Try for free

Washington L&I workers' comp forms for attending providers

Washington Department of Labor & Industries forms for attending providers, therapists, dentists and prescribers on State Fund and self-insured workers' comp claims.

The Washington State Department of Labor & Industries (L&I) publishes the workers' compensation forms for State Fund and self-insured claims. At the first visit, the treating provider completes the provider section of the Report of Accident (ROA, F242-130-000) on State Fund claims, or the Provider's Initial Report (F207-028-000) on self-insured claims. The Activity Prescription Form (APF, F242-385-000) reports work status, physical capacities, restrictions, time-loss certification and the treatment plan on both.

Send the ROA to L&I within 5 days of the first visit. It is a carbonless form that only providers can order from L&I, so there is no copy to download. The APF is required at the first visit and whenever work status or capacities change. Prescribers request opioids on the subacute (F252-097-000) and chronic (F252-091-000) forms. 9 of the 30 forms have a Spanish version, and several are Word documents. Vero Documents fills PDF forms from the visit note and the chart.

Physicians, NPs and PAs

Psychology and mental health

Occupational therapy

Dental

Hearing

Other providers

More US forms

Workers' compensationState programs, plus federal OWCP245 formsWashingtonWashington78 formsState disability and paid leaveCalifornia, New York, New Jersey and the paid leave states51 formsFMLAFederal, plus insurers’ own versions25 forms

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Where do I get the Washington ROA form?

The Report of Accident (F242-130-000) cannot be downloaded. It is a multi-part carbonless form that only medical providers can order from L&I, and the PDF on the L&I site explains how to order it. The provider sends it to L&I within 5 days of the first visit or files the provider portion electronically. The worker can file their portion online at FileFast. It is for State Fund claims only.

Which providers can complete the Activity Prescription Form?

Attending providers: MD/DO, DC, ND, DPM, ARNP, PA-C, OD and DMD/DDS. The APF (F242-385-000) is required at the first visit and when work status or physical capacities change, and it serves both State Fund and self-insured claims. On State Fund claims it goes to the L&I claim file. On self-insured claims it goes to the employer or its third-party administrator.

What is the difference between the ROA and the Provider's Initial Report?

The Report of Accident (F242-130-000) opens a State Fund claim, and the worker and the provider each complete a portion. On a self-insured employer's claim, the provider uses the Provider's Initial Report (F207-028-000) instead, a Word form that goes with the employer's SIF-2. Send it to the self-insured employer or its third-party administrator, not to L&I.

Which L&I forms cover opioid prescribing?

The Subacute Opioid Request Form (F252-097-000) covers opioids 6 to 12 weeks after injury or surgery. The Chronic Opioid Request Form (F252-091-000) covers opioids beyond 12 weeks and renewal every 90 days. Starting chronic therapy also takes an Opioid Treatment Agreement (F252-095-000), signed with the worker and renewed yearly or with a new prescriber. Dentists use F252-118-000 to go past the three-day opioid limit.