Forms

Form 29 - superceded by Form 17 - Review of decision

Form 29 is superceded by Form 17. Form 17 allows a business or indiviual to apply for an internal review of a 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.

Group training record

A sample form to use in recording workers' training

Suitable duties program

For employers to complete. This two-page template creates a four week return to work plan.

Injured worker authorisation

A form whereby an injured worker authorises the communication of information between their medical provider and employer in relation to their worker's compensation claim.

Form 133/133A: Employer reporting - Injury that may be compensable (reportable injuries)

Form for employers to report injuries that may be compensable (reportable injuries)

Form 103 - Administrative release form

Employers use this one page form to request information to assist with the rehabilitation and return to work of an injured worker, or request information relating to the review of a decision.

Partial incapacity form

Form 105 - for employers to complete

Worker determination form

This form is for use by policy holder/employer.

FM106 Claim Form

Use this form to make a claim with WorkCover Queensland or your self-insurer for a work-related illness or injury.

Form 44 - Provisional Improvement Notice (PINs)

Provisional Improvement Notice (PIN) form used at the workplace by the Workplace Health and Safety Representative.