28 Tex. Admin. Code § 160.2 - Non-Subscribing Employer's Report of Injury

(a) An employer that does not have workers' compensation insurance coverage (non-subscriber) and employs five or more employees not exempt from workers' compensation insurance coverage shall file with the division a report of each:

(1) death;

(2) on-the-job injury that results in more than one day's absence from work for the injured employee; and

(3) occupational disease of which the employer has knowledge.

(b) An employer shall file a report required by subsection (a) of this section with the division not later than the seventh day of the month following the month in which:

(1) the death occurred;

(2) the employee was absent from work for more than one day as a result of the on-the-job injury; or

(3) the employer acquired knowledge of the occupational disease.

(c) A report shall be filed in writing or electronically and shall be in the form and manner prescribed by the division. A report must include:

(1) the employer's business name;

(2) the employer's North American Industry Classification System (NAICS) codes;

(3) the employer's business mailing address;

(4) the employer's physical address (if different from mailing address);

(5) the employer's telephone number;

(6) the employer's federal employer identification number (FEIN);

(7) the name, title, telephone number, signature, and date of signature of the person completing the report for the employer;

(8) the reporting period;

(9) the injured employee's name;

(10) the employee's social security number;

(11) the employee's date of birth;

(12) the employee's date of hire;

(13) the employee's sex;

(14) the employee's occupation;

(15) the employee's hourly wage;

(16) the employee's NAICS code;

(17) the employee's race/ethnic identification;

(18) the address where injury or occupational disease occurred;

(19) the type of location of where injury or occupational disease occurred;

(20) the date of injury or occupational disease;

(21) the date reported by employee;

(22) the return-to-work date or expected date;

(23) the reported cause of injury;

(24) the nature of injury or occupational disease;

(25) any equipment involved in the injury;

(26) body part(s) affected;

(27) the first day of absence from work;

(28) the number of days absent from work;

(29) whether the injury is an occupational disease;

(30) whether the injury resulted in death; and

(31) a description of incident.

(d) Employers are responsible for timely and accurate filing of reports under this section. A report required by this section is considered filed with the division only when it accurately contains all of the data elements specified under subsection (c) of this section and is received by the division.

(e) This section is effective January 1, 2013.

Notes

28 Tex. Admin. Code § 160.2

The provisions of this §160.2 adopted to be effective June 1, 1992, 17 TexReg 3252; amended to be effective February 2, 1996, 21 TexReg 515; amended to be effective March 13, 2000, 25 TexReg 2148; amended to be effective January 1, 2013, 37 TexReg 5592