Certificate of Capacity Form
- Certificate of Capacity Form (PDF 594KB)
Document Type: Form
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.
- Word version also available here
- Certificate of Capacity for Hospital Scanning
- Frequently asked questions - Information on accessing and completing the Certificate of Capacity
- Certificate of Capacity - GP users guide
- Example Completed Certificate of Capacity - Mental Health
- More information about the Certificate of Capacity is available here
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.
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.
For information and advice on this form please contact the Advisory Service on 1800 136 089.