21 V.S.A. § 702: Contents; penalty

(a) Reports submitted pursuant to section 701 of this chapter shall state:

(1) the name and nature of the business of the employer;

(2) the location of the place where the accident occurred;

(3) the name, age, sex, wages, and occupation of the injured employee;

(4) the date and hour of the accident causing the injury;

(5) the injury’s nature and cause; and

(6) any other information required by the Commissioner.

(b) An employer who refuses or neglects to make reports required pursuant to section 701 of this chapter may be assessed an administrative penalty of not more than $100.00 per violation after notice and opportunity for hearing under section 688 of this title.