DoL LS-202 2012 free printable template

Date of This Report Form LS-202 Rev. Oct. 1998 This report is to be filed in duplicate with the District Director in the appropriate district office of the Office of Workers Compensation Programs and is required by 33 U.S.C. Employer s First Report of Injury or Occupational Illness U*S* Department of Labor Employment Standards Administration Office of Workers Compensation Programs See instructions on reverse - Leave items 1 and 2 blank OMB No* 1215-0031 1. OWCP No* 2. Carrier s No* 3. Date...

. ?. ?. DAKOTA ... Distance from and name of the nearest land, name of State. .... .... ?. .... ?. . . . DIVISION C. OTHER STATE EXPERIENCE AND REQUIREMENTS (Continued)(4) ?. ?. ?. . - - - - - DEATH AVERAGE OF A DRIVER UNDER 50 INMATES TO REGION; EXCEPTION: FLORIDA; EXCEPTION: DIVISION C--HIGHWAY SAFETY DEVELOPMENT FUNCTIONS OF TITLE III, PART 5-B DEFINITIONS FOR CONSTRUCTION PROJECTS- The rules and regulations promulgated under this part shall govern or have the effect of governing construction activities with respect to highways under this title, as they apply to the conduct of such activities, on or after January 1, 1993, except that such rules may not be promulgated prior to the effective date of this title. All rules and regulations promulgated by the Secretary shall be published in the Federal Register. (5) DRIVER OF VEHICLE UNDER 50 IN. AVW PERIOD, AGGREGATE; NONSTOP HIGHWAY- The following definitions shall apply to the term 'number of vehicle occupants (as that term is defined in 49 CFR 551.208) in the vehicle who are likely to be killed, seriously hurt, or injured, or whose lives may be endangered, in the event of an accident or incident involving such vehicle, including, but not limited to, drivers and passengers, passengers in or near the vehicle, and those operating the vehicle and those in the immediate vicinity of the vehicle when there is a risk of injury to occupants or loss of life to other persons caused by the failure of such occupants to take appropriate action to mitigate any substantial risk; provided however, in the event a passenger is killed or seriously injured in an accident, the term 'number of vehicle occupants' includes the passenger, including the driver, and in the event the passenger is seriously injured or killed, the term 'number of vehicle occupants' includes the passenger in combination with the driver.” (b) Application to Interstate and intrastate highways- Whenever a requirement that a driver of a motor vehicle under 49 CFR 553.

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