Useful resources

Notify us of an injury by fax or email

Use this form if an employee sustains a work-related injury and has not completed a claim form. This ‘initial notification of injury’ form can be downloaded and sent to us via email or fax. You can also lodge the claim with our online form.
Club Employers Mutual Form – Initial Notification of Injury
Injury claim form to be completed by worker

Use this form to make a workers’ compensation claim for weekly payments or medical, hospital and rehabilitation expenses.
SIRA – Worker’s injury claim form
Other work related injury claim form to be completed by worker

Use this form to provide additional information if you were injured during a work-related journey or during a recess or authorised absence from work.
SIRA – Other work related injury claim form
SIRA Standards of Practice

SIRA has developed these Standards to support and encourage insurers to have effective claims management practices that will help deliver positive experiences and outcomes for workers, employers and the people of NSW.
SIRA Standards of Practice

Workers Compensation Guidelines

Here the State Insurance Regulatory Authority (SIRA) details requirements, information and guidance for workers, employers, insurers and other stakeholders.
Workers Compensation Guidelines
Employer’s workers compensations obligations

The State Insurance Regulatory Authority (SIRA) has produced this guide to explain an employer’s obligations under workers compensation legislation. It contains practical advice for achieving the best outcomes for both workers and employers.
A Workers Compensation Guide for Employers
SafeWork Australia’s notifying fact sheet

This information sheet provides general guidance on mandatory reporting requirements for ‘notifiable incidents’ under Work Health and Safety (WHS) legislation i.e. incidents that involve a death, ‘serious’ injury or ‘dangerous occurence’.
SafeWork Australia’s notifying fact sheet
Injury Management Program

Our Injury Management Program ensures our injury management approach and practices are structured, integrated and consistent to achieve best practice outcomes for all parties involved.
Club Employers Mutual – Injury Management Program

There are certain procedures and guidance material employers are required to have in place and documents and templates based on best practice principles. These resources are designed so you are prepared and ready to support your employees in a safe, sustained and efficient recovery following their injury.
Return to Work (RTW) Toolkits

Electronic Funds Transfer (EFT)

This form can be used by workers, employers or service providers wishing to receive claim related payments via EFT.
Club Employers Mutual Form – Electronic Funds Transfer (EFT) Request – Claim Payments
Pre-injury Average Weekly Earnings (PIAWE) Agreements

This form can be used by workers, employers or service providers wishing to receive claim related payments via EFT.
This video explains PIAWE agreements and how to enter into a PIAWE agreement for a COVID-19 claim.
This brief guide explains how to calculate PIAWE for a PIAWE agreement.
SIRA PIAWE Agreement Form – please use this form to enter a PIAWE agreement for non-COVID-19 claims
Average weekly earnings (to be completed by employer)

Use this form to provide us with details of a worker’s earnings so we can calculate their Pre-Injury Average Weekly Earnings.
Club Employers Mutual Form – PIAWE Details
Claim travel expenses (to be completed by worker)

If you are a worker, use this form to make a claim for travel expenses incurred in relation to your claim.
Club Employers Mutual Form – Claim Travel Expense Reimbursement

Witness statements

Use this form to collect statements from witnesses of an incident.
Club Employers Mutual Form – Statement of Witness to an Injury
Withdraw claim (to be completed by worker)

If you are a worker withdrawing your claim, use this form to confirm your decision.
Club Employers Mutual Form – Letter of Authority to Withdraw Claim
Statutory Declaration

Use this form to provide a written statement which needs to be signed and declared true before an authorised witness. This statutory declaration is used to legally verify the following information: a worker’s employment and income status, dependents status, incident details, litigation status.
Club Employers Mutual Form – Statutory Declaration
Consent to obtain medical information (to be completed by worker)

If you are a worker, complete this form to provide consent to obtain medical information.
Club Employers Mutual Form – Letter of Authority to Release Docs & Info
Job Seeking Log

Complete this form as evidence of a worker’s progress with obtaining new employment.
Club Employers Mutual Form – Job Seeking Log