Injury Reporting Centre Onboarding Form

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

Company*

Types of Roles/Physical Demands*

Role

Physical Demands

E.g. Mechanic, Operator

Locations*

(State/Territory/Country)

Contact List*

Name

Job Role

Email Address

(Who to include in correspondence)

Do you have your own injury management software that Recovery Partners will need to have access to?*

E.g. Solv/Safety Culture/Salesforce

If you do, please provide login details for this platform.

Suitable Duties*

Role

Suitable Duties

Do you need Recovery Partners to lodge the claim? If so please provide your Policy Number, ABN and Trading Name.*

Will Recovery Partners be used for ongoing rehabilitation support?*

Preferred Treatment Clinics

Treatment Clinic

Contract Details