In order to assess the concern you’re raising, WorkSafe needs some information from you.

This includes your name and contact details, details about the incident/s, who was involved (both who caused the harm and who experienced it) and what has been done about it including who else has been told about it.

Some of the questions are optional, however, we ask for this information as it can help us to make decisions. It takes 10-20 minutes to complete.

WorkSafe can only consider concerns if they are associated with work.

WorkSafe can only consider work-related mental health concerns if they were experienced by you or you have permission from the person who it is about.

Tell us a bit about the person/s affected by the concern

WorkSafe will usually contact you via email in the first instance. We ask for your contact number in case we need to contact you.

We may be limited in what we can do as we often contact people with further questions. As you fill out this form, please share any information that you think may be relevant.

We will make a note of this and keep your details confidential. If we reach a point where sharing your information with the business will help prevent harm, we will ask you first.

Tell us a bit about the person
Information about the person will help us assess your concern. You don't have to name the person if you don't feel safe.

Please check your information is correct before submitting your report.
To make changes, select an ‘Edit this section’ button below.