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FM106 Claim Form
Use this form to make a claim with WorkCover Queensland or your self-insurer for a work-related illness or injury.
DOCX 98.48 kB 28 August 2020 -
Health and safety checklist for working from home
Checklist to assess WHS risks for working from home arrangements.
PDF 222.78 kB 6 April 2022 -
Healthy worker funding program application form
Application form for high-risk industries for work health funding program
DOC 335.36 kB 28 August 2020 -
Worker determination form
This form is for use by policy holder/employer.
DOC 941.57 kB 28 August 2020 -
EFT Payment Form FM204
Complete this form to get paid (electronic funds transfer).
PDF 36.91 kB 28 August 2020 -
Request for surgery FM302
Request for surgery approval - This form is only to be used for claims where WorkCover Queensland is the insurer.
PDF 120.11 kB 18 March 2021 -
Be recognised - Assessment for silver recognition
Be recognised silver application form to be recognised for health and wellbeing at work.
PDF 231.82 kB 28 August 2020 -
Statutory appointments and public sector employment currently held
We ask candidates for appointment to a government body to complete and sign this form. It tells us about your current public sector employment and any statutory appointments to Qld Government bodies and the amount of remuneration (including daily meeting fees) received for them.The Department of Education is collecting your personal information for the purpose of assessing your eligibility for appointment to Queensland Government statutory bodies and to receive fees should you be appointed.
DOC 35.33 kB 28 August 2020 -
Form 106 - Queensland health and safety representative (HSR) training provider application
Form 106 - Queensland health and safety representative (HSR) training provider application
PDF 262.43 kB 28 August 2020 -
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.
DOC 686.08 kB 28 August 2020 -
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.
DOC 59.9 kB 28 August 2020 -
Form 133/133A: Employer reporting - Injury that may be compensable (reportable injuries)
Form for employers to report injuries that may be compensable (reportable injuries)
PDF 151.47 kB 28 August 2020