Forms

Suitable duties program

For employers to complete. This two-page template creates a four week return to work plan.

Request for surgery FM302

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

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.

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.

Injured worker authorisation

A form whereby an injured worker authorises the communication of information between their medical provider and employer in relation to their worker's compensation claim.

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..

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

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

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).

Group training record

A sample form to use in recording workers' training

Cleaner: Work Capabilities Form

For use by medical practitioner

Whiplash disability questionnaire

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

Make a referral to the medical assessment tribunal

Form