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Form 29 - superceded by Form 17 - Review of decision
Form 29 is superceded by Form 17.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.
14 September 2020 -
Form 44 - Provisional Improvement Notice (PINs)
Provisional Improvement Notice (PIN) form used at the workplace by the Workplace Health and Safety Representative.
PDF 130.5 kB 28 August 2020 -
Form 3 - Incident notification form
Incident notification (Form 3). Use this form (or the online service) to notify of a serious injury, electrical incident, serious illness, fatality, or dangerous incident at your workplace.
PDF 247.08 kB 28 August 2020 -
Suitable duties program
For employers to complete. This two-page template creates a four week return to work plan.
DOCX 156.31 kB 15 March 2024 -
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