Forms LS-203 Web Form DLHWC (Longshore) LS-1, Request for Examination and/or Treatment DLHWC (Longshore) LS-201, Notice of Employee’s Injury or Death DLHWC (Longshore) LS-200, Report of Earnings DLHWC (Longshore) LS-203, Employee’s Claim for Compensation OWCP-5a, Work Capacity Evaluation For Psychiatric/ Psychological Conditions OWCP-5b, Work Capacity Evaluation For Cardiovascular/ Pulmonary Conditions OWCP-5c, Work Capacity Evaluation for Musculoskeletal Conditions Travel Mileage Reimbursement Form