Employer injury claim report

What it contains

The Employer's injury claim report is:

• a record of the employer's details
• a record of the worker's details
• a record of particulars of a workplace incident
• an opportunity provide additional information, such as disputing liability

Completing an injury claim report online

You should submit this report to your WorkSafe agent after you submit your worker's completed injury claim form. WorkSafe encourages you to complete this form to provide additional information about a worker's claim.

Your worker can submit an injury claim form online using myWorkSafe. If they do, and you wish to submit an employer injury claim report, you will need a myWorkSafe claims administrator role to complete it. You can apply for this role from your personal myWorkSafe account. If you don’t have an account, you will be prompted to sign up for one.

For more information on how to apply for a myWorkSafe claims administer role, visit the Online claims information for employers page.

Submitting a PDF report

You can submit your report using our PDF form.

Make sure you download it to your computer and fill it in using Adobe Reader. It may not save if you fill it in using your browser.

More information

If you need help completing this form, or are unsure what to do next, you can contact:

• your WorkSafe agent
• WorkSafe's advisory service on 1800 136 089 between 7.30 am and 6.30 pm, Monday to Friday.