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Form 29 - superceded by Form 17 - Review of decision

Form 29 is superceded by Form 17.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.

Tax file number declaration

WorkCover uses the information contained in TFN Declarations to work out how much tax to withhold.

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.

Request for surgery FM302

Request for surgery approval - This form is only to be used for claims where WorkCover Queensland is the insurer.

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.

EFT Payment Form FM204

Complete this form to get paid (electronic funds transfer).

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.

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

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

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.

Consent to check national police records and advise a third party

Queensland police form 8/6/2004