Forms

Group training record

A sample form to use in recording workers' training

EFT Payment Form FM204

Complete this form to get paid (electronic funds transfer).

Statutory appointments and public sector employment currently held

We ask candidates for appointment to a government body to complete and sign this form. It tells us about your current public sector employment and any statutory appointments to Qld Government bodies and the amount of remuneration (including daily meeting fees) received for them.The Department of Education is collecting your personal information for the purpose of assessing your eligibility for appointment to Queensland Government statutory bodies and to receive fees should you be appointed.

Cleaner: Work Capabilities Form

For use by medical practitioner

Partial incapacity form

Form 105 - for employers to complete

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.