053-4 Wyo. Code R. § 4-3
The employer must file a report of injury within ten days after the date on which the employer is notified of the injury. Failure by an employer to report may result in a fine or jail. W.S. § 27-14-506(c). The report must be filed with the Division; it shall be on the required form, dated, signed by the employer or employer's authorized representative and shall contain the following information:
(a) The worker's date of hire and job title;
(b) A statement of whether the worker is a regular employee, volunteer, inmate, governmentally subsidized work experience program participant, or has an interest in the business as owner, partner or corporate officer;
(c) The worker's current monthly earnings;
(d) The opinion of the employer as to whether the worker suffered a work-related injury that is compensable under the Act; and
(e) If the employer's opinion is that the injury is not compensable under the Act, the employer shall specify its reason for that opinion. Those matters will be addressed by the Division as part of the determination process.
053-4 Wyo. Code R. § 4-3