2014 DoL LS-210-2025

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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 number and Carrier's number at the top of the form. This information is crucial for identifying the case.
Fill in the name and address of the injured employee, ensuring accuracy for effective communication.
Provide details about the accident, including the date and initial period of disability. Use inclusive dates for clarity.
If applicable, document any subsequent periods of disability, again using inclusive dates. This helps track ongoing issues.
Indicate whether medical attention was received and provide relevant details if applicable. This section is vital for benefit determination.
Complete employer information, including name, address, and authorized signature. Ensure all fields are filled out accurately to avoid delays.
Finally, review all entries for completeness before submitting your report through our editor.

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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 the meaning of dol?

Home. U.S. Department of Labor. The .gov means its official.

What does DOL mean in employment?

U.S. Department of Labor (DOL) The Department of Labor (DOL) administers federal labor laws to guarantee workers rights to fair, safe, and healthy working conditions, including minimum hourly wage and overtime pay, protection against employment discrimination, and unemployment insurance.

How do I find my DOL number?

0:33 1:55 If youre a former employee. And dont have access to a W-2. You can contact the IRS directly theyMoreIf youre a former employee. And dont have access to a W-2. You can contact the IRS directly theyre also surprisingly friendly.

What is a DOL form?

ls-203 - Employees Claim for Compensation. Page 1. U.S. Department of Labor. Office of Workers Compensation Programs.

What is DOL paperwork?

Application to Employ Disabled Person. Authorization for Accidental Overpayment Deduction. Authorization for Voluntary Payroll Deduction. Employee Request for Waiver of Day of Rest.