COVID-19 incident notification (additional impacted person) form

Notify WorkSafe about an additional impacted person (where applicable), in relation to your notification about a positive confirmed diagnosis of COVID-19 in the workplace.
Last updated

Oct 2020

File type and size

PDF, 69.92 kB

What it contains

This form requests information about any additional impacted person, in relation to a positive confirmed diagnosis of COVID-19 in the workplace.

Important: Complete an additional impacted person form, for each additional positive confirmed diagnosis of COVID-19 in the workplace.

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