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Workers’ Compensation Claim Form (SRC 016)

Summary

This form is to be completed if you wish to claim workers' compensation under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).

Available formats

Online form

You can now complete and submit your workers' compensation form online.

Supporting information

The following resources are available to assist you with completing your claim for workers' compensation.

Employee:

Employer:

Alternative format

Last updated: July 2016

If you would like to request this publication in a different format to what is available for download (above), or the publication is not currently available for download, please refer to:

Page last updated: 24 Mar 2017