You must notify the client’s family or guardian as soon as possible to explain the serious incident that has occurred and the action being taken to meet the immediate needs of the client.
Other people involved / witness to incident
Details of Incident
Other Areas Informed
By submitting this form you are agreeing all information provided is correct and you are authorised to submit this information
The TAC will retain the information provided and may use or disclose it to make further inquiries or assist in the ongoing management of the claim or any claim for common law damages. The TAC may also be required by law to disclose this information. Without this information the TAC may be
unable to determine entitlements or assess whether treatment is reasonable and may not be able to approve further benefits and treatment. If you require further information about our
Personal and health information collected by the Victorian WorkCover Authority (VWA) and its Agents on this form is used for the purpose of processing, assessing and managing claims under Victorian workers' compensation legislation to assist with a worker's rehabilitation and return to work and to assist
the VWA and its Agents to better manage claims generally.
For the purposes of processing, assessing and managing a claim, the VWA and the Agent of the injured worker's employer may use and/or disclose personal and health information collected in this form or about the worker to each other and to the following types of organisations:
- employees, contractors and agents of the VWA and its Agents;
- employers of the injured worker;
- solicitors, medical practitioners and other health service providers, private investigators, loss adjusters and other service providers acting on behalf of the VWA or the Agent in relation to the claim;
- the Accident Compensation Conciliation Service and Medical Panels;
- a court or tribunal in the course of criminal proceedings or any proceedings under any of the Acts which the VWA administers;
- any other person, organisation or government agency authorised by the individual the information is about, or by law, to obtain the information.