An employee injured in the performance of his duty, or someone on his behalf, shall give notice thereof. Notice of a death believed to be related to the employment shall be given by an eligible beneficiary specified in section 8133 of this title, or someone on his behalf. A notice of injury or death shall—
(a) be given within 30 days after the injury or death;
(b) be given to the immediate superior of the employee by personal delivery or by depositing it in the mail properly stamped and addressed;
(c) be in writing;
(d) state the name and address of the employee;
(e) state the year, month, day, and hour when and the particular locality where the injury or death occurred;
(f) state the cause and nature of the injury, or, in the case of death, the employment factors believed to be the cause; and
(g) be signed by and contain the address of the individual giving the notice.
(Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 543; Pub. L. 93–416, §12(a), Sept. 7, 1974, 88 Stat. 1146.)
| Derivation | U.S. Code | Revised Statutes and Statutes at Large |
|---|---|---|
| (a) | 5 U.S.C. 765. | Sept. 7, 1916, ch. 458, §15, 39 Stat. 746. |
| 5 U.S.C. 766. | Sept. 7, 1916, ch. 458, §16, 39 Stat. 746. | |
| (b) | 5 U.S.C. 767. | Sept. 7, 1916, ch. 458, §17, 39 Stat. 746. |
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