Forms

Worker determination form

This form is for use by policy holder/employer.

Form 23 - Removal of worker from lead risk work

Lead is a highly toxic cumulative poison for which manufacturers and importers must prepare, review, amend and provide Safety Data Sheets and suppliers must provide the Safety Data Sheets and label lead containers.

Form 132A: Application for assessment of permanent impairment

Form to be completed by a worker to request a permanent impairment assessment.

Request for Specialised Program FM303

Request for Specialised Program FM303. This form is to only be used for claims where specialised programs are required at a private hospital.

Form 88 - Application for appointment/renewal - accredited provider for workplace health and safety auditor (self-insurance)

Form starts on page five. This application is for individuals wishing to become an accredited workplace health and safety (WHS) auditor (self - insurance) or to renew their accreditation. Includes guide to completing the form (8 pages total).

Form 542.3 Application for a claim review

Form 542.3 Application for a claim review. Use this form to request a free review by WCRS of a decision by your insurer. This form includes a guidlines to help you complete it..

Form 32 Provider management plan

A form template for the medical provider to submit an injured worker's treatment plan details to the worker's compensation insurer.

Form 28 - Hazardous chemicals health monitoring report

Under the Work Health and Safety Regulation 2011 where health monitoring is required for a hazardous chemical, the PCBU must send a copy of the health monitoring report to Workplace Health and Safety Queensland in certain circumstances.

Application for a premium/policy review

Applying for a premium/policy review

Claim form - asbestos injury

Form 202 , October 2019

Form 1990.182D Application for damages certificate

Includes information on eligibility