§ 110. Record and report of injuries by employers. 1. An employer,
or a third party designated by the employer, shall record any injury or
illness incurred by one of its employees in the course of employment
using the form prescribed by the chair for reporting injuries under
subdivision two of this section. Such form, a copy of which shall be
provided to the injured employee upon request, shall be maintained by
the employer, or a third party designated by the employer, for at least
eighteen years, and shall be subject to review by the chair at any time.
Such form need not be filed with the chair unless the status of such
injury or illness changes resulting in a loss of time from regular
duties or in medical treatment which would require reporting in
accordance with subdivision two of this section.

2. An employer, or a third party designated by the employer, shall
file with the chair of the workers' compensation board and with the
carrier if the employer is insured, upon a form prescribed by the chair,
a report of any accident resulting in personal injury which has caused
or will cause a loss of time from regular duties of one day beyond the
working day or shift on which the accident occurred, or which has
required or will require medical treatment beyond ordinary first aid or
more than two treatments by a person rendering first aid. Such report
shall state the name and nature of the business of the employer, the
location of its establishment or place of work, the name, address and
occupation of the injured employee, the time, nature and cause of the
injury and such other information as may be required by the chair. Such
report shall be filed within ten days after the occurrence of the
accident. An employer shall furnish a report of an occupational disease
incurred by an employee in the course of his or her employment, to the
chair of the workers' compensation board, and to the carrier if the
employer is insured, upon the same form. The carrier, within fourteen
days of receipt of the report or accompanying the initial check
forwarded to the employee, whichever is earlier, or a self-insured
employer, within fourteen days of transmitting the report to the chair
or accompanying the initial check forwarded to the employee, whichever
is earlier, shall provide the injured employee or, in the case of death,
his or her dependents with a written statement of their rights under
this chapter, in a form prescribed by the chair. An employer shall file
a report of any other accident resulting in personal injury incurred by
its employee in the course of employment, upon the same form, whenever
directed by the chair.

3. Any injury or illness which is not required to be reported in
accordance with subdivision two of this section, shall not be used as a
basis for determining experience modification rates, provided the
employer pays in the first instance or reimburses the employer's insurer
for the treatment rendered to the employee.

4. An employer who refuses or neglects to make a report or to keep
records as required by this section shall be guilty of a misdemeanor,
punishable by a fine of not more than one thousand dollars. The board
or chair may impose a penalty of not more than two thousand five hundred
dollars upon an employer who refuses or neglects to make such report.

5. The chair shall be authorized to promulgate regulations necessary
to carry out the provisions of this section.