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Ls 202 Form
Under the following Act (Mark one) 7. Indicate where injury occurred (Longshore Act only) (Mark one) A A Aboard vessel or over navigable waters B Nonappropriated Fund Instrumentalities Act B Pier/Wharf C Outer Continental Shelf Lands Act C Dry dock D Defense Base Act D Marine terminal E Building way F Marine railway G Other adjoining area 2. Prime Contract # 3. Sub-Contract # 12. Did injury cause loss of time beyond day or shift of accident? Yes No 13. Date and hour...Show details
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