Incident notification

A workplace or electrical safety incident that falls into one of the below categories is required to be notified to the Office of Industrial Relations Queensland under the Work Health and Safety Act 2011, the Safety in Recreational Water Activities Act 2011, or the Electrical Safety Act 2002.
Use this form to notify Workplace Health and Safety Queensland or the Electrical Safety Office of an incident, select the item below that best describes the incident outcome and click 'Next'. If a worker has been injured, you can also make a claim with WorkCover Queensland using this form.

The death of a person other than by electricity
Important Notice
Please confirm the following:
Work hours: Monday 8am - Friday 5pm.
After work hours: Friday 5pm - Monday 8am and Queensland Government public holidays.

An injury or illness requiring a person to have immediate treatment as an in-patient in a hospital
Important Notice
Please confirm the following:
Work hours: Monday 8am - Friday 5pm.
After work hours: Friday 5pm - Monday 8am and Queensland Government public holidays.

A serious injury or illness requiring a person to have any of the following ...


An infection to which the carrying out of work was a significant contributing factor
An infection reliably attributable to carrying out work ...

contraction of the following zoonoses in the course of work involving handling or contact with animals, animal hides, skins, wool or hair, animal carcasses or animal waste products: ...

A dangerous incident that exposed a worker or any other person to a serious risk to a person's health or safety emanating from an immediate or imminent exposure to ...


A serious electrical incident involving electrical equipment where ...

A dangerous electrical event involving ...

If the incident does not fall within one of the above categories, you can still make a claim with WorkCover Queensland using the online claim form.

Your contact details
First name:
Surname:
Middle name:
Telephone/mobile:
Email:
TITLE
Notifier's relationship to this incident notification:
e.g. Are you the employer?
** Only these options will allow you to make a claim with WorkCover Queensland for an injured person.
Should another person be contacted for further information?
Alternative contact details
First name:
Surname:
Middle name:
Telephone/mobile:
Email:
TITLE

