This is a generic notice that could be used as a guide in preparing a notice of an injury due to the negligence of a third party or a co-employee.
Subject: Important Notice: Employee Personal Injury Due to Negligence [Employee's Name] [Employee's Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Employer's Name] [Company/Organization Name] [Employer's Address] [City, State, ZIP Code] Dear [Employer's Name], I hope this letter finds you well. I am writing to inform you of a personal injury that occurred on [date] during working hours at the premises of [Company/Organization Name] located in San Antonio, Texas. I believe the incident was a direct result of employer negligence. This notification is aimed at initiating the necessary steps to address the workplace safety concerns effectively. I, [Employee's Name], am an employee of [Company/Organization Name], working in the capacity of [job position]. On the aforementioned date, I sustained a personal injury due to what I perceive as employer negligence. The circumstances of the incident are detailed as follows: 1. Date and Time: [Date and Time of Incident] 2. Location: [Exact location within premises] 3. Description of Incident: [Explain the incident, how it unfolded, and the objects or circumstances leading to the injury] 4. Contributing Factors: [Elaborate on any known factors that may have contributed to the incident] 5. Witnesses: [List any individuals who witnessed the incident and their contact information, if available] 6. Immediate Actions Taken: [Describe any immediate actions taken after the injury, such as seeking medical attention, documenting the incident, or notifying a supervisor] Given the seriousness of the situation and the implications it may have on both the employee's well-being and the company's reputation, I urge you to take the necessary steps to address this matter promptly. My prior efforts to communicate my concerns have unfortunately not yielded the desired resolution, prompting me to initiate this formal notification. I kindly request that an investigation be conducted to determine the causes and identify any potential negligence on the part of the employer. Additionally, I would appreciate it if appropriate measures are taken to prevent similar incidents from occurring in the future. Providing a safe and secure work environment is not only a legal obligation but also essential for the well-being of all employees. As an employee dedicated to the success and growth of [Company/Organization Name], I believe that resolving this matter will contribute to maintaining a positive and productive work environment. I am willing to cooperate fully during the incident investigation and subsequent proceedings. I request a prompt acknowledgement of receipt of this letter and the initiation of the necessary actions on your part. Furthermore, I trust that [Company/Organization Name] will handle this matter with the utmost professionalism and commitment to employee welfare. Please do not hesitate to contact me should you require any additional information or clarification regarding this incident. I can be reached at the provided contact details above. Thank you for your immediate attention to and cooperation in resolving this matter. I anticipate a swift and satisfactory resolution. Sincerely, [Employee's Name] [Employee's Signature] Enclosure: Incident Documentation (if applicable)Subject: Important Notice: Employee Personal Injury Due to Negligence [Employee's Name] [Employee's Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Employer's Name] [Company/Organization Name] [Employer's Address] [City, State, ZIP Code] Dear [Employer's Name], I hope this letter finds you well. I am writing to inform you of a personal injury that occurred on [date] during working hours at the premises of [Company/Organization Name] located in San Antonio, Texas. I believe the incident was a direct result of employer negligence. This notification is aimed at initiating the necessary steps to address the workplace safety concerns effectively. I, [Employee's Name], am an employee of [Company/Organization Name], working in the capacity of [job position]. On the aforementioned date, I sustained a personal injury due to what I perceive as employer negligence. The circumstances of the incident are detailed as follows: 1. Date and Time: [Date and Time of Incident] 2. Location: [Exact location within premises] 3. Description of Incident: [Explain the incident, how it unfolded, and the objects or circumstances leading to the injury] 4. Contributing Factors: [Elaborate on any known factors that may have contributed to the incident] 5. Witnesses: [List any individuals who witnessed the incident and their contact information, if available] 6. Immediate Actions Taken: [Describe any immediate actions taken after the injury, such as seeking medical attention, documenting the incident, or notifying a supervisor] Given the seriousness of the situation and the implications it may have on both the employee's well-being and the company's reputation, I urge you to take the necessary steps to address this matter promptly. My prior efforts to communicate my concerns have unfortunately not yielded the desired resolution, prompting me to initiate this formal notification. I kindly request that an investigation be conducted to determine the causes and identify any potential negligence on the part of the employer. Additionally, I would appreciate it if appropriate measures are taken to prevent similar incidents from occurring in the future. Providing a safe and secure work environment is not only a legal obligation but also essential for the well-being of all employees. As an employee dedicated to the success and growth of [Company/Organization Name], I believe that resolving this matter will contribute to maintaining a positive and productive work environment. I am willing to cooperate fully during the incident investigation and subsequent proceedings. I request a prompt acknowledgement of receipt of this letter and the initiation of the necessary actions on your part. Furthermore, I trust that [Company/Organization Name] will handle this matter with the utmost professionalism and commitment to employee welfare. Please do not hesitate to contact me should you require any additional information or clarification regarding this incident. I can be reached at the provided contact details above. Thank you for your immediate attention to and cooperation in resolving this matter. I anticipate a swift and satisfactory resolution. Sincerely, [Employee's Name] [Employee's Signature] Enclosure: Incident Documentation (if applicable)
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.
