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. (Approved by the Office of Management and Budget under control numbers 1215-0031 and 1215-0063) [58 FR 68032, Dec. 23, 1993]