20 CFR § 702.202 - Employer's report; form and contents.

---
identifier: "/us/cfr/t20/s702.202"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "20 CFR § 702.202 - Employer's report; form and contents."
title_number: 20
title_name: "Employees' Benefits"
section_number: "702.202"
section_name: "Employer's report; form and contents."
chapter_name: "OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR"
subchapter_number: "A"
subchapter_name: "LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES"
part_number: "702"
part_name: "ADMINISTRATION AND PROCEDURE"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "5 U.S.C. 301, and 8171  33 U.S.C. 901  42 U.S.C. 1651  43 U.S.C. 1333; 28 U.S.C. 2461 note (Federal Civil Penalties Inflation Adjustment Act of 1990); Pub. L. 114-74 at sec. 701; Reorganization Plan No. 6 of 1950, 15 FR 3174, 64 Stat. 1263; Secretary's Order 10-2009, 74 FR 58834."
regulatory_source: "38 FR 26861, Sept. 26, 1973, unless otherwise noted."
cfr_part: "702"
---


# 702.202 Employer's report; form and contents.

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:

(a) The name, address and business of the employer;

(b) The name, address, occupation and Social Security Number (SSN) of the employee;

(c) The cause, nature, and other relevant circumstances of the injury or death;

(d) The year, month, day, and hour when, and the particular locality where, the injury or death occurred;

(e) Such other information as the Director may require.

(Approved by the Office of Management and Budget under control numbers 1215-0031 and 1215-0063)

[58 FR 68032, Dec. 23, 1993]