Forms

Form 44 - Provisional Improvement Notice (PINs)

Provisional Improvement Notice (PIN) form used at the workplace by the Workplace Health and Safety Representative.

FM106 Claim Form

Use this form to make a claim with WorkCover Queensland or your self-insurer for a work-related illness or injury.

Be recognised - Assessment for silver recognition

Be recognised silver application form to be recognised for health and wellbeing at work.

Health and safety checklist for working from home

Checklist to assess WHS risks for working from home arrangements.

Form 39 - Completion statement by registered training organisation (RTO) and employer

Completion statement by registered training organisation (RTO) and employer

Service provider application form

Form 301: Completing this form does not guarantee referrals from WorkCover Queensland.

Form 106 - Queensland health and safety representative (HSR) training provider application

Form 106 - Queensland health and safety representative (HSR) training provider application

Online services injury and payment profile database - Terms and conditions

Terms and conditions for the OIR Online services injury and payment profile database.

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.

Form 325B - Application for a lung disease examination

An application form for a lung disease confirmation examination under the Worker's Compensation and Rehabilitation Act 2003.

Authorisation of administrator user

Authorisation of administrator user representative for a third party organisation

Queensland Workers Memorial Honour Roll application and eligibility criteria

Queensland Workers Memorial Honour Roll application and eligibility criteria.