---
kind: "section"
citation: "20 C.F.R. § 702.202"
title: "20"
number: "702.202"
heading: "Employer's report; form and contents."
url: "https://uscodex.org/cfr/20/702.202"
---

# §702.202. Employer's report; form and contents.


The 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.

## Notes

### Amendments

[58 FR 68032, Dec. 23, 1993]

### Authority

Authority: 5 U.S.C. 301, and 8171 et seq.; 33 U.S.C. 901 et seq.; 42 U.S.C. 1651 et seq.; 43 U.S.C. 1333; 28 U.S.C. 2461 note (Federal Civil Penalties Inflation Adjustment Act of 1990); Pub. L. 114-74 at sec. 701; Reorganization Plan No. 6 of 1950, 15 FR 3174, 64 Stat. 1263; Secretary's Order 10-2009, 74 FR 58834.

### Source

Source: 38 FR 26861, Sept. 26, 1973, unless otherwise noted.

### Amendments

[58 FR 68032, Dec. 23, 1993]