South Dakota Employee Written Notice of Work Injury
EMPLOYEE WRITTEN NOTICE OF WORK INJURY
Before sending: Notify the employer immediately, or as soon as practical, of the injury. Give this written notice no later than three business days after the injury. South Dakota law does not require a particular form, but the notice must say when, where, and how the injury happened. Keep a copy and a record of delivery. This employee notice does not replace the employer's injury report to its insurer.
Date of written notice: [MONTH DAY, YEAR]
To employer or authorized representative: [EMPLOYER NAME AND MANAGER/SUPERVISOR]
Employer address or delivery location: [ADDRESS]
From employee: [FULL LEGAL NAME]
Employee's job title and department: [TITLE / DEPARTMENT]
Employee contact information: [PHONE / EMAIL / MAILING ADDRESS]
Injury report
I am giving written notice of an injury that occurred in the course of my work.
When it occurred: [DATE AND APPROXIMATE TIME; INCLUDE SHIFT IF RELEVANT]
Where it occurred: [WORKSITE, ADDRESS, AND SPECIFIC LOCATION]
How it occurred: [DESCRIBE THE TASK, EVENT, EQUIPMENT, AND SEQUENCE OF FACTS]
Body part(s) or condition affected, as currently known: [DESCRIPTION]
When and to whom I first reported it: [DATE, TIME, PERSON, METHOD; OR "NOT YET REPORTED"]
Medical attention sought, if any: [DATE AND PROVIDER; OR "NONE YET"]
Please acknowledge receipt of this notice and tell me how the employer will report the injury to its workers' compensation insurer. I will provide additional factual information as it becomes available.
Employee signature: ______________________________
Date signed: [MONTH DAY, YEAR]
Delivery record — keep with your copy
Method: ☐ Hand delivery ☐ Mail with tracking ☐ Employer's designated written-reporting channel: [DESCRIBE]
Date and time delivered or sent: [DATE AND TIME]
Recipient, tracking, or confirmation: [DETAILS]
Employer acknowledgment, if given: ______________________________ Date/time: [DATE AND TIME]
If the employer refuses to file a claim: The South Dakota Department of Labor and Regulation directs employees to contact its Division of Labor and Management at 605-773-3681 for help with the necessary forms.
Official sources: SDCL § 62-7-10 · DLR employee guidance
About this template
- Last updated
- November 4, 2026
- Citations checked
- November 4, 2026
- Jurisdiction
- South Dakota
- Category
- Employment & HR
Legal authority
- S.D. Codified Laws § 62-7-10
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.
S.D. Codified Laws § 62-7-10 (timing) (checked November 4, 2026): "Written notice of the injury shall be provided to the employer no later than three business days after its occurrence."
S.D. Codified Laws § 62-7-10 (content) (checked November 4, 2026): "The notice need not be in any particular form but must advise the employer of when, where, and how the injury occurred."
South Dakota Department of Labor and Regulation, Employee Rights and Responsibilities (checked November 4, 2026): "If your employer refuses to file a workers' compensation claim on your behalf, you may contact the Division of Labor and Management at 605.773.3681."
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