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May 8, 2009   
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DOL Form LS-202

View ESA-OWCP-DLHWC's Form LS-202 Online htm
Agency: ESA-OWCP-DLHWC
Title: DLHWC (Longshore) LS-202, Employer's First Report of Injury or Occupational Illness
Form Description: DLHWC (Longshore) LS-202, Employer's First Report of Injury or Occupational Illness: This is a required form which is submitted by the employer to report an injury or occupational illness when the employer becomes aware of such injury or illness and/or the injured worker loses one or more shifts of work due to the injury/illness. It is a reporting tool, not an admission of liability.
OMB Control Number: 1215-0031

 

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