Your Lodgement of a Workers' Compensation claim notification

Progress: Employer details Injured worker details Injury details Contact details Summary

Employer details

To lodge a notification of injury, please answer the following questions. All questions marked with an * are mandatory.

Employer's details

Select the state/juristiction the policy covers * Please select... ACT NT Tasmania WA Seafarers

Please enter your policy number and if appropriate the cost centre and risk number

Policy number *

Cost Centre Level 1 Level 2 Level 3 Level 4 Level 5

Risk number

Employer's details - please enter your address details

Policy name *

Street number

Street *

Suburb / Town *

Postcode *

State * Please select... ACT NSW NT Queensland SA Tasmania Victoria WA

Employer's mailing address

Is the above address also your mailing address? *