Notify WorkSafe Victoria about an issue impacting an effective return to work.

This form can be completed by people who identify as one of the following:

  • injured worker
  • injured worker’s representative
  • injured worker’s manager / supervisor
  • return to work co-ordinator
  • occupational rehabilitation provider
  • injured worker’s treating health practitioner.

The form can only be used when agreed / prescribed return to work resolution procedures are unavailable or have not resolved the issue(s).

How to submit a return to work issue

  1. Check what options are available to resolve return to work issues

    Read the following to see what options are available to resolve return to work issues.

  2. Identify the return to work issue

    Return to work issues include:

    1. Insufficient or no return to work information or policy in place.
    2. 'If you are injured' poster not displayed.
    3. Insufficient or no register of injuries.
    4. No return to work co-ordinator appointed.
    5. Concern regarding a specific injured person not being supported effectively in their return to work.