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WA L&I F413-070-000: Cholinesterase Recommendations

Under Washington's cholinesterase monitoring program for agricultural pesticide handlers (WAC 296-307-148), the supervising medical provider uses this L&I sample form to tell the employer what a test result means. It reports only the percent change from baseline for red blood cell and serum cholinesterase, plus a checked recommendation ranging from no action to removal from handling and return to work.

Who completes it

The medical provider supervising the monitoring completes the whole form: employer, job site, employee and test date, the RBC and serum percent change from baseline, the recommendation, and a printed name and signature.

Submitting and payment

How to submit it
The provider gives the recommendation to the employer, may telephone it first and note the date on the form, and must give a copy to the employee.

Good to know

  • The form's thresholds: a drop of more than 20% from baseline calls for a review of handling practices; 30% or more for RBC or 40% or more for serum means removal from handling.
  • A removed employee keeps the job at the same pay and may return to handling once levels are back within 20% of baseline, reported under item 4.
  • The employer sees only the percent change; the employee's specific test values are shared only with the employee's permission.
  • L&I publishes it in English and in Spanish (F413-070-999) as editable Word documents dated 2006.

Get the official form

Download the current version from the source each time; forms change without notice.

Cholinesterase Monitoring Health Care Provider Recommendations

Official pageWord fileVersión en español

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Frequently asked questions

What cholinesterase drop requires removal from pesticide handling in Washington?

On the L&I form, removal is recommended when red blood cell cholinesterase falls 30% or more, or serum cholinesterase falls 40% or more, from the employee's baseline. The employee stays off handling and other potential exposure until levels return to within 20% of baseline, and the employer reviews handling practices.

Does the employer receive the employee's cholinesterase test results?

Only the percent change from baseline and the provider's recommendation. The employee information attached to the form explains that specific results are not included unless the employee has given the provider permission to share them; employees can get their own results from the provider.

Is there a Spanish version of F413-070-000?

Yes. L&I publishes the Spanish version as F413-070-999, titled Recomendaciones del Proveedor Médico. Both versions are Word documents rather than PDFs, so the provider can type the results and recommendation directly and print the letter for signature.