A form to complete if a worker is exposed to a specific hazardous substance which may present a health risk to them.
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The employer must complete section 2 of the form, and supply it to the registered medical practitioner before health monitoring is provided.
The registered medical practitioner will assess the employee for adverse affects, check test/examination results and certify the employee's fitness to work with the hazardous substances.
Employers must submit the health monitoring report to WorkSafe Victoria:
Engineered stone licence holders must provide WorkSafe with a copy of any health monitoring reports that relate to the health of employees within 30 days of the report being received.
Completed health monitoring reports and any supporting recommendations should be submitted to WorkSafe Victoria by email: occupationalhealth @ worksafe.vic.gov.au.