Application for registration to provide services to workers

Providers can use this form to register with WorkSafe to provide services to injured workers.

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What it contains

Providers can complete this form to register with WorkSafe to provide services to injured workers. Information to be completed in the form includes:

  • service application type
  • applicant details, including practice, business or company details
  • banking details
  • provider registration requirements
  • applicant consent and declaration