Certificate of Capacity Form

  • Certificate of Capacity Form (PDF 594KB)
    Document Type: Form
    Keycode: FOR844/02/01.15
    Division Author: Return to Work Division
    Current Version: 2
    Summary: The Certificate of Capacity form is to be completed and issued by a medical medical practitioner, physiotherapist, chiropractor or osteopath. An injured worker must have a Certificate of Capacity to receive loss of income compensation.

About this form

Certificates of Capacity are used by VWA Agents and employers to determine a worker's capacity for work and the nature of their injury. Certificates can be issued by a medical practitioner, physiotherapist, chiropractor or osteopath. An injured worker must have a Certificate of Capacity to receive loss of income compensation.

How to complete the form

You can complete this form by:

  • opening the document and typing in the information and then printing it, or
  • printing the form and filling in the information clearly using a ballpoint pen

Please ensure that all mandatory and relevant information is completed.

Disclaimer
It is an offence under the legislation to provide false or misleading information. A person who providers a false or misleading Certificate of Capacity could be liable to prosecution.

Further information

Please send feedback about the Certificate of Capacity to medicalcertificatefeedback@vwa.vic.gov.au

For information and advice on this form please contact the Advisory Service on 1800 136 089.