Forms

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.

Health and safety checklist for working from home

Checklist to assess WHS risks for working from home arrangements.

Application for reinsurance set limit

Form 42 - For use by self-insurers

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.

Appointment to government body - Personal particulars form for candidates

Candidates to complete

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

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

Compliment or complain about our services

We are committed to excellent customer service. Both positive and negative feedback helps us to provide better services to our stakeholders. Complaints about our services are taken seriously and we follow a clear process to try and resolve your issue.

Form 6 - Response to lump sum offer

Response to lump sum offer pursuant to section 182B of the Workers’ Compensation Act 1990 (as amended)

Application form – Rehabilitation and return to work coordinator (RRTWC) course approval

Version 1

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

Completion statement by registered training organisation (RTO) and employer

Partial incapacity form

Form 105 - for employers to complete

Worker determination form

This form is for use by policy holder/employer.