Forms

 

Form Updates

 

1 January 2019

The Commission has updated ​the following forms and guides.

  • Form 1: ​Application for Expedited Assessment
  • Form 1B: ​Reply to Application for Expedited Assessment
  • Form 2: ​Application to Resolve a Dispute
  • Form 2A: Reply to Application to Resolve a Dispute
  • ​Form 18: ​Wages Schedule
  • Certificate of Determination – Consent Orders
  • Guide to completing Form 1 – Application for Expedited Assessment
  • Guide to completing Form 1B – Reply to Application for Expedited Assessment
  • Guide to completing Form 2 – Application to Resolve a Dispute
  • Guide to completing Form 2A – Reply to Application to Resolve a Dispute

 

October 2018

The Commission has updated the following forms:

 

  • Form 6: Application to Resolved a Work Injury Managment Disptue
  • Form 8A: Application for Leave to Serve a Direction for Production Outside the State
  • Form 13: Application for Leave to Refer a Question of Law
  • Form 13A: Response to Application for Leave to Refer a Question of Law

 

October 2018

The Commission has created the following Form and Template:

  • Form 6B: Reply to Application to Resolved a Work Injury Managment Disptue
  • Template: Notice for Production

 

If you are unable to open the word version please use the PDF format.

 

Expedited Assessment

Form 1: Application for Expedited Assessment MS Word or PDF
Guide to Completing Form 1 
Form 1A - Application to Revoke an Interim Payment Direction. MS Word or PDF
Form 1B - Reply to Application for Expedited Assessment. MS Word or PDF
Guide to completing Form 1B

Resolving a Dispute

Form 2 - Application to Resolve a Dispute. MS Word or PDF 
Guide to Completing Form 2 
Form 2 Cover - Multiple Respondents. MS Word or PDF
Form 2 Cover - Section 162. MS Word or PDF
Form 2 Cover - Uninsured Employer. MS Word or PDF
Form 2 Cover - Additional Insurer/Scheme Agent. MS Word or PDF
Form 2 - supporting documents and information
Form 2A - Reply to Application to Resolve a Dispute. MS Word or PDF
Guide to completing Form 2A 
Form 2B - Application to Join a Party to Proceedings.MS Word or PDF 
Form 2C - Application to Admit Late Documents. MS Word or PDF
Form 2D - Application in Respect of Death of Worker. MS Word or PDF
Guide to completing Form 2D 
Form 4 - Certificate of Service. MS Word or PDF

Commutation

Form 5A - Application to Register a Commutation Agreement. MS Word or PDF 
For​m 5C - Application for Determination to Commute Liability.MS Word or PDF

Work Injury Management

Form 6 - Application to Resolve a Workplace Injury Management Dispute. MS Word​​ or PDF 
Guide to completing Form 6 
Form 6B - Reply to Application to Resolve a Workplace Injury Management Dispute. MS Word​​ or PDF

Threshold Assessments

Form 7 - Application for Assessment by Approved Medical Specialist. MS Word or PDF
Form 7A - Response to application for assessment by an AMS. MS Word or PDF
Guide to Completing Form 7​

Directions for Production

Form 8 - Direction for Production. MS Word or PDF
Guide to Completing Form 8

Form 8A - Application for Leave to Serve a Direction for Production Outside the State.
MS Word or PDF 
Order
SEPA Notice to Producer 
Form 8B - Summons to Attend. MS Word or PDF
Guide to Completing Form 8B
Order
SEPA Notice to Producer​​

Arbitral Appeal

Form 9 - Appeal Against Decision of Arbitrator. MS Word or PDF
Guide to completing Form 9

Form 9A - Notice of opposition to appeal against decision of Arbitrator. MS Word or PDF
Guide to completing Form 9A

Form 9 Schedule - Additional Respondent Insurer Scheme Agent Schedule. MS Word or PDF

Medical Appeal

Form 10 - Appeal Against a Decision of Approved Medical Specialist. MS Word or PDF
Guide to completing Form 10
Form 10A - Notice of Opposition to Appeal Against Decision of Approved Medical Specialist. MS Word or PDF
Guide to completing Form 10A

Work Injury Damages

Form 11 - Direction for Access to Informa​​​tion and Premises. MS Word or PDF​
Form 11A - Certificate of Service for Work Injury Damages Claims. MS Word or PDF​
Form 11B - Application to Cure a Defective Pre-filing Statement. MS Word or PDF​
Form 11C - Application for Mediation to Resolve Work Injury Damages Claim. MS Word or PDF
Form 11D - Response to an Application for Mediation to Resolve Work Injury Damages Claim. MS Word or PDF​
Form 11E - Application to Strike Out of Pre-Filing Statement. MS Word or PDF ​
Form 11F - Opposition to Application to Strike Out of Pre-Filing Statement. MS Word or PDF

Question of Law

Form 13 - Application for Leave to Refer​ a Question of Law. MS Word or PDF
Form 13A - Notice of Opposition to Application for Leave to Refer a Question of Law. MS Word or PDF

Discontinue

Form 14A - Agreement to Discontinue Proceedings. MS Word or PDF Guide to completing Form 14A Form 14B - Election to Discontinue Proceedings. MS Word or PDF Guide to completing Form 14B

Assessment of Costs

Form 15 - Application for Assessment of Costs - Schedule 6 before 1 November 2006. MS Word or PDF
Form 15A - Application for Assessment of Costs - Schedule 6 on or after 1 November 2006 MS Word or PDF
Form 15B - Application for Assessment of Costs -Schedule 7 MS Word or PDF

Wages Schedule

Form 18 - Wages Schedule. MS Word or PDF

Misc​​ellaneous Applications

Form 20 - Miscellaneous Application. MS Word or PDF
Guide to Completing Form 20
Certficate of Determination - Consent Orders MS Word or PDF

Notice of Production between Parties MS Word​ or PDF ​​​​​​​​​​​​​​