Initial notification of injury form
All work related incidents that involve a worker, where workers compensation is or may be payable, must be reported to HEM within 48 hours. Notifications received after 4pm on a business day will be considered to be notified on the following business day.
(req) = Required information. Form cannot be submitted without this essential information.
(imp) = Important information. Please make every effort to complete these fields.
Date format for fields below = (dd/mm/yyyy)