Notice of injury or death: Requirements
- availability of form
- notice by leased employee.
1.An employee or, in the event of the employee’s death, one of the dependents of the employee, shall provide written notice of an injury that arose out of and in the course of employment to the employer of the employee as soon as practicable, but within 7 days after the accident.
2.The notice required by subsection 1 must:
(a)Be on a form prescribed by the Administrator. The form must allow the injured employee or the dependent of the employee to describe briefly the accident that caused the injury or death.
(b)Be signed by the injured employee or by a person on behalf of the employee, or in the event of the employee’s death, by one of the dependents of the employee or by a person acting on behalf of the dependent.
(c)Include an explanation of the procedure for filing a claim for compensation.
(d)Be prepared in duplicate so that the injured employee or the dependent of the employee and the employer can retain a copy of the notice.
3.Upon receipt of the notice required by subsection 1, the employer, the injured employee’s supervisor or the agent of the employer who was in charge of the type of work or the area where the accident occurred shall sign the notice. The signature of the employer, the supervisor or the employer’s agent is an acknowledgment of the receipt of the notice and shall not be deemed to be a waiver of any of the employer’s defenses or rights.
4.An employer shall maintain a sufficient supply of the forms required to file the notice required by subsection 1 for use by his or her employees.
5.An employer shall retain any notice provided pursuant to subsection 1 for 3 years after the date of the accident. An employer insured by a private carrier shall not file a notice of injury with the private carrier.
6.The claim of a leased employee is not barred if the leased employee gives notice to his or her client company supervisor, rather than to his or her leasing company supervisor. Notification of an injury by a leased employee to his or her client company supervisor shall be deemed sufficient notice of injury to the employer.
Section 616C.015 — Notice of injury or death: Requirements; availability of form; retention; notice by leased employee.,