A written report of any injury or illness associated with a tanning device shall be forwarded to the department within five working days of its occurrence or knowledge thereof. The report shall include:(1) the name of the affected individual;(2) the name and location of the tanning facility involved;(3) the date of the injury or illness;(4) the nature of the injury or illness;(5) identification of the tanning device involved in the injury or illness, including brand, model, and location;(6) the name and address of health care provider, if any;(7) the name of the operator on duty at the time of injury or illness; and(8) any other information considered relevant to the situation.