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Form 29 - superceded by Form 17 - Review of decision
Form 29 is superceded by Form 17.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 -
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 -
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 -
Group training record
A sample form to use in recording workers' training
DOCX 17.62 kB 28 August 2020 -
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Worker determination form
This form is for use by policy holder/employer.
DOC 941.57 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 -
Form 44 - Provisional Improvement Notice (PINs)
Provisional Improvement Notice (PIN) form used at the workplace by the Workplace Health and Safety Representative.
PDF 171.35 kB 29 July 2024 -
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 -
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 -
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 -
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