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  • Form 86 Lead health monitoring report

    A form completed before lead risk work to monitor health for each worker.

    PDF 208.07 kB 28 August 2020

  • Form 74 - Amendment to existing authorisation

    If your workplace uses, handles or stores prohibited or restricted carcinogenic hazardous chemicals, you may be required to be authorised for those purposes.

    PDF 2.9 MB 9 April 2021

  • Form 29 - superceded by Form 17 - Review of decision

    Form 29 is superceded by Form 17.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

  • Partial incapacity form

    Form 105 - for employers to complete

    DOC 708.1 kB 28 August 2020

  • Worker determination form

    This form is for use by policy holder/employer.

    DOC 941.57 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 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 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