Temporary service outage

This website will be unavailable for a short five minute period between 21:30 and 23:30 on Friday 30th October 2020 and on Sunday 1st November 2020. We apologise for any inconvenience this may cause.

Health surveillance notification form: Other

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 100, EAST PERTH  WA  6892.

Form – notification
Last updated 23 Jun 2020

Share this page:

Last modified: