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Get Survey Of Occupational Injuries And Illnesses Fax Form - Stats Bls

L Injuries and Illnesses are required by Federal Law to respond. If you have questions please contact us at the phone number listed on the front of your survey instructions. Section 1: Establishment Information 12 - 12345678901234567890 - 10 Establishment ID Number (from front of survey instructions) Company Name and Report For (from front of survey instructions) Contact Name and Title (please print) Today s Date Telephone Number (ext) ( ) - ( ) Fax Number - 1 Enter the annual average.

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