2014 DoL LS-210-2026

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The document is an Employer's Supplementary Report of Accident or Occupational Illness, required by the U.S. Department of Labor's Office of Workers' Compensation Programs. It outlines the necessary information to be reported when an employee is injured or becomes disabled, including details about the accident, periods of disability, medical treatment received, and employer information. The report must be filed promptly to determine entitlement to benefits.

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Click ‘Get Form’ to open the 2014 DoL LS-210 in our platform.
Begin by entering the OWCP No. and Carrier's No. in the designated fields at the top of the form.
Fill in the name of the injured employee, including their first, middle initial, and last name.
Provide the date of the accident using the format (Month, day, year) in section 4.
Complete the address of the injured employee, ensuring all details are accurate.
For sections regarding periods of disability, input dates for 'From' and 'Through' as well as any return-to-work dates.
Indicate whether medical attention was received and provide necessary details if applicable.
Finally, ensure that all required signatures are completed before saving or exporting your filled form.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (103 Votes)
2014	4.2 Satisfied (78 Votes)
2010	4 Satisfied (49 Votes)

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What is an LS 207?

The LS-207 represents the employers or insurance carriers formal basis for denying the claim; a copy of the form must be provided to you. If you disagree with the denial of benefits, please contact the Longshore Claims Examiner servicing your claim to seek assistance.

What is LS200?

The LS-200 form is the report of earnings form that the employer carrier will send to claimants to provide their earnings including self employment earnings. The form must be returned within 30 days or the employer carrier may terminate benefits.

What is a labor form?

A Labor Application Form can be used by an employer to collect information about an applicant for employment. The information collected on the Labor Application Form is typically reviewed by the hiring manager as part of the screening process to determine if the applicant should be interviewed.

What is the most common workers compensation claim?

Each employer who is subject to the recordkeeping requirements of the Occupational Safety and Health Act of 1970 must maintain for each establishment, a log of all recordable occupational injuries and illnesses. This form (OSHA No. 200) may be used for that purpose.

What is an OSHA 200 form?

Labor Law 200 The law requires all worksite to be constructed, equipped, arranged, operated, and conducted as to provide reasonable and adequate protection to the lives, health, and safety of all persons employed therein or lawfully frequenting such places.

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What is the LS 200 form?

ls-200 - Report of Earnings.

What is an LS 202?

ls-202 - Employers First Report of Injury or Occupational Illness.

2014 DoL LS-210-2026

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