sented in term time or vacation to any justice of said court, who on reasonable notice shall hear the parties and render judgment thereon. The judgment in such action if in favor of the plaintiff shall be for a lump sum equal to the amount of payments then due and prospectively due under this act. In such action by an executor or administrator the judgment may provide the proportions of the award or the costs to be distributed to or between the several dependents. If such determination is not made it shall be determined by the probate court in which such executor or administrator is appointed, in accordance with this act, on petition of any party interested, on such notice as such court may direct. Any employer who has declared his intention to act under the compensation features of this act shall also have the right to apply by similar proceedings to the superior court or to any justice thereof for a determination of the amount of the weekly payments to be paid the injured workman, or of a lump sum to be paid the injured workman in lieu of such weekly payments; and either such employer or workman may apply to said superior court or to any justice thereof in similar proceeding for the determination of any other question that may arise under the compensation feature of this act; and said court or justice, after reasonable notice and hearing, may make such order as to the matter in dispute and taxable costs as justice may require.

Sec. 10. Any person entitled to weekly payments under this act against any employer shall have the same preferential claim therefor against the assets of the employer as is allowed by law for a claim by such person against such employer for unpaid wages or personal services. Weekly payments due under this act shall not be assignable or subject to levy, execution, attachment or satisfaction of debts. Any right to receive compensation under this act shall be extinguished by the death. of the person entitled thereto.

Sec. 11. No claim of any attorney-at-law for any

contingent interest in any recovery under this act for services in securing such recovery or for disbursements shall be an enforceable lien on such recovery, unless the account of the same be approved in writing by a justice of the superior court, or, in case the same be tried in any court, by the justice presiding at such trial.

Sec. 12. Every employer subject to the provisions of this act, shall from time to time make to the commissioner of labor such returns as to its operation as said commissioner may require upon blanks to be furnished by said commissioner. Any employer failing to make such returns when required by said commissioner shall, until such returns are made, be subject to the provisions of section 2 of this act.

§ 297. Administration of the New Hampshire workmen's compensation act.-The New Hampshire compensation act does not provide for a board charged with duties of administration. In this respect it is similar to the New Jersey act and is presumed to work automatically. The act, however, provides that the commissioner of labor shall prescribe certain forms of declaration and reports of industrial accidents to be filled out by employers covered by the act and filed with the bureau of labor.

§ 298. Formal procedure-List of forms.—The commissioner of labor of New Hampshire, pursuant to the provisions of the act, has prescribed three forms which are required to be used by employers covered by the act. They are designated as follows: (a) Declaration of employer that he accepts the provision of the act; (b) Report of industrial accident-Part I; (c) Supplemental report of industrial accident-Part II.

§ 299. Form of declaration of employer. (a)

To the Commissioner of Labor of the State of New Hampshire. Concord, N. H.:

The undersigned...

in accordance

with Section 3 of Chapter 163 of the Laws of New Hampshire of

1911, hereby declares that it accepts the provisions of the said Chapter 163, Laws of 1911, relating to compensation payable to injured workmen in its employ, and attaches hereto a copy of its last financial statement for the period ending----.

----as

evidence of its ability to comply with the provisions of the said act.

On this------day of------in the year------before me personally -------to me known, who being by me duly sworn, did depose and say that he resides in__‒‒‒

came--

;

the corporation described in and which executed the foregoing instrument; that he knows the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said corporation, and that he signed his name thereto by like order. (SEAL)

Notary Public.

§ 300. Form of report of industrial accident to bureau of labor. (b)1

Part I.

Employer's name..

----Office address: Street

Employer, place and time.

and No.------------City or town-‒‒‒‒‒‒‒‒‒‒‒State‒‒‒‒‒‒‒‒‒‒Nature Location of plant or place of work where

accident occurred, if not at office address___

of business_____

The injured person

Name ----------Address

--Age

Nativity -

What language spoken and understood?_‒‒‒‒‒‒‒‒‒Parent or guardian, if minor‒‒‒‒‒‒‒‒‒‒State whether manual or mechanical labor, and employment as specified in a, b, c, d, e, of section 1, chapter 163, Laws of 19111a. ---Length of experience (here and elsewhere) in this employment--------Regular occupation, or not‒‒‒‒‒‒‒‒ Piece or time worker--‒‒‒‒ Wages, or average earnings per day -Working days per week‒‒‒‒‒

The injury

Date an exact hour of accident‒‒‒‒‒‒‒‒‒‒Date notice was received by employer._-------State fully nature and extent of injury----. Employment or department in which accident occurred____

Machine or appliance causing Accident

Name of machine, tool, device or other appliance--‒‒‒

1 Immediate report.

1a See ante, § 296.

Did the

employé thoroughly understand the machine, tool or device and was he properly instructed regarding its operation; cleaning when not in operation; how to shut off power quickly---

What safeguards?------------Was machine, or part of machine, or appliance on which accident occurred defective?.

Had management been notified of defect?______

Medical Attendance

Attending physician, or hospital where sent---
Name
--Address

§ 301. Form of supplemental report of industrial accident to bureau of labor. (c)2

Part II.

Name of employer------------Name of injured person.

Extent of Disability

Did injury result in death?__________If not, has it caused

a. Permanent total disability (meaning inability to do any work)? If so, state nature of permanent injury or condition causing such disability---

b. Permanent partial disability (meaning ability to do some work but not of same kind or amount as before accident) ?‒‒‒‒‒‒‒‒‒‒ If so, state nature of permanent injury or condition causing such disability----------On what date was work resumed?‒‒‒‒‒‒ Present wages, or average earnings, per day at such work‒‒‒‒‒‒ c. Temporary disability (meaning that injured person has been able to resume same kind and amount of work as before accident)?------------If so, for how many working days did such disability last?_____

d. Disability, the extent of which is not known two weeks after first report?__________If so, state estimated period of disaability

(In this case the employer is expected to keep a record from which report of ultimate extent of disability can be furnished when requested.)

Dependents

In case injury caused death or permanent total disability as shown above, give name, address, age and relationship of each person dependent on injured person's earnings:

2 Report on disability. Part II, to be sent in at the end of two weeks.

CHAPTER XVIII.

THE MASSACHUSETTS WORKMEN'S COMPENSATION ACT.