Form F262-009-303 "Industrial Insurance Discrimination Complaint Form" - Washington (Somali)

This is a legal form that was released by the Washington State Department of Labor and Industries - a government authority operating within Washington.

The document is provided in Somali. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Washington State Department of Labor and Industries;
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  • Compatible with most PDF-viewing applications;

Download a printable version of Form F262-009-303 by clicking the link below or browse more documents and templates provided by the Washington State Department of Labor and Industries.

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Download Form F262-009-303 "Industrial Insurance Discrimination Complaint Form" - Washington (Somali)

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Caymiska Warshada Foomka
Cabashada Takoorka
Investigations
PO Box 44277
Olympia WA 98504-4277
Wac: 1-866-324-3310 ama 360-902-9155
Iimayl u dir:
CSIIIDComplaints@Lni.wa.gov
Waa inaad ku soo gudbisaa cabashadaada gudaha 90 maalmood ee xad
Case Number (Dept. Use Only)
gudubka lagu andacoonayo.
Xuquuqahaaga waa:
RCW 51.48.025 Aargoosiga loo shaqeeyaha la mamnuucay ― Baadhitaanada ― Daawaynaha
1)
Ma jiro loo shaqeeye eryi kara ama qaab kastaba ku takoori kara loo shaqeeye kasta sababtoo ah loo
shaqeeyahan waxa uu soo xereeyay ama cid kala xidhiidhay ujeedada soo xaraynta cabasho magdhow
ah ama ku dhaqanka xuquuqo kasta oo lagu siiyay hoosta cinwaankan. Si kastaba ha ahaatee, ma jirto
qaybtan wax ku jira oo ka hor istaagta loo shaqeeye inuu wax tallaabo ah ka qaado shaqaalaha
iyaddoo sababo kale ah ay ka mid tahay, laakiin aan ku xadidnayn ku guul daraysiga shaqaalaha inuu
dhowro caafimaadka ama heerarka badbaadada ee uu sharciga ka dhigtay loo shaqeeyahu, ama inta
jeer ama sifada shilalka shaqaalaha ee shaqada la xidhiidha.
2)
Shaqaale kasta oo rumaysan in isaga ama iyadda la eryay ama haddii kale uu takooray loo
shaqeeyahu iyaddoo lagu xad gudbayo qaybtan waxay ku soo xarayn karaa cabashada maamulaha
takoorka lagu andacoonayo gudaha sagaashan maalmood laga bilaabo taariikhda xad gudubka
lagu andacoonayo. Marka la helo cabashadan, maamulahu waxa uu bilaabi doonaa baadhitaan in la
sameeyo, sida uu maamulahu u arko inay habboontahay. Gudaha sagaashan maalmood oo helida
cabashada ah lagu soo gudbiyay hoosta qaybtan, maamulahu waxa uu ku wargelin doontaa qofka
cabanaya go’aankiisa ama keeda. Haddii baadhitaankan, la go’aamiyo in qaybtan lagu xad gudbay,
maamulahu waxa uu keeni doonaa tallaabadan maxkamadda sare ee degmadda taas oo xad gudubka
lagu andacooday inuu ka dhacay.
Haddii maamulahu uu go’aamiyo in qaybtan aan lagu xadgudbin, shaqaalahu waxa uu ubilaabi karaa
3)
tallaabada isagoo is metelaya ama is metelayso.
Tallaabo kasta oo la hoos keeno qaybtan, maxkamada sare waxay haysan kartaa nidaamka sharciga,
