Forms

FM106 Claim Form

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

Form 542.3 Application for a claim review

Form 542.3 Application for a claim review. Use this form to request a free review by WCRS of a decision by your insurer. This form includes a guidlines to help you complete it..

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

Version 1

Form 132A: Application for assessment of permanent impairment

Form to be completed by a worker to request a permanent impairment assessment.

Form 79.1 - Application for renewal single employer self insurance licence

Application for renewal - single employer self-insurance licence

Form 79.2 Application for renewal - group employer self-insurance licence

Application for renewal - group employer self-insurance licence

Form 88 - Application for appointment/renewal - accredited provider for workplace health and safety auditor (self-insurance)

Form starts on page five. This application is for individuals wishing to become an accredited workplace health and safety (WHS) auditor (self - insurance) or to renew their accreditation. Includes guide to completing the form (8 pages total).

Form 132M Work capacity certificate - workers' compensation

To be completed by treating practitioner

Form 1990.182D Application for damages certificate

Includes information on eligibility

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.