Form 5 - Reference of prohibition notice for review

Information status

All documents issued prior to 1 July 2017 were issued by the former Department of Commerce. Documents listed here are the latest versions available, but may be subject to review. For more information on this document, please contact

This publication is for: 
Employee / workerEmployer

If you wish to submit a review of a prohibition notice to the WorkSafe Western Australia Commissioner you will need to complete a reference of prohibition notice for review form.

Form – application
Last updated 21 May 2014

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