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Hazardous substance health surveillance report

What it is and how to notify WorkSafe.

Download the report

About the report

A registered medical practitioner will complete this report if your worker is exposed to a specific hazardous substance which may present a health risk to them.

If the report finds that the worker must not have any further contact with the hazardous substances for any period of time, you must notify WorkSafe.

Specific hazardous substances which you need to report are listed in column 1 of schedule 3 in the NOHSC National Model Regulations for the Control of Workplace Hazardous Substances. WorkSafe may determine further hazardous substances which require a health surveillance report, there will be published in the Government Gazette.

What you need to do

  1. The employer must complete section 2 of the form, and supply it to the doctor before health surveillance is provided.

    Download the report

  2. The doctor will assess the worker for adverse affects, check test / examination results and certify the employee's fitness to work with the hazardous substances.

  3. If the doctor recommends the worker is removed from working with the hazardous substance, then you must notify WorkSafe by submitting this report.

  4. Send your completed Hazardous substance health surveillance report form to WorkSafe's Occupational Hygiene unit.

    Contact the Occupational Hygiene unit

WorkSafe Advisory

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Translating and interpreting service

Call 131 450 to translate this information or to speak to WorkSafe in your language.
For more information about this free service, visit Translating and Interpreting Service (TIS National).

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