• 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.

• 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.

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.