DOL Form LS-210

View OWCP-DLHWC's Form LS-210 Online htm
Agency: OWCP-DLHWC
Title: DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness
Form Description: DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness: The employer uses this form to notify the Department of Labor of changes to the initial injury report (LS-202) filed.
OMB Control Number: 1240-0003