Forms

Employer Forms

• Workers Compensation Claim Form
• Employer’s Report Form
• Claim Advice Slip - Optional
• Compensation Reimbursement Invoice
• Insurance Broker Consent Authority

Employee Forms

• Consent Authority
• Declaration of Employment
• Electronic Funds Transfer (EFT) Form - Application for Claimants
• Recurrence of Injury Form
• Reimbursement of Travelling Expenses
• Travel Incident

WorkCover WA Forms

• Workplace Fatality Compensation Claim Form (WorkCover WA Regulated Form)
• Declaration of worker not residing in Western Australia (WorkCover WA Form)
• Statement of Social and Financial Circumstances

Witness Forms

• Witness Statement Form

• Injury Management System Template
• Return to Work Template

• Property Claim Form - agency property
• Property Claim Form - personal property
• Property in Transit Claim Form - Employee to complete, employer to approve
• Fire Protection Impairment Form

• Motor Vehicle Claim Form - Driver to complete, employer to authorise

• General Liability Claim Form - Authorising person to complete
• Professional Liability Claim Form - Authorising person to complete
• Consent Authority - Optional

• Application for Events Cover Form - Event organiser to complete
• DFES Volunteer Injury Claim Form
• DFES Volunteer Witness Statement
• Electronic Funds Transfer (EFT) Form - Application for Claimants
• Electronic Funds Transfer (EFT) Form for Service Providers
• Fire Protection Impairment Form
• Dust Disease Claim Form
• Personal Accident Claim Form - Injured party to complete
• Personal Injury and Property Damage Report Form
• Statutory Declaration Form
• Travel Claim Form