Psychosocial hazard reporting form collection statement

Provision of information

If you don't provide this information, we may not be able to:

• investigate your allegation
• accept or process your application.

Collection statement

We may use personal and health information collected in this report to assess and determine compliance with:

• the Occupational Health and Safety Act 2004 (OHS Act)
• associated regulations, laws and legal proceedings.

Under the OHS Act, WorkSafe may use or disclose information for:

• the administration and enforcement of legislation
• law enforcement functions and legal proceedings
• investigating or conducting an interview in connection with the application
• public health and safety purposes
• the administration and evaluation of WorkSafe's programs generally.

A WorkSafe inspector may need to visit the identified workplace to make enquiries about your allegation. If appropriate, the inspector may refer this matter to another agency.

WorkSafe may disclose personal and or health information to:

• its contractors and agents
• a court or tribunal
• other regulatory agencies including the police
• government agencies such as AUSTRAC
• any person authorised by the individual.

Contact

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’s Privacy Policy

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