Initial notification of injury form where policy details are not known

To notify us on an injury, please answer the following questions. Questions marked with an asterisk* are mandatory. Once you submit this form, a case manager will be in contact within 48 hours.

    Claim Details



    Employer's Details

    Worker's Details

    Email unknown


    Please upload documents here.
    File types accepted include: DOC, DOCX, PDF, JPG, PNG. Maximum file size allowed is 20MB

    If you know the worker's wage details please provide them here:

    Injury Details

    Treatment Details

    Notifier's Details

    For further information on our privacy practises please click here and select the Privacy Statement applicable to you. By providing this information I agree to the Trinity Insurance Privacy Statement.

    Please note that if the incident involves a death, ‘serious’ injury or ‘dangerous occurrence’, you must also notify SafeWork NSW immediately on 13 10 50 – please refer to the SafeWork Australia’s notifying fact sheet for further information.