Fill out these forms if you are/were employed under a state award/agreement or state legislation.
If in doubt, ring the SafeWork SA Help Centre on 1300 365 255 for information or assistance.
When filling in the form, please ensure that you:
- answer all of the questions
- provide as much detail as possible including
- start and finish dates of work
- job title and duties performed
- whether the work was full-time, part-time or casual
- the number of hours employed each week
- gross weekly rate of pay
- provide as much evidence as possible to support the claim, such as copies of time and wage records, group certificates, pay slips, an employment declaration form and written contracts
- sign and date the claim form before returning it to SafeWork SA.
Please note: During the course of SafeWork SA's investigation, circumstances may arise which require us to make a copy of this claim available to your employer. Accordingly, you are encouraged to ensure that all statements or allegations made are accurate and truthful.