The Report of Accident opens a Washington State Fund workers' compensation claim for a work injury or occupational disease. The worker and the provider who first treats the injury each complete a portion at the initial visit, and the provider must file it within 5 days of treatment even if the worker objects. The signing provider becomes the attending provider on the claim until a written transfer of care.
The health care provider who first treats the work injury completes and signs the provider section after an in-person exam. The worker completes the worker and employer sections, on the paper form or online through L&I's FileFast.
Download the current version from the source each time; forms change without notice.
Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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.
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No. The ROA is not available to download; the PDF under its form number only explains how medical providers order free paper copies through L&I's forms ordering page. Providers can instead file State Fund ROAs online through FileFast or a Health Information Exchange, and workers can complete their part on FileFast.
Providers who first treat an injured worker must tell them of their right to file. Under L&I's policy, even if the worker objects after hearing those rights, the provider must still file the ROA within 5 days of treatment, and no contract or agreement can exempt anyone from filing.
The provider who completes and signs the ROA is listed as the attending provider on the claim until L&I receives a written transfer of care. Only attending provider types with a valid L&I provider number may sign the ROA and be paid for completing it.