Section 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.