WorkCover WA Forms
13 forms from WorkCover WA. Each form's page links the official copy, shows its first page and explains how to complete and lodge it. Choose a form below.
Forms (13)
Common Law Settlement Agreement - Memorandum
WorkCover WA form CL3, the Common Law Settlement Agreement - Memorandum, records the terms of a settled common law damages claim for a workplace injury. It is filed with the WorkCover WA Director.
Interlocutory Application (Form AS7)
Form AS7 is the WorkCover WA Interlocutory Application used in the Workers Compensation Arbitration Service. It asks an arbitrator for procedural orders, such as leave to file late evidence, join a party or adjourn.
Memorandum of Consent Order (Form AS9)
Form AS9 is the WorkCover WA Memorandum of Consent Order for the WA Workers Compensation Arbitration Service. Parties use it to ask an arbitrator to make agreed orders.
Memorandum of Consent to Finalising Order (Form CS7)
Form CS7 is the WorkCover WA Memorandum of Consent to Finalising Order. Parties lodge it in WA workers compensation conciliation to have agreed orders made under s 318.
Notice Consenting or Opposing Application for Order and/or Assessment of Costs (Form AS16)
Form AS16 is the WorkCover WA reply to an application for costs in WA workers compensation arbitration. It records consent or opposition, with grounds, within 14 days.
Notice Consenting or Opposing Interlocutory Application (Form AS8)
Form AS8 is the WorkCover WA reply to an interlocutory application in WA workers compensation arbitration. It consents to or opposes the orders sought, with grounds.
Notice of Discontinuance (Form AS14)
Form AS14 is the WorkCover WA Notice of Discontinuance for arbitration. The party who started a WA workers compensation arbitration uses it to end all or part of it.
Notice of Discontinuance (Form CS6)
Form CS6 is the WorkCover WA Notice of Discontinuance for conciliation. The applicant uses it to end conciliation of a WA workers compensation dispute.
Notice of Representation (Form AS13)
Form AS13 is the WorkCover WA Notice of Representation for arbitration. A lawyer or authorised agent uses it to notify an appointment or cessation within 3 working days.
Notice of Representation (Form CS4)
Form CS4 is the WorkCover WA Notice of Representation for conciliation. A lawyer or authorised agent uses it to notify the Director of an appointment or cessation.
Order for Production of Documents or Material (Form AS10)
Form AS10 is the WorkCover WA Order for Production of Documents or Material. It is the proposed s 341 order lodged with an interlocutory application in WA arbitration.
Statement of Social and Financial Circumstances (Form CS2)
Form CS2 is the WorkCover WA Statement of Social and Financial Circumstances. A worker lodges it with a conciliation application for extra income compensation or medical expenses.
Summons to Witness (Form AS11)
Form AS11 is the WorkCover WA Summons to Witness, used to require a person to attend and give evidence before a WA workers compensation arbitrator.
Governing legislation
About WorkCover WA Forms
WorkCover WA issues the government agency forms below for Western Australia matters. Each has its own page with a link to WorkCover WA's official copy, a preview of the first page and the steps to complete and lodge it. The most used forms also have a plain-English guide, checked against the rules that govern them.
They are governed by Workers Compensation and Injury Management Act 2023. We check each form against WorkCover WA's published version and refresh our copy when it changes. If a form here ever differs from WorkCover WA's website, the official version applies.
Frequently Asked Questions
What forms does WorkCover WA issue?
13 forms are live for WorkCover WA, under Workers Compensation and Injury Management Act 2023. Choose a form for a link to the official copy and the steps to complete and lodge it.
Are these the current WorkCover WA forms?
We check each form against WorkCover WA's published version, update our copy when it changes, and show on each form's page when it was last checked. Download the official copy from the form's page before you lodge it.
How do I lodge a form with WorkCover WA?
Each form's page sets out how to complete and lodge it. Requirements differ from form to form, so follow that page and WorkCover WA's own instructions for the form. Law practices can also fill these forms from their matter data through the document assembly API.