Comcare - Australian Goverment
Comcare - Australian Goverment
Putting you first at the centre of what we do. Keeping you healthy and safe at work. Supporting you when you are harmed at work. Ensuring your scheme works and is sustainable.
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Forms

This section provides you with a single access point for the main Comcare forms you may need to complete.


Claims forms

Access to leave and release of Comcare payments [PDF]

Access to leave and release of Comcare payments [RTF]

Application for gym (SRC 239) [PDF]  

Application for gym (SRC 239) [RTF]

Application for household or attendant care services (SRC 19) [PDF] 

Application for household or attendant care services (SRC19) [RTF]

Authority and consent for the release of medical information (SRC 131) [PDF]  

Authority and consent for the release of medical information (SRC 131) [RTF]

Authority and Release of Superannuation Information [PDF]

Authority and Release of Superannuation Information [RTF]

Cessation of employment form (SRC 266) [PDF]

Cessation of employment form (SRC 266) [RTF]

Claim for aids and appliances, excluding hearing aids [PDF]  

Claim for aids and appliances, excluding hearing aids [RTF]

Claim for compensation for a work-related death (SRC 184) [PDF]
Claim for compensation for a work-related death - Employer information (SRC 245) [PDF]

Claim for time off work / Period of Reduced Earnings (SRC 169) [PDF,197KB]

Claim for time off work / Period of Reduced Earnings (SRC 169) [RTF,96KB] 

Claim for incapacity for work/record of earnings statement of hours worked and gross weekly earnings in paid employment [PDF]

Claim for incapacity for work/record of earnings statement of hours worked and gross weekly earnings in paid employment [RTF]

Claim for incapacity for work/record of earnings statement of weekly hours worked in self-employment [PDF]

Claim for incapacity for work/record of earnings statement of weekly hours worked in self-employment [RTF]

Claim for workers' compensation (SRC 16) [PDF]

Claim for workers' compensation (SRC 16) [RTF]

Compensation claim for permanent impairment and non-economic loss [PDF]  

Compensation claim for permanent impairment and non-economic loss [RTF]

Medical certificate for workers' compensation (SRC 132) [PDF]  

Medical certificate for workers' compensation (SRC 132) [RTF]

Medical services claim form (SRC 67) [PDF] 

Medical services claim form (SRC 67) [RTF]

Pay Start Information [PDF]

Pay Start Information [RTF]

Physiotherapy treatment notification plan [PDF, 195KB]

Physiotherapy treatment notification plan [RTF, 50KB]

Physiotherapy treatment notification plan exlanatory notes [PDF, 154KB]

Physiotherapy treatment notification plan exlanatory notes [RTF, 20KB]

PsychologyCounselling treatment notification plan [PDF, 211KB]

PsychologyCounselling treatment notification plan [RTF, 73KB]

PsychologyCounselling treatment notification plan explantory notes [PDF, 148KB]

PsychologyCounselling treatment notification plan explantory notes [RTF, 19KB]

Request to change bank account and/or personal details (SRC 170) [pdf]

Request to change bank acount and/or personal details (SRC 170) [rtf]

Section 45 election form [PDF]   

Section 45 election form [RTF]

Standard PI assessment report format [DOC]

Return to work forms
Amendment to referral for rehabilitation assessment (SRC 248) [PDF]
Medical diagnosis and prognosis (SRC 119) [PDF]
Potential suitable duties within the work area / employer organisation (SRC 118) [PDF]
Pre-injury work description (SRC 117) [PDF]
Referral for rehabilitation assessment (SRC 116) [PDF]

Return to work plan - Amendment (SRC 86) [PDF]

Return to work plan - Amendment [RTF]

Return to work plan - Closure (SRC 41) [PDF]

Return to work plan (SRC 40) [PDF 245KB]

Return to work plan (SRC 40) [RTF]

Work trial agreement (SRC 64) [PDF, 162KB]

Work trial agreement (SRC 64) [RTF, 52KB]


Plant and plant design registration forms
Plant and plant design Registration forms

Major hazard facility forms
Major hazard facility notification, licencing, and certification

Hazardous chemicals and pipelines forms
Hazardous chemicals and pipelines - Notification Packages
Agency update forms

Agency update forms completion guide [PDF, 157KB]

Agency update forms completion guide [RTF, 251KB]

Case manager data updates [PDF] 

Case manager data updates [RTF]

CIS access request form [PDF] 

CIS access request form [RTF]
Comcare new customer creation [PDF] 

Comcare new customer creation [RTF]
Cost centre update form [PDF] 

Cost centre update form [RTF]

Premium forms

Estimates of payroll and number of employees for 2011-2012 [PDF]

Estimates of payroll and number of employees for 2011-2012 [RTF]

Revised estimates of payroll and number of employees for 2011-2012 [PDF]

Revised estimates of payroll and number of employees for 2011-2012 [RTF]

Contract forms

Supplier Direct Credit Information [PDF]

Supplier Direct Credit Information [RTF]

Supporting documents

General Conditions of Contract [PDF]

General Conditions of Contract [RTF]

General Conditions of Quotation [PDF]

General Conditions of Quotation [RTF]


Payment forms

Electronic Funds Transfer Request [PDF 102KB]

Electronic Funds Transfer Request [RTF 46KB]

Electronic Funds Transfer Request for Department/Agency [PDF, 103KB]

Electronic Funds Transfer Request for Department/Agency [RTF, 43KB]

Electronic Funds Transfer Request for Providers [PDF, 103KB]

Electronic Funds Transfer Request for Providers [PDF, 43KB]