Report employer issues form

A form to provide information about an employer you think may not have complied with their obligations under the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act).
Last updated

Aug 2016

Reading level

easy

File Type and Size

PDF, 111.98 kB

Document Length

9 pages

What it contains

This form allows you to provide information to WorkSafe Victoria (WorkSafe) about an employer you think may not have complied with their obligations under the WIRC Act.

WorkSafe will assess the information provided and take appropriate action.