Access a Workers Compensation Claim Form

Read the information on who can claim for workers compensation and how to make a workers compensation claim. To make a claim, you need to complete a Workers Compensation Claim Form. You also need a completed Workers Compensation Certificate of Capacity (medical certificate) which you will get from your treating doctor.

Completing the Workers Compensation Claim Form

Access and fill in the Workers Compensation Claim Form below. You have two options:

Option 1: Print and fill in the form by hand

1. Use the link below to open the Workers Compensation Claim Form.
2. Print the form and answer all the questions in the worker section using a pen.
3. See Next Steps below for what to do next.

Workers Compensation Claim Form (Printable) (PDF, 609.3 KB)

Option 2: Digitally fill in the form (then print and sign it by hand)

Note: This option may not work well on a phone/tablet.

1. Use the link below to download/save the Workers Compensation Claim Form to your computer. Note: Completing the PDF in your browser without downloading it first might cause some problems.
2. Using your mouse, click into the answer box you need to fill in and type an answer. You can also use the tab key on the keyboard to move to each answer box. Click on the circle buttons to show your selection for Yes/No answers.
3. When you have answered all the questions in the worker section, print the form (there is a Print button on page 8). Once printed, sign the signature boxes using a pen.
4. See Next Steps below for what to do next.

Workers Compensation Claim Form (Fillable)

Next steps

When you have completed (and signed) the worker section of the Workers Compensation Claim Form:

• Give it to your employer with your completed Workers Compensation Certificate of Capacity (medical certificate).
• Find out who you need to forward these two documents to at your employer, and how. For example, find out who you should deliver them to in person, or what address to post them to, or if the employer agrees, which email address to send them to. If in doubt, post both documents to your employer’s usual business address.
• Keep a record of your submitted Workers Compensation Claim Form and Workers Compensation Certificate of Capacity (medical certificate).

Help completing the form

If you need help, talk to your employer, contact WorkSafe Tasmania or contact Worker Assist Tasmania who offer free, confidential advice to injured workers.

WorkSafe Tasmania resources

Provide feedback on the Workers Compensation Claim Form

Workers Compensation Handbook: The Basics (PDF, 295.3 KB)

Workers Rehabilitation and Compensation Act 1988: Summary of the Act (PDF, 215.3 KB)

A Guide to Workers Rehabilitation and Compensation in Tasmania (PDF, 615.3 KB)