This form is to be used to apply for a review of decisions under the Work Health and Safety Act 2020, Work Health and Safety (General) Regulations 2022, Work Health and Safety (Mining) Regulation 2022 and the Work Health and Safety (Petroleum and Geothermal Energy Operations) Regulations 2022 in relation to matters for the performance of a function at a general workplace, mine or petroleum site. 

If you are seeking a review by the WorkSafe Western Australia Commissioner of an improvement notice issued under the Occupational Safety and Health legislation you are required to submit your request using the reference of improvement notice for review form.

For mine sites (SRS users), a review of an improvement notice or a prohibition notice should be requested using SRS.

Further information

• Request for review form – to be completed if you are seeking a review of a notice issued under the Work Health and Safety legislation
• Reference of improvement notice for review form – to be completed if you are seeking a review of an improvement notice issued under the Occupational Safety and Health legislation