Employer's First Report of Injury or Occupational Disease; Physician's Report on Impairment of Vision; and Employer's Supplementary Report of Accident or Occupational Illness
DOL/ESA-15
OMB: 1240-0003
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0003 can be found here: