Information and Forms For Agencies

Visit the WorkSafe employer page for the latest forms and information and FAQs.

Please use the below forms for Northern Territory claims only.

Forms

• Workers’ compensation claim form – PDF / Word
• Statement of Fitness for Work Submission – online
• Medical & Pharmaceutical Items Reimbursement Form – online
• Workers Compensation Timesheet – Claim for Payment – online
• Travel Reimbursement Form – online / hardcopy
• Bank Account Details – for EFT Payments – online
• Miscellaneous/all other items Reimbursement Form – online

About GB’s services

• Introducing Gallagher Bassett – PDF
• GB LaunchPad Flyer – PDF
• GB Injury Hotline Poster – PDF
• GB Injury Hotline Supervisor Flyer – PDF
• Have you been injured at work? – PDF
• After you lodge a claim – PDF
• Return to Work: everyone’s responsibility – PDF

Bulletins

• Alternative Employer Incentive Scheme – online
• Guidelines for settling of journey claims – online
• Workers compensation insurance requirements for employers – online

Publications

• Employers guide to workers’ compensation – PDF / Word

Support Services

• Interpreting and Translating Services – web / email / phone 1800 334 944
• Indigenous Support Services – email / phone 1800 334 944

Useful Links

• NT WorkSafe
• Northern Territory Government