Delaware Employee Accident Injury Notice
DELAWARE EMPLOYEE ACCIDENT INJURY NOTICE
Before you send this: Use this for an accident-related injury. Section 2341 calls for notice to the employer within 90 days after the accident. Unless the employer already has actual knowledge of the injury, compensation is not due until notice is given or knowledge obtained. The statute does not make this written form mandatory; a dated copy helps document what the employer received. Occupational-disease notice follows a separate rule in § 2342.
Notice date: [__/__/____]
To employer or authorized representative: [NAME / TITLE]
Employer name and delivery address: [NAME / ADDRESS]
From employee: [FULL NAME]
Employee contact information: [MAILING ADDRESS / PHONE / EMAIL]
Accident and injury
I give notice of an accident at work and a resulting injury under 19 Del. C. § 2341.
Accident date and time: [DATE] at [TIME]
Location: [WORKSITE AND SPECIFIC PLACE]
What happened: [BRIEF FACTUAL DESCRIPTION]
Nature of injury and affected body part(s): [DESCRIPTION]
Earlier notice or employer knowledge, if any: [WHO KNEW / WHAT THEY KNEW / DATE / HOW, OR "NONE KNOWN"]
Witnesses or available records, if any: [NAMES / RECORDS, OR "NONE"]
Please confirm receipt and provide the contact information for the person handling this injury report. I will supply additional accurate information through the applicable compensation process.
Employee signature: ______________________________ Date: [__/__/____]
If delivered by someone on the employee's behalf: [NAME / RELATIONSHIP / CONTACT]
Submitter signature: ______________________________ Date: [__/__/____]
Delivery record — retain with a copy
Recipient and role: [NAME / TITLE]
Method and destination: [HAND DELIVERY / MAIL / ELECTRONIC METHOD AND ADDRESS]
Delivery or confirmed receipt date: [__/__/____]
Proof retained: [ACKNOWLEDGMENT / RECEIPT / EMAIL RECORD / OTHER]
Official source
About this template
- Last updated
- November 4, 2026
- Citations checked
- November 4, 2026
- Jurisdiction
- Delaware
- Category
- Employment & HR
Legal authority
- 19 Del. C. § 2341
- 19 Del. C. § 2342
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on November 4, 2026.
19 Del. C. § 2341 (accident notice and employer knowledge) (checked November 4, 2026): "Unless the employer has actual knowledge of the occurrence of the injury or unless the employee, or someone on the employee’s behalf, or some of the dependents, or someone on their behalf, gives notice thereof to the employer within 90 days after the accident, no compensation shall be due until such notice is given or knowledge obtained."
19 Del. C. § 2342 (separate occupational-disease route) (checked November 4, 2026): "gives the employer written notice or claim that the employee has contracted 1 of the compensable occupational diseases"
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