sababta la muujiyay, si loogu xakameeyo xad gudubyada qayb hoosaadka (1) qaybtan iyo si loo
dalbado dhammaan khafiifinta ugu habboon ay ka mid tahay dib u shaqaalaysiinta ama dib u soo
celinta shaqaalaha iyaddoo wadata dib u bixin mushaharkii hore.
Macluumaadka Qofka cabanaya
Magaca buuxa (Kaaga) Qofka cabanaya
Taariikhda Dhalashada
Taariikhda Cabashada
Cinwaanka Hadda
Magaalada
Gobolka
Summada Sibka
Lambarka Telefoonka Guriga
Lambarka Telefoonka Moobilka
Lambarka Sheegashada Dhaawaca
Taariikhda dhaawaca
Miyaad ku hadashaa Ingiriisiga?
Waa maxay luqadda aad doorbidaa dhammaan wada xidhiidhada aad la yeelato Shaqada
& Warshadaha?
Haa
Maya
Waa maxay qaabka wada xidhiidhka aad doorbidaa?
Cinwaanka Iimaylka Hadda
Telefoonka
Boosta
Iimayl
Macluumaadka Loo shaqeeyaha
Magaca Ganacsiga
Cinwaanka Ganacsiga
Magaalada
Gobolka
Summada Sibka
Magaca Kormeertaha
Lambarka Telefoonka Kormeeraha
Cinwaanka Shaqadaada
Intee in leeg ayaad u shaqaysay loo shaqeeyaha?
Weli ma waxaad u shaqaysaa loo shaqeeyay?
Miyaa shaqadaada la joojiyay?
Haa
Maya
Haa
Maya
F262-009-303 Industrial Insurance Discrimination Complaint Form (Somali) 12-2017
Caymiska Warshada Foomka
Cabashada Takoorka
Investigations
PO Box 44277
Olympia WA 98504-4277
Wac: 1-866-324-3310 ama 360-902-9155
Iimayl u dir:
CSIIIDComplaints@Lni.wa.gov
Waa inaad ku soo gudbisaa cabashadaada gudaha 90 maalmood ee xad
Case Number (Dept. Use Only)
gudubka lagu andacoonayo.
Xuquuqahaaga waa:
RCW 51.48.025 Aargoosiga loo shaqeeyaha la mamnuucay ― Baadhitaanada ― Daawaynaha
1)
Ma jiro loo shaqeeye eryi kara ama qaab kastaba ku takoori kara loo shaqeeye kasta sababtoo ah loo
shaqeeyahan waxa uu soo xereeyay ama cid kala xidhiidhay ujeedada soo xaraynta cabasho magdhow
ah ama ku dhaqanka xuquuqo kasta oo lagu siiyay hoosta cinwaankan. Si kastaba ha ahaatee, ma jirto
qaybtan wax ku jira oo ka hor istaagta loo shaqeeye inuu wax tallaabo ah ka qaado shaqaalaha
iyaddoo sababo kale ah ay ka mid tahay, laakiin aan ku xadidnayn ku guul daraysiga shaqaalaha inuu
dhowro caafimaadka ama heerarka badbaadada ee uu sharciga ka dhigtay loo shaqeeyahu, ama inta
jeer ama sifada shilalka shaqaalaha ee shaqada la xidhiidha.
2)
Shaqaale kasta oo rumaysan in isaga ama iyadda la eryay ama haddii kale uu takooray loo
shaqeeyahu iyaddoo lagu xad gudbayo qaybtan waxay ku soo xarayn karaa cabashada maamulaha
takoorka lagu andacoonayo gudaha sagaashan maalmood laga bilaabo taariikhda xad gudubka
lagu andacoonayo. Marka la helo cabashadan, maamulahu waxa uu bilaabi doonaa baadhitaan in la
sameeyo, sida uu maamulahu u arko inay habboontahay. Gudaha sagaashan maalmood oo helida
cabashada ah lagu soo gudbiyay hoosta qaybtan, maamulahu waxa uu ku wargelin doontaa qofka
cabanaya go’aankiisa ama keeda. Haddii baadhitaankan, la go’aamiyo in qaybtan lagu xad gudbay,
maamulahu waxa uu keeni doonaa tallaabadan maxkamadda sare ee degmadda taas oo xad gudubka
lagu andacooday inuu ka dhacay.
Haddii maamulahu uu go’aamiyo in qaybtan aan lagu xadgudbin, shaqaalahu waxa uu ubilaabi karaa
