Claims

It is important that you notify HEM within 48 hours of becoming aware of all work related incidents that involve a worker, where workers compensation may be payable.

Initial notification of injury form

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

YesNo
YesNo

Employer's Details

Worker's Details

Language:

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

Injury Details

Treatment Details






Notifier's Details

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.