Form F417-278-000 Report of an Injury, Illness, or Close Call - Washington

What Is Form F417-278-000?

This is a legal form that was released by the Washington State Department of Labor and Industries - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F417-278-000?
A: Form F417-278-000 is a report used in Washington to document an injury, illness, or close call at the workplace.

Q: Who needs to fill out this form?
A: Employers are responsible for filling out this form when an employee experiences an injury, illness, or close call at work.

Q: What should be reported in this form?
A: This form should be used to report any work-related injuries, illnesses, or close calls that occur at the workplace.

Q: Are employees required to fill out this form?
A: No, employees are not responsible for filling out this form. It is the employer's responsibility to complete it.

Q: Why is it important to report work-related injuries and illnesses?
A: Reporting work-related injuries and illnesses is important for tracking patterns, preventing future incidents, and ensuring that employees receive appropriate medical care and benefits.

Q: How long do employers have to submit this form?
A: Employers must submit Form F417-278-000 within 8 calendar days from the date of the incident or discovery of an occupational disease.

Q: What information should be included in the form?
A: The form requires information such as the date and time of the incident, a description of what happened, the injured employee's personal information, and any witnesses or supervisors involved.

Q: Is there a fee for submitting this form?
A: No, there is no fee for submitting Form F417-278-000.