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Workers Compensation Claim Form

by Michael Carpenter, from the Community

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This workers compensation claim form helps organisations capture the key details needed after a workplace injury. It records employer information (including ABN and policy details), injured worker details, incident date and time, injury type and location, medical treatment, hospital admission, time off work, and return to work status. The template references Domino’s Sydney CBD and Pyrmont sites but can be adapted for other workplaces. Use as a starting point only and seek professional advice for your jurisdiction and policies.

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Digitize any process, procedure or policy
Eliminate mistakes made by paper-based processes
Create and share professional reports instantly
Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy
Eliminate mistakes made by paper-based processes
Create and share professional reports instantly
Confirm accountability and compliance with a digital log

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Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.