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/jurisdiction the policy covers * Please select... Australian Capital Territory Northern Territory Tasmania Western Australia Seafarers

Policy number *

Employer's details - please enter your address details

Policy name *

Street number *

Street *

Suburb / Town *

Postcode *

State * Please select... ACT NSW NT QLD SA TAS VIC WA

Employer's mailing address

Is the above address also your mailing address? *