Maine Employee Written Work Injury Notice
MAINE EMPLOYEE WRITTEN WORK INJURY NOTICE
Before you send this: For an injury on or after January 1, 2020, 39-A M.R.S. § 301 generally calls for notice within 60 days after the injury. Older injury dates have different periods. Section 302 addresses employer knowledge, incapacity, and mistake of fact; if timing is disputed, obtain advice promptly. Send this notice to the employer or a person authorized to receive employee accident reports, and keep proof of delivery.
Notice date: [__/__/____]
To employer or designated accident-report recipient: [NAME AND TITLE]
Employer address or delivery destination: [ADDRESS]
From employee: [FULL NAME]
Employee mailing address: [ADDRESS]
Employee phone or email: [CONTACT]
Notice of injury
I give notice under 39-A M.R.S. § 301 of an injury arising from the following work event:
Time and date of injury: [DATE] at [TIME]
Place of injury: [WORKSITE, ADDRESS, AND SPECIFIC LOCATION]
Cause of injury — what happened: [FACTUAL DESCRIPTION]
Nature of injury and affected body part(s): [DESCRIPTION]
Earlier report, if any: I told [NAME / TITLE] on [DATE] by [METHOD], or [NONE].
Witnesses or available records, if any: [NAMES / RECORDS, OR "NONE"]
Please confirm receipt and tell me who will handle the injury report. I will provide additional accurate information through the applicable claim process.
Employee signature: ______________________________ Date: [__/__/____]
If given 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: [RECEIPT / EMAIL RECORD / OTHER]
Official sources
About this template
- Last updated
- November 4, 2026
- Citations checked
- November 4, 2026
- Jurisdiction
- Maine
- Category
- Employment & HR
Legal authority
- 39-A M.R.S. § 301
- 39-A M.R.S. § 302
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.
39-A M.R.S. § 301 (current notice period) (checked November 4, 2026): "For claims for which the date of injury is on or after January 1, 2020, proceedings for compensation under this Act, except as provided, may not be maintained unless a notice of the injury is given within 60 days after the date of injury."
39-A M.R.S. § 301 (notice content) (checked November 4, 2026): "The notice must include the time, place, cause and nature of the injury, together with the name and address of the injured employee."
39-A M.R.S. § 301 (recipient) (checked November 4, 2026): "The notice must be given to the employer, or to one employer if there are more employers than one; or, if the employer is a corporation, to any official of the corporation; or to any employee designated by the employer as one to whom reports of accidents to employees should be made."
39-A M.R.S. § 302 (employer knowledge) (checked November 4, 2026): "Want of notice is not a bar to proceedings under this Act if it is shown that the employer or the employer's agent had knowledge of the injury."
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