Montana Employee Written Work Injury Notice
MONTANA EMPLOYEE WRITTEN WORK INJURY NOTICE
Before you send this: Use this for an accident-related injury, not an occupational-disease claim. Give the employer or its insurer notice of the accident and injury within 30 days after the accident. Montana law also recognizes an employer's actual knowledge in the circumstances stated in § 39-71-603(1); a dated written notice helps preserve a delivery record. A benefits claim has a separate signed-writing requirement under § 39-71-601(1), so do not rely on this notice alone to complete a claim.
Notice date: [__/__/____]
To employer or employer's insurer: [NAME]
Employer or insurer delivery address: [ADDRESS]
From employee: [FULL NAME]
Employee contact information: [MAILING ADDRESS / PHONE / EMAIL]
Accident and injury
I give notice of an accident at work and the resulting injury under Mont. Code Ann. § 39-71-603(1).
Date and time of accident: [DATE] at [TIME]
Place where accident occurred: [WORKSITE, ADDRESS, AND SPECIFIC LOCATION]
Nature of injury and affected body part(s): [DESCRIPTION]
What happened: [BRIEF FACTUAL DESCRIPTION]
Person to whom I previously reported the accident, if any: [NAME / TITLE / DATE / METHOD, OR "NONE"]
Witnesses or available records, if any: [NAMES / RECORDS, OR "NONE"]
Please confirm receipt of this notice and provide the name and contact information of the person or insurer handling this matter. I will provide further accurate information requested through the applicable claim process.
Employee signature: ______________________________ Date: [__/__/____]
If submitted by someone on the employee's behalf: [NAME / RELATIONSHIP / CONTACT]
Submitter signature: ______________________________ Date: [__/__/____]
Delivery record — retain with a copy
Delivered to: [EMPLOYER / MANAGING AGENT / SUPERINTENDENT / INSURER AND NAME]
Method and destination: [HAND DELIVERY / MAIL / ELECTRONIC METHOD AND ADDRESS]
Delivery or confirmed receipt date: [__/__/____]
Proof of delivery retained: [RECEIPT / EMAIL RECORD / OTHER]
Official sources
About this template
- Last updated
- November 4, 2026
- Citations checked
- November 4, 2026
- Jurisdiction
- Montana
- Category
- Employment & HR
Legal authority
- Mont. Code Ann. § 39-71-603(1), (3)
- Mont. Code Ann. § 39-71-601(1)
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.
Mont. Code Ann. § 39-71-603(1) (notice content and recipient) (checked November 4, 2026): "notice of the time and place where the accident occurred and the nature of the injury is given to the employer or the employer's insurer"
Mont. Code Ann. § 39-71-603(1) (timing) (checked November 4, 2026): "within 30 days after the occurrence of the accident that is claimed to have caused the injury"
Mont. Code Ann. § 39-71-603(1) (actual knowledge) (checked November 4, 2026): "Actual knowledge of the accident and injury on the part of the employer or the employer's managing agent or superintendent in charge of the work in which the injured employee was engaged at the time of the injury is equivalent to notice."
Mont. Code Ann. § 39-71-603(3) (occupational disease) (checked November 4, 2026): "This section does not apply to occupational diseases."
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