Get Dol Ls-202 2020-2025

Filling out the Department of Labor LS-202 form is an essential step in reporting an injury or occupational illness in accordance with U.S. labor laws. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to fill out your DoL LS-202 form online.

1. Press the ‘Get Form’ button to access the form and open it for editing. This initiates the process of online completion.
2. Enter the OWCP number, if applicable. This number identifies the case in the Office of Workers' Compensation Programs.
3. Fill in the carrier's number, which is provided by the insurance carrier covering the injury.
4. Input the date and time of the accident in the specified format (mm/dd/yyyy). This is crucial for chronological records.
5. Provide the name of the injured or deceased employee, including first name, middle initial, last name, and their telephone number.
6. Complete the employee’s address, including the street number, city, state, ZIP code, and country.
7. Indicate under which Act the injury is reported, marking the appropriate option (e.g., Longshore and Harbor Workers’ Compensation Act).
8. Specify where the injury occurred by marking the relevant option related to maritime employment.
9. Respond to questions regarding lost time due to the injury, including dates and hours lost, ensuring to mark ‘Yes’ or ‘No’ accurately.
10. Detail the employee's occupation and specify the department they typically work in.
11. Provide information about the employee’s working days and the nature of the injury, being as descriptive as possible.
12. Elaborate on how the accident occurred in the designated section. Clarity and detail are important here.
13. Indicate if medical attention was authorized and provide the name of the treating physician and hospital, if applicable.
14. Fill in the insurance carrier's details and any other relevant information pertaining to the employer and their business.
15. Complete the official title and phone number of the person signing the report and ensure to add their signature.
16. Finally, save changes made to the document. You can download, print, or share the completed form as necessary.

Complete your LS-202 form online today to ensure timely processing of your injury report.