Section 702.202 - Employer's report; form and contentsThe 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.58 FR 68032, Dec. 23, 1993 Approved by the Office of Management and Budget under control numbers 1215-0031 and 1215-0063