Forms

Partial incapacity form

Form 105 - for employers to complete

Worker determination form

This form is for use by policy holder/employer.

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.

Form 44 - Provisional Improvement Notice (PINs)

Provisional Improvement Notice (PIN) form used at the workplace by the Workplace Health and Safety Representative.

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.

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

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

FM106 Claim Form

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

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.

Health and safety checklist for working from home

Checklist to assess WHS risks for working from home arrangements.

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

Completion statement by registered training organisation (RTO) and employer

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

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