Collection statement - incident notification form

Collection of personal and health information

We use personal and health information from this form to:

• monitor, assess and investigate workplace incidents
• administer and enforce legislation administered by WorkSafe
• administer and evaluate WorkSafe’s programs generally
• conduct legal proceedings.

We collect this information as required by the:

• Occupational Health and Safety Act 2004
• other legislation administered by WorkSafe.

If you do not send this form, you may receive a fine.

Use of personal information

WorkSafe may share your information with:

• its contractors and agents
• other regulatory agencies
• a court or tribunal
• any person or organisation authorised by the individual to which it relates, or by law, to obtain it.

Contact WorkSafe’s Privacy team if you:

• have questions about how your personal or health information will be handled
• would like access to your information.

You can do this by emailing [email protected] or reading WorkSafe’s Privacy Policy.

WorkSafe Victoria (WorkSafe) is a body corporate established under Victorian workers compensation legislation.