COVID-19 incident notification form

Notify WorkSafe about a positive confirmed diagnosis of COVID-19 in the workplace.

Last updated

Oct 2020

File type and size

PDF, 98.22 kB

What it contains

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

Important: Only complete this print form if you can't access, complete and submit the COVID-19 incident notification online form.

Employers must notify WorkSafe about a confirmed diagnosis of COVID-19 in the workplace.