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.
Type into every field, sign it, and save it - all on your own machine. The completed form is never uploaded.
PDF from WorkCover WA's website.
DraftOur fillable copy of this form has not been through editorial review yet. Check it against WorkCover WA's current form before you rely on it.
- Format
- Category
- Government agency form
- Form number
- Form AS11
- Version
- v9cd3f65a
- Last verified
- 11 August 2026
Workers Compensation and Injury Management Act 2023

For law practices: 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.
What Form AS11 is for
Section 343 of the Workers Compensation and Injury Management Act 2023 (WA) lets the Registrar or an arbitrator issue a summons requiring a person to attend before an arbitrator. Rule 34 of the Arbitration Rules 2024 requires the summons to be in the approved form (AS11). If it is issued at a party's request, that party must give it to the witness personally (r 68) at least 7 days before the attendance date (r 34(2) and (3)). The witness does not have to comply unless it was given that way and any prescribed witness allowance was paid when it was given or a reasonable time before attendance (r 34(4)). Failing to comply with a summons without reasonable excuse is an offence with a fine of up to $5,000 (s 386).
When you need it
- You are a party to an arbitration and need a witness to attend who will not come voluntarily.
- You have the arbitrator's leave, where required, to call oral evidence. An interlocutory application (AS7) is the usual way to seek leave to call oral evidence, including from a medical practitioner.
- You have been served with an AS11 and want to know what it requires.
How to fill it in
- 1
Section A - case details
Enter the case number, the applicant and the respondent.
- 2
Section B - witness details
Give the witness's full name and address, and the time (WA time), day, date and place they must attend before the Registrar or arbitrator.
- 3
Section C - issued at the request of
Name the party at whose request the summons is issued.
- 4
Sections D and E
Section D has a signature and date block, and Section E is signed and dated by the Registrar or arbitrator when the summons is issued.
Filing, lodging and service
- Lodge the completed summons with the Arbitration Service for issue, through WorkCover WA Online unless you are EDS exempt (rr 61-63). Exempt parties can use arbitration@workcover.wa.gov.au, deliver it to 2 Bedbrook Place, Shenton Park WA 6008, or post it.
- Once issued, give the summons to the witness personally at least 7 days before the attendance date, unless an arbitrator or the Registrar extends or shortens that time (r 34; notes on the form). Personal service means leaving it with the person, or putting it down in front of them and explaining what it is if they refuse it (r 68).
- Pay or tender the prescribed witness allowance when you give the summons or a reasonable time before attendance (r 34(4)(b)).
Common mistakes
- Leave enough time. Count 7 clear days before the hearing when booking the hearing date and arranging service.
- Bring the witness allowance with you when serving, so there is no argument the witness was not required to attend.
- If a document or record is what you need, an order for production (AS10) under s 341 may be the better tool.
Frequently Asked Questions
How do I summons a witness to a WorkCover WA arbitration?
Have a Summons to Witness (AS11) issued by the Registrar or an arbitrator under s 343, then serve it personally at least 7 days before the hearing and pay the witness allowance (r 34).
What if a witness ignores the summons?
Failing to comply with a summons without reasonable excuse is an offence under s 386, with a fine of up to $5,000. The witness need not comply if the summons was not served properly or the allowance was not paid (r 34(4)).
Can a summons be emailed to the witness?
No. Rule 34(3) requires a witness summons to be given personally in accordance with r 68.
Checked against the official sources on 26 October 2026
- Workers Compensation and Injury Management Act 2023 (WA) ss 343, 386
- Workers Compensation and Injury Management Arbitration Rules 2024 (WA) rr 34, 61-63, 68
- WorkCover WA - Form AS11 Summons to Witness
- WorkCover WA - Arbitration publications and forms
- WorkCover WA - Guide to the Workers Compensation Arbitration Service
General information about the form, not legal advice about your matter. Rules and forms change: if anything here differs from the court or agency's current instructions, theirs apply.
Field map
9 boxes on the Summons to Witness (Form AS11) fill from your matter. 12 are for you to complete: ticks, signatures and anything that needs judgement.
- Client
- Client full name(s), Client postal address (full), Client postcode, Client suburb
- Court
- Court file number
- Key Dates
- Current date
- Operator
- Operator signature (image)
Matter plans that use this form
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