A Washington Report of Accident (ROA) is the form used in the state of Washington to report workplace injuries, accidents, or occupational diseases. It must be completed and submitted to the Department of Labor and Industries (L&I) within eight hours of the incident. The form is used to document the type of injury or illness, the date of the incident, the time of the incident, the location, the name of the injured employee, the contact information of the employee, employer, and other persons involved, and any other relevant information. There are two types of ROA forms that must be submitted: 1. ROA Form 1 — This form is used to report a workplace injury, accident, or occupational disease. 2. ROA Form 3 — This form is used to report a fatality or serious injury or illness that results in permanent disability. The ROA Form 1 must be completed by the employer and submitted to L&I within eight hours of the incident. The form must include detailed information about the incident, including the date and time of the incident, the location, and the name of the injured employee. The form also must include detailed information about the type of injury or illness, the contact information of the employee, employer, and other persons involved, and any other relevant information. The ROA Form 3 must be completed by the employer and submitted to L&I within twenty-four hours of the incident. The form must include detailed information about the fatality or serious injury or illness, including the date and time of the incident, the location, and the name of the injured employee. The form also must include detailed information about the type of injury or illness, the contact information of the employee, employer, and other persons involved, and any other relevant information.
Washington Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease
Description
How to fill out Washington Report Of Accident (ROA) Workplace Injury, Accident Or Occupational Disease?
If you’re searching for a way to appropriately complete the Washington Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease without hiring a legal professional, then you’re just in the right spot. US Legal Forms has proven itself as the most extensive and reputable library of official templates for every individual and business scenario. Every piece of paperwork you find on our online service is drafted in accordance with federal and state regulations, so you can be sure that your documents are in order.
Adhere to these simple guidelines on how to obtain the ready-to-use Washington Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease:
- Make sure the document you see on the page complies with your legal situation and state regulations by checking its text description or looking through the Preview mode.
- Enter the document name in the Search tab on the top of the page and select your state from the dropdown to find another template in case of any inconsistencies.
- Repeat with the content verification and click Buy now when you are confident with the paperwork compliance with all the requirements.
- ​Log in to your account and click Download. Register for the service and opt for the subscription plan if you still don’t have one.
- Use your credit card or the PayPal option to purchase your US Legal Forms subscription. The blank will be available to download right after.
- Choose in what format you want to get your Washington Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease and download it by clicking the appropriate button.
- Upload your template to an online editor to fill out and sign it rapidly or print it out to prepare your paper copy manually.
Another wonderful thing about US Legal Forms is that you never lose the paperwork you purchased - you can pick any of your downloaded blanks in the My Forms tab of your profile whenever you need it.
Form popularity
FAQ
L&I or your self-insured employer must receive your Report of Accident within 1 year of your injury date to file a claim. We must receive it within two years from the date of your doctor's diagnosis for occupational disease claims.
File a claim online with FileFast (24-hours per day). Workers can also file by phone at 1-877-561-FILE (3453) Monday ? Friday, 8 a.m. ? 5 p.m.
Initial payment: At least 25% of the state's average monthly wage, but no more than 6 times the state's average monthly wage. Subsequent payments: At least 25% of the state's average monthly wage, but no more than 150% the state's average monthly wage.
Right to get medical care needed for treatment at no cost. Right to get time loss benefit payment if unable to work for more than 3 days. Right to turn down (decline) ?light duty? work offer unless approved by your doctor. Right to get a permanent partial disability payment if your injury is permanent.
Filling out the Report of Accident (ROA)
Important: Employers by law must report to L&I the death or in-patient hospitalization of any worker (within 8 hours) and any non-hospitalized amputation or loss of eye (within 24 hours) due to an on-the-job injury by calling 1-800-423-7233.
Call 1-800-423-7233, option 1 To report an on-the-job fatality, in-patient hospitalization, amputation, or loss of an eye, call 1-800-423-7233.
After an injury or illness occurs, your employer must: Provide a workers' compensation claim form to you within one working day a work-related injury or illness is reported. Return a completed copy of the claim form to you within one working day of receipt.