2005 Idaho Code - 72-702 — FORM OF NOTICE AND CLAIM

                                  TITLE  72
                      WORKER'S COMPENSATION AND RELATED
                        LAWS -- INDUSTRIAL COMMISSION
                                  CHAPTER 7
                                  PROCEDURES
    72-702.  FORM OF NOTICE AND CLAIM. Such notice and such claim shall be in
writing; the notice shall contain the name and address of the employee, and
shall state in ordinary language the time, place, nature and cause of the
injury or disease and shall be signed by him or by a person on his behalf, or,
in the event of his death, by any one or more of his dependents, or by a
person on their behalf. The notice may include the claim.