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Form 29 - superceded by Form 17 - Review of decision
Form 29 is superceded by Form 17.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 -
Form 28 - Hazardous chemicals health monitoring report
Under the Work Health and Safety Regulation 2011 where health monitoring is required for a hazardous chemical, the PCBU must send a copy of the health monitoring report to Workplace Health and Safety Queensland in certain circumstances.
PDF 180.08 kB 18 April 2024 -
Form 44 - Provisional Improvement Notice (PINs)
Provisional Improvement Notice (PIN) form used at the workplace by the Workplace Health and Safety Representative.
PDF 130.5 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 -
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 -
FM106 Claim Form
Use this form to make a claim with WorkCover Queensland or your self-insurer for a work-related illness or injury.
DOCX 98.48 kB 28 August 2020 -
Health and safety checklist for working from home
Checklist to assess WHS risks for working from home arrangements.
PDF 222.78 kB 6 April 2022 -
Healthy worker funding program application form
Application form for high-risk industries for work health funding program
DOC 335.36 kB 28 August 2020 -
Worker determination form
This form is for use by policy holder/employer.
DOC 941.57 kB 28 August 2020 -
EFT Payment Form FM204
Complete this form to get paid (electronic funds transfer).
PDF 36.91 kB 28 August 2020 -
Request for surgery FM302
Request for surgery approval - This form is only to be used for claims where WorkCover Queensland is the insurer.
PDF 120.11 kB 18 March 2021 -
Form 106 - Queensland health and safety representative (HSR) training provider application
Form 106 - Queensland health and safety representative (HSR) training provider application
PDF 262.43 kB 28 August 2020