Ls 201 2026

1. Click ‘Get Form’ to open the ls 201 in the editor.
2. Begin by entering the Employee's Name in the designated field, ensuring you include Last, First, and Middle names.
3. Fill in the Home Mailing Address with complete details including Number, Street, City, State, and Zip Code.
4. Input the Date of Birth using the format Month, Day, Year. Select Male or Female as applicable.
5. Provide the Social Security Number as it is required by law for processing claims.
6. Enter the Home Telephone number including area code for contact purposes.
7. Complete the Employer's Name and Address fields accurately to ensure proper communication.
8. Document the Date and Hour of Injury along with a detailed description of where it occurred.
9. Indicate whether the employee stopped work due to injury by selecting Yes or No. If Yes, provide the date they stopped working.
10. Explain the Cause of Injury clearly and indicate any Effects of Injury on specific body parts or if death occurred.
11. Ensure that either the employee or their representative signs in Item 17 or Item 18 based on whether it's an injury or death claim.

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