Forms

Worker determination form

This form is for use by policy holder/employer.

Request for surgery FM302

Request for surgery approval - This form is only to be used for claims where WorkCover Queensland is the insurer.

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.

Whiplash disability questionnaire

This questionnaire has been designed to provide information on the impact that your whiplash injury and symptoms have upon your lifestyle.

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 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 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.

Consent to check national police records and advise a third party

Queensland police form 8/6/2004

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.

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

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

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

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

Application for reinsurance set limit

Form 42 - For use by self-insurers