Incident details

Incident details

Injured people
Title
Relationship to workplace incident
Treatment given ( Yes / No ) : If Yes
Place of injury
Did the injury happen
Residential address: ( Yes / No ) : If No
ACCESS
ALLEY
ALLEYWAY
AMBLE
ANCHORAGE
ANNEX
APPROACH
ARCADE
ARTERIAL
ARTERY
AVENUE
AVENUE EAST
AVENUE NORTH
AVENUE SOUTH
AVENUE WEST
BANAN
BASIN
BEACH
BEND
BLOCK
BLOVE
BOARDWALK
BOULEVARD
BRACE
BRAE
BREAK
BRIDGE
BROADWAY
BROW
BYPASS
BYWAY
CAUSEWAY
CENTRE
CENTREWAY
CHASE
CIRCLE
CIRCLET
CIRCUIT
CIRCUS
CLOSE
COLONNADE
COMMON
CONCOURSE
COPSE
CORNER
CORSO
COURT
COURTYARD
COVE
CRESCENT
CRESCENT WEST
CREST
CROSS
CROSSING
CROSSROAD
CROSSWAY
CRUISEWAY
CUL-DE-SAC
CUTTING
DALE
DELL
DEVIATION
DIP
DISTRIBUTOR
DRIVE
ORTH">DRIVE NORTH
DRIVEWAY
EDGE
ELBOW
END
ENTRANCE
ESPLANADE
OUTH">ESPLANADE SOUTH
EXPRESSWAY
EXTENSION
FAIRWAY
FIRETRACK
FIRETRAIL
FLAT
FOLLOW
FOOTWAY
FORESHORE
FORMATION
FREEWAY
FRONT
FRONTAGE
GAP
GARDEN
GARDENS
GATE
GATES
GLADE
GLEN
GRANGE
GREEN
GROUND
GROVE
GULLY
HEADLAND
HEIGHTS
HIGHROAD
HIGHWAY
HILL
INTERCHANGE
INTERSECTION
ISLAND
JUNCTION
KEY
LANE
LANE SOUTH
LANEWAY
LEES
LINE
LINK
LITTLE
LOOKOUT
LOOP
LOWER
MALL
MEANDER
MEW
MEWS
MONTAIGNE
MOTORWAY
MOUNT
STREET TYPE
NOOK
OUTLOOK
PARADE
ORTH
PARADE NORTH
PARK
PARK NE
PARKLANDS
PARKWAY
PART
PASS
PASSAGE
PATH
PATHWAY
PIAZZA
PLACE
PLAZA
POCKET
POINT
PORT
PROMENADE
QUAD
QUADRANGLE
QUADRANT
QUAY
QUAYS
RAMBLE
RAMP
RANGE
RESERVE
REST
RETREAT
RIDE
RIDGE
RIDGEWAY
RIGHT OF WAY
RING
RISE
RIVER
RIVERWAY
RIVIERA
ROAD
ROAD EAST
ROAD NORTH
ROAD SOUTH
ROAD WEST
ROADS
ROADSIDE
ROADWAY
RONDE
ROSEBOWL
ROTARY
ROUND
ROUTE
ROW
RUE
RUN
SERVICEWAY
SHUNT
SIDING
SLOPE
SPUR
SQUARE
STAIRS
STATE HIGHWAY
STATION
STEPS
STRAND
STREET
STREET EAST
STREET NORTH
STREET SOUTH
STREET WEST
STRIP
SUBWAY
TARN
TERRACE
THOROUGHFARE
TOLLWAY
TOP
TOR
TOWERS
TRACK
TRAIL
TRIANGLE
TRUNKWAY
TURN
UNDERPASS
VALE
VIADUCT
VIEW
VILLAS
VISTA
WADE
WALK
WALKWAY
WAY
WHARF
WYND
YARD
Different postal address? If Yes
Is the address inside QLD? ( Yes / No ) : If No
ACCESS
ALLEY
ALLEYWAY
AMBLE
ANCHORAGE
ANNEX
APPROACH
ARCADE
ARTERIAL
ARTERY
AVENUE
AVENUE EAST
AVENUE NORTH
AVENUE SOUTH
AVENUE WEST
BANAN
BASIN
BEACH
BEND
BLOCK
BLOVE
BOARDWALK
BOULEVARD
BRACE
BRAE
BREAK
BRIDGE
BROADWAY
BROW
BYPASS
BYWAY
CAUSEWAY
CENTRE
CENTREWAY
CHASE
CIRCLE
CIRCLET
CIRCUIT
CIRCUS
CLOSE
COLONNADE
COMMON
CONCOURSE
COPSE
CORNER
CORSO
COURT
COURTYARD
COVE
CRESCENT
CRESCENT WEST
CREST
CROSS
CROSSING
CROSSROAD
CROSSWAY
CRUISEWAY
CUL-DE-SAC
CUTTING
DALE
DELL
DEVIATION
DIP
DISTRIBUTOR
DRIVE
ORTH">DRIVE NORTH
DRIVEWAY
EDGE
ELBOW
END
ENTRANCE
ESPLANADE
OUTH">ESPLANADE SOUTH
EXPRESSWAY
EXTENSION
FAIRWAY
FIRETRACK
FIRETRAIL
FLAT
FOLLOW
FOOTWAY
FORESHORE
FORMATION
FREEWAY
FRONT
FRONTAGE
GAP
GARDEN
GARDENS
GATE
GATES
GLADE
GLEN
GRANGE
GREEN
GROUND
GROVE
GULLY
HEADLAND
HEIGHTS
HIGHROAD
HIGHWAY
HILL
INTERCHANGE
INTERSECTION
ISLAND
JUNCTION
KEY
LANE
LANE SOUTH
LANEWAY
LEES
LINE
LINK
LITTLE
LOOKOUT
LOOP
LOWER
MALL
MEANDER
MEW
MEWS
MONTAIGNE
MOTORWAY
MOUNT
STREET TYPE
NOOK
OUTLOOK
PARADE
ORTH
PARADE NORTH
PARK
PARK NE
PARKLANDS
PARKWAY
PART
PASS
PASSAGE
PATH
PATHWAY
PIAZZA
PLACE
PLAZA
POCKET
POINT
PORT
PROMENADE
QUAD
QUADRANGLE
QUADRANT
QUAY
QUAYS
RAMBLE
RAMP
RANGE
RESERVE
REST
RETREAT
RIDE
RIDGE
RIDGEWAY
RIGHT OF WAY
RING
RISE
RIVER
RIVERWAY
RIVIERA
ROAD
ROAD EAST
ROAD NORTH
ROAD SOUTH
ROAD WEST
ROADS
ROADSIDE
ROADWAY
RONDE
ROSEBOWL
ROTARY
ROUND
ROUTE
ROW
RUE
RUN
SERVICEWAY
SHUNT
SIDING
SLOPE
SPUR
SQUARE
STAIRS
STATE HIGHWAY
STATION
STEPS
STRAND
STREET
STREET EAST
STREET NORTH
STREET SOUTH
STREET WEST
STRIP
SUBWAY
TARN
TERRACE
THOROUGHFARE
TOLLWAY
TOP
TOR
TOWERS
TRACK
TRAIL
TRIANGLE
TRUNKWAY
TURN
UNDERPASS
VALE
VIADUCT
VIEW
VILLAS
VISTA
WADE
WALK
WALKWAY
WAY
WHARF
WYND
YARD

