Notice of Representation (Form CS4)
DraftThis template has not been through our editorial review yet. Check it against WorkCover WA's current form before you rely on it.
- Format
- Category
- Government agency form
- Form number
- Form CS4
- Version
- v9053df93
- Last updated
- 1 September 2026
Workers Compensation and Injury Management Act 2023
Type into every field, sign it, and save it - all on your own machine. The completed form is never uploaded.
How to lodge - Online portal
- 1
Assemble the form
Pull the latest Notice of Representation (Form CS4) into your practice management system. Your matter details (property address, lot and plan, parties, and your firm details) populate the form automatically, on your own machine.
- 2
Review and check
Confirm the populated fields are correct and complete any office-use or matter-specific fields the catalogue does not fill.
- 3
Upload to the council portal
Open WorkCover WA's online lodgement portal at https://www.workcover.wa.gov.au/ and upload the completed form.
Lodgement notesWorkers' Compensation Conciliation Service form. Intake's '(Conciliation)' suffix is a disambiguator, not part of the official title. PDF only; no Word version published.
This form maps to the published matter-field vocabulary, so your practice management system fills it from your matter data - on your own machine. Practice management systems can fetch and assemble it through the document assembly API.