WorkSafe Victoria's Authority and consent to release medical information form, subject to and in accordance with the Accident Compensation Act 1985 and the Workplace Injury Rehabilitation and Compensation Act 2013.
You are now leaving the WorkSafe Victoria website.
The website you are entering is not maintained or funded by the State of Victoria.
Please follow the link to continue to this website.
;%20}%20%3c/style%3e%3cclipPath%20id='clippath'%3e%3crect%20class='cls-2'%20width='18.58'%20height='19'/%3e%3c/clipPath%3e%3c/defs%3e%3cg%20id='Layer_2-2'%20data-name='Layer_2'%3e%3cg%20id='Layer_1-2'%3e%3cg%20class='cls-3'%3e%3cpath%20class='cls-1'%20d='M11.06,8.04L17.98,0h-1.64l-6.01,6.98L5.53,0H0l7.25,10.56L0,18.99h1.64l6.34-7.37,5.07,7.37h5.53l-7.52-10.95h0ZM8.81,10.65l-.74-1.05L2.23,1.23h2.52l4.72,6.75.73,1.05,6.14,8.78h-2.52l-5.01-7.16h0Z'/%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)