3)
tallaabada isagoo is metelaya ama is metelayso.
Tallaabo kasta oo la hoos keeno qaybtan, maxkamada sare waxay haysan kartaa nidaamka sharciga,
sababta la muujiyay, si loogu xakameeyo xad gudubyada qayb hoosaadka (1) qaybtan iyo si loo
dalbado dhammaan khafiifinta ugu habboon ay ka mid tahay dib u shaqaalaysiinta ama dib u soo
celinta shaqaalaha iyaddoo wadata dib u bixin mushaharkii hore.
Macluumaadka Qofka cabanaya
Magaca buuxa (Kaaga) Qofka cabanaya
Taariikhda Dhalashada
Taariikhda Cabashada
Cinwaanka Hadda
Magaalada
Gobolka
Summada Sibka
Lambarka Telefoonka Guriga
Lambarka Telefoonka Moobilka
Lambarka Sheegashada Dhaawaca
Taariikhda dhaawaca
Miyaad ku hadashaa Ingiriisiga?
Waa maxay luqadda aad doorbidaa dhammaan wada xidhiidhada aad la yeelato Shaqada
& Warshadaha?
Haa
Maya
Waa maxay qaabka wada xidhiidhka aad doorbidaa?
Cinwaanka Iimaylka Hadda
Telefoonka
Boosta
Iimayl
Macluumaadka Loo shaqeeyaha
Magaca Ganacsiga
Cinwaanka Ganacsiga
Magaalada
Gobolka
Summada Sibka
Magaca Kormeertaha
Lambarka Telefoonka Kormeeraha
Cinwaanka Shaqadaada
Intee in leeg ayaad u shaqaysay loo shaqeeyaha?
Weli ma waxaad u shaqaysaa loo shaqeeyay?
Miyaa shaqadaada la joojiyay?
Haa
Maya
Haa
Maya
F262-009-303 Industrial Insurance Discrimination Complaint Form (Somali) 12-2017
Taariikhdii U dabaysay ee La
Taariikhdii U dabaysay ee
shaqeeyay:
La shaqeeyay:
Macluumaadka Qareenka
Ma haysataa qareen kaa metelaya cabashadan?
Haa
Maya
Magaca Qareenka
Lambarka Telefoonka Qareenka
Cinwaanka Qareenka
Magaalada
Gobolka
Summada Sibka
Dhaawaca iyo Macluumaadka Takoorka
Miyaad dhaawacaaga uga warbixisay loo shaqeeyaha?
Magaca iyo Cinwaanka qofka aad dhaawacan uga warbixisay
Haa
Maya
Miyaa lagaa fasaxay inaad shaqayso wakhtigan?
Hadda ma waxa aad ku jirtaa hawl fudud/xayiraado?
Haa
Waajiba shaqo oo Buuxa
Haa
Maya
Waajib shaqo oo Fudud
Maya
Taariikhda aad Shaqada ku Noqotay
Ka fasaxida la Filayo ee Taariikhda Shaqada
Taariikhda Falka Lagu andacoonayo ee Takoorka
Tallaabada uu Qaaday Loo shaqeeyahu
Sababtee ayaad u rumaysantahay in loo shaqeeyahu u qaaday falkan? Haddii aadu baahan tahay meel banaan oo dheeraad ah, ku
lifaaq boggag dheeraad ah.
Liiska magacyada, cinwaanka, iyo lambarada telefoonka ee markhaatiyaasha falka(alka) takoorka ee lagu andacoonaya.
Miyaad cabasho u gudbisay wakaalad kasta oo kale?
Haa
Maya
Haddii “Haa”, wakaaladee/wakaaladahee ayaad la xidhiidhay?
Waxaan ku cadaynayaa hoosta ciqaabaha been ku dhaarashada in macluumaadka aan halkan ku bixiyay inay
tahay run ilaa inta ugu wanaagsan aqoontayda.
Magaca Daabac
Saxeexa
Taariikhda
Foomka boostadda la
Department of Labor and Industries
buuxiyay:
Investigations
PO Box 44277
Olympia WA 98504-4277
F262-009-303 Industrial Insurance Discrimination Complaint Form (Somali) 12-2017
Ama iimayl u dir:
CSIIIDComplaints@Lni.wa.gov
F262-009-303 Industrial Insurance Discrimination Complaint Form (Somali) 12-2017
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