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Form 32 Provider management plan
A form template for the medical provider to submit an injured worker's treatment plan details to the worker's compensation insurer.
PDF 39.93 kB 28 August 2020 -
Form 71 - Request for Work Health and Safety Prosecutor (WHSP) to commence a prosecution
Request the Work Health and Safety Prosecutor to bring a prosecution under section 231 of the Work Health and Safety Act 2011 (including in relation to the Safety in Recreational Water Activities Act 2011) or section 186A of the Electrical Safety Act 2002.
PDF 161.05 kB 28 August 2020 -
Request for Specialised Program FM303
Request for Specialised Program FM303. This form is to only be used for claims where specialised programs are required at a private hospital.
PDF 118.38 kB 1 November 2021 -
Form 17 - Application for internal review of decision
Complete this form to apply for an internal review of decision under the Work Health and Safety Act 2011, Work Health and Safety Regulation 2011, Electrical Safety Act 2002 or Safety in Recreational Water Activities Act 2011.
PDF 278.16 kB 25 October 2021 -
Form 325B - Application for a lung disease examination
An application form for a lung disease confirmation examination under the Worker's Compensation and Rehabilitation Act 2003.
PDF 691.69 kB 28 August 2020 -
Depression, anxiety, stress, scale (dass) response form
Two page form for self-assessement
DOC 15.87 kB 28 August 2020 -
Application form – Rehabilitation and return to work coordinator (RRTWC) course approval
Version 1
PDF 156.2 kB 28 August 2020 -
Service provider application form
Form 301: Completing this form does not guarantee referrals from WorkCover Queensland.
DOC 105.98 kB 28 August 2020 -
Form 6 - Response to lump sum offer
Response to lump sum offer pursuant to section 182B of the Workers’ Compensation Act 1990 (as amended)
PDF 547.13 kB 28 August 2020 -
Form 23 - New notification of lead risk work
Lead is a highly toxic cumulative poison for which manufacturers and importers must prepare, review, amend and provide Safety Data Sheets and suppliers must provide the Safety Data Sheets and label lead containers.
PDF 2.5 MB 13 April 2021 -
Queensland Workers Memorial Honour Roll application and eligibility criteria
Queensland Workers Memorial Honour Roll application and eligibility criteria.
PDF 209.85 kB 11 September 2020 -
Form 275 Notice of claim for damages
A twelve page form, last updated 2018
PDF 813.13 kB 28 August 2020