Employer details
Business address
Is the address inside QLD? ( Yes / No ) : If No
ACCESS
ALLEY
ALLEYWAY
AMBLE
ANCHORAGE
ANNEX
APPROACH
ARCADE
ARTERIAL
ARTERY
AVENUE
AVENUE EAST
AVENUE NORTH
AVENUE SOUTH
AVENUE WEST
BANAN
BASIN
BEACH
BEND
BLOCK
BLOVE
BOARDWALK
BOULEVARD
BRACE
BRAE
BREAK
BRIDGE
BROADWAY
BROW
BYPASS
BYWAY
CAUSEWAY
CENTRE
CENTREWAY
CHASE
CIRCLE
CIRCLET
CIRCUIT
CIRCUS
CLOSE
COLONNADE
COMMON
CONCOURSE
COPSE
CORNER
CORSO
COURT
COURTYARD
COVE
CRESCENT
CRESCENT WEST
CREST
CROSS
CROSSING
CROSSROAD
CROSSWAY
CRUISEWAY
CUL-DE-SAC
CUTTING
DALE
DELL
DEVIATION
DIP
DISTRIBUTOR
DRIVE
ORTH">DRIVE NORTH
DRIVEWAY
EDGE
ELBOW
END
ENTRANCE
ESPLANADE
OUTH">ESPLANADE SOUTH
EXPRESSWAY
EXTENSION
FAIRWAY
FIRETRACK
FIRETRAIL
FLAT
FOLLOW
FOOTWAY
FORESHORE
FORMATION
FREEWAY
FRONT
FRONTAGE
GAP
GARDEN
GARDENS
GATE
GATES
GLADE
GLEN
GRANGE
GREEN
GROUND
GROVE
GULLY
HEADLAND
HEIGHTS
HIGHROAD
HIGHWAY
HILL
INTERCHANGE
INTERSECTION
ISLAND
JUNCTION
KEY
LANE
LANE SOUTH
LANEWAY
LEES
LINE
LINK
LITTLE
LOOKOUT
LOOP
LOWER
MALL
MEANDER
MEW
MEWS
MONTAIGNE
MOTORWAY
MOUNT
STREET TYPE
NOOK
OUTLOOK
PARADE
ORTH
PARADE NORTH
PARK
PARK NE
PARKLANDS
PARKWAY
PART
PASS
PASSAGE
PATH
PATHWAY
PIAZZA
PLACE
PLAZA
POCKET
POINT
PORT
PROMENADE
QUAD
QUADRANGLE
QUADRANT
QUAY
QUAYS
RAMBLE
RAMP
RANGE
RESERVE
REST
RETREAT
RIDE
RIDGE
RIDGEWAY
RIGHT OF WAY
RING
RISE
RIVER
RIVERWAY
RIVIERA
ROAD
ROAD EAST
ROAD NORTH
ROAD SOUTH
ROAD WEST
ROADS
ROADSIDE
ROADWAY
RONDE
ROSEBOWL
ROTARY
ROUND
ROUTE
ROW
RUE
RUN
SERVICEWAY
SHUNT
SIDING
SLOPE
SPUR
SQUARE
STAIRS
STATE HIGHWAY
STATION
STEPS
STRAND
STREET
STREET EAST
STREET NORTH
STREET SOUTH
STREET WEST
STRIP
SUBWAY
TARN
TERRACE
THOROUGHFARE
TOLLWAY
TOP
TOR
TOWERS
TRACK
TRAIL
TRIANGLE
TRUNKWAY
TURN
UNDERPASS
VALE
VIADUCT
VIEW
VILLAS
VISTA
WADE
WALK
WALKWAY
WAY
WHARF
WYND
YARD