StacksVerified U.S. regulatory reference

20 CFR §702.202

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
The employer's report of an employee's injury or death shall be in writing and on a form prescribed by the Director for this purpose, and shall contain:
  1. (a)The name, address and business of the employer;
  2. (b)The name, address, occupation and Social Security Number (SSN) of the employee;
  3. (c)The cause, nature, and other relevant circumstances of the injury or death;
  4. (d)The year, month, day, and hour when, and the particular locality where, the injury or death occurred;
  5. (e)Such other information as the Director may require.