Claims and rehabilitation forms

• Aids and Appliances (Excluding Hearing Aids) Claim form (PDF 75.4 KB)
• Alterations to a Place of Residence or Work or Modifications to a Vehicle or Article Claim form (PDF 114.5 KB)
• Authority (or Removal of Authority) to Act on Employee's Behalf form (PDF 67.8 KB)
• Authority and Consent for the Collection and Release of Medical Information Pertaining to my Claim form (PDF 72.8 KB)
• Authority and Consent for the Release of Superannuation Information form (PDF 114.9 KB)
• Certificate of Capacity for Work form (PDF 450.1 KB)
• Cessation of Employment form (PDF 76.5 KB)
• Claim for Time Off Work form (PDF 64.9 KB)
• Claim for Time Off Work Online form
• Customer Information System (CIS) Access Request and Rehabilitation Case Manager update form (PDF 137.3 KB)
• Customer Information System (CIS) Cost Centre Update form (PDF 118.9 KB)
• Customer Information System (CIS) Login
• Customer Information System (CIS) New Customer Creation form (PDF 96.2 KB)
• Exercise as Medical Treatment Claim form (PDF 114.0 KB)
• Hearing Aid Request form (PDF 114.0 KB)
• Household or Attendant Care Services application form (PDF 118.3 KB)
• Incapacity for Work and Record of Earnings (Paid Employment) Claim form (PDF 109.8 KB)
• Incapacity for Work and Record of Earnings (Self Employment) Claim form (PDF 107.8 KB)
• Journey Claim form (PDF 126.0 KB)
• Lump Sum Redemption section 137 application form (PDF 112.1 KB)
• Medical Services Claim form (PDF 95.9 KB)
• Medication Review form (PDF 67.8 KB)
• Normal Weekly Earnings Advice form (PDF 172.3 KB)
• Online Claims Lodgement user guide for employers (PDF 124.5 KB)
• Online Forms Employer Login
• Online Forms Super User quick reference guide (PDF 99.9 KB)
• Online Forms Super User Registration form (PDF 110.4 KB)
• Online Forms Super User Registration reference guide (PDF 106.5 KB)
• Parliamentary Injury Compensation Scheme Claim form (PDF 232.2 KB)
• Pay Start Information form (PDF 73.2 KB)
• Periodic Review form (PDF 154.5 KB)
• Permanent Impairment and Non-economic Loss Compensation Claim form (PDF 141.9 KB)
• Physiotherapy Treatment Plan (PDF 147.8 KB)
• Psychology Extended Consultation Request form (PDF 125.0 KB)
• Psychology Treatment Plan (PDF 150.4 KB)
• Reconsideration Request form (PDF 161.6 KB)
• Register or Update Email and Bank Details Online form for service providers
• Rehabilitation Assessment or Examination form (PDF 286.8 KB)
• Rehabilitation Assessment or Examination sample form (PDF 308.7 KB)
• Rehabilitation Program Alteration form (PDF 252.2 KB)
• Rehabilitation Program Alteration sample form (PDF 204.3 KB)
• Rehabilitation Program Closure Record form (PDF 412.8 KB)
• Rehabilitation Program Closure Record sample form (PDF 284.7 KB)
• Rehabilitation Program form (PDF 312.6 KB)
• Rehabilitation Program sample form (PDF 431.4 KB)
• Section 45 Election form (PDF 115.3 KB)
• Statement of Financial Circumstances form (PDF 106.4 KB)
• Suitable Duties form (PDF 92.3 KB)
• Suitable Duties sample form (PDF 120.9 KB)
• Update Email and Bank Details Online form for employees
• Work Trial Agreement form (PDF 87.8 KB)
• Work Trial Agreement sample form (PDF 117.8 KB)
• Work-related Death Compensation Claim form (PDF 229.0 KB)
• Work-related Death Compensation Claim information for employers (PDF 150.7 KB)
• Workers' Compensation Claim form (PDF 190.5 KB)
• Workers' Compensation Online Claim form