Get Ls 201

Filling out the Ls 201 form is an essential step for employees who have experienced an injury or death related to their employment under the Longshore and Harbor Workers' Compensation Act. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to effectively complete the Ls 201 online.

1. Press the ‘Get Form’ button to access the online version of the Ls 201 form and open it in your designated document editor.
2. Begin by entering the employee's name in the specified fields, ensuring to include the last name, first name, and middle initial as required.
3. Fill in the employee's home mailing address, including the street address, city, state, and ZIP code in the designated sections.
4. Input the employee's date of birth in the format of month, day, and year.
5. Select the employee's sex by checking either the 'Male' or 'Female' option.
6. Provide the employee's home telephone number, including the area code.
7. Enter the employee's Social Security number, as it is required by law.
8. Specify the name and address of the employer, filling in all required fields for clarity.
9. Indicate the employee's job title in the allotted space.
10. Record the date of the injury in the format of month, day, and year.
11. Input the hour the injury occurred.
12. Detail the exact place where the injury took place.
13. Indicate whether the employee stopped work due to the injury by selecting 'Yes' or 'No.'
14. If applicable, provide the date the employee stopped working due to the injury.
15. Describe the cause of the injury, explaining how the injury or occupational illness was related to employment.
16. Specify the effects of the injury, indicating which parts of the body were affected or if death occurred.
17. If reporting an injury, have the employee sign in the designated area, while also including the date and printed name.
18. If reporting a death, a claimant or representative should sign, along with the date and printed name.
19. Lastly, ensure to state the method of delivery of this notice to the employer and the date this was completed.
20. Review all entered information for accuracy, then save changes, and explore options to download, print, or share the completed form.

Complete and submit your Ls 201 form online today to ensure timely processing of your injury claims.