/08
(pce) Performance Based Physical Capacities Evaluation - 3/93
(dr estimate) Doctor's Estimate Of Physical Capacities - 6/06
(dr worksheet) Doctor's Worksheet For Rating Dorso-Lumbar & Lumbo-Sacral Impairment - 9/00
(hearing worksheet) Hearing Impairment Calculation Worksheet - 9/00
(notice occ) Notice Of Occupational Disease Or Infection - 9/07
(OT PTprogress) Physical Therapy / Occupational Therapy Progress Report To Claim Managers - 6/06
(StatementForPharmacyServices) Statement For Pharmacy Services - 2/07
(functional) Functional Progress Foem - 12/05
(jobmodassist) Job Modification Assistance Application - 1/08
(opioid) Opoid Progress Report - 9/08
COMPLIANCE FORMS
(Poster) Notice to Employees (POSTER)
(Poster Printing Tips) Poster Printing Tips
(appelective) Application for Elective Coverage of Excluded Employments - 11/03
(cancelelective) Cancellation of Elective Coverage - 7/01
(cancelexcluded) Cancellation of Elective Coverage for Excluded Employment - 10/02
SELF INSURANCE FORMS
(selfinsurer) Agreement of Assumption (Certified Self-Insurer) - 11/00
(application) Application for Self-Insurance Certification - 9/06
(MOCC) Closure Order and Notice - N/D
(PPD-NTL) Permanent Partial Disability Closure Order and Notice - N/D
(PPD-TL) Permanent Partial Disability Closure Order and Notice - N/D
(thirdparty) Self-Insured Third Party Election Form - 3/02
(207176af.doc) Self-Insurance Certification Questionnaire - 1/06
(SI Poster) Self-Insurance Poster - 8/02
(SI Poster sp) Self-Insurance Poster (Spanish)
(assignment) Assignment of Account Agreement - 12/04
(filing info) Workers Compensation Filing Information - 7/96
(memo) Memorandum of Understanding - 12/92
(SSoffset) SSO Calculations Only - 8/00
(CE) Continuing Education Report of Course Completion - 2/08
(Q-Report) Quarterly Report for Self-Insured Business - 6/05
(Q-Statement Supp) Quarterly Statement of Supplemental Benefits Paid - 11/97
(SIF-4) Self-Insured Employers Request for Denial of Claim - 10/08
(SIF-5) SI Report on Occupational Injury or Disease - 9/07
(SIF-5A) SIF Cover Sheet- Wage Calculations - 5/07
(letter of credit) Irrevocable Standby Letter of Credit - 5/08
(amend letter of credit) Amendment of Irrevocable Standby Letter of Credit - 12/06
(memo letter of credit) Memorandum of Understanding Irrevocable Letter of Credit - 8/94
(providerchange) Provider Account Change Form - 3/09
(activityform) Activity Prescription Form - 7/09