Form LS-210 Employer's Supplementary Report of Accident or Occupatio

Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness

ls-210 (002)

Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness

OMB: 1240-0003