Interactive online form:
Fill out the form online and print it after you've completed it. The form contains two pages.

Early Report Form for Employee:
This form is for the employee to complete.

Early Report Form for Workplace:
This form is for a representative of the employee's workplace to complete.

 

 

 

Editable MS Word form:
For managers - modify the form to suit the needs of your organisation. Requires MS Word 97 or higher.

Early Report Form for Employee (227KB)

Early Report Form for Workplace (662KB)

PDF form:
Fill out the form by typing your entries directly on the PDF, save it and print it. Alternatively you can print the blank form and complete it by hand. The form contains two pages. Acrobat Reader is required.

Early Report Form for Employee (365KB):
This form is for the employee to complete.

Early Report Form for Workplace (355KB):
This form is for a representative of the employee's workplace to complete.

Download Adobe Acrobat Reader