This form is to be used to apply for a review of decisions under the following legislation:

• Work Health and Safety Act 2020
• Work Health and Safety (General) Regulations 2022
• Work Health and Safety (Mining) Regulation 2022
• 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 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.

• Email review.officer@dmirs.wa.gov.au
• Post WorkSafe Commissioner, Locked Bag 100 East Perth 6892
• In person Level 1, Mason Bird Building, 303 Sevenoaks St, Cannington WA 6107. 

Mine sites who are Safety Regulation System (SRS) users, a review of an improvement notice or a prohibition notice, or to apply for an extension of the due date of the improvement notice(s) is to be requested using SRS.

If you are seeking a review of an improvement notice issued under the Occupational Safety and Health legislation you need to complete the Reference of improvement notice for review form.