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Worker determination form
This form is for use by policy holder/employer.
DOC 941.57 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 -
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 -
Whiplash disability questionnaire
This questionnaire has been designed to provide information on the impact that your whiplash injury and symptoms have upon your lifestyle.
PDF 87.6 kB 28 August 2020 -
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.
PDF 118.38 kB 1 November 2021 -
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.
PDF 39.93 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 -
Consent to check national police records and advise a third party
Queensland police form 8/6/2004
DOC 111.1 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 -
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