Health surveillance notification form: Other

Office closure

Our offices will close from Monday 24 December 2018 and will reopen on Thursday 3 January 2019. For urgent assistance during that period you can contact us.

This publication is for: 
Employee / workerEmployer

Occupational Safety and Health Regulation 5.23 & 5.24 - where no specific health surveillance form is available, Appointed Medical Practitioners should use this form when supervising health surveillance on workers who are at risk of suffering an identifiable disease or health effect due to exposure at work and return the completed form to Occupational Physician, WorkSafe, Locked Bag 14, Cloisters Square PERTH  WA  6850

WorkSafe
Form – notification
Last updated 14 Dec 2017

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