Incident notification form

Sections 35 to 39 of the Work Health and Safety (National Uniform Legislation) Act 2011 states NT WorkSafe must be notified of the occurrence of an incident as soon as practicable by the person conducting a business or undertaking on 1800 019 115.

You will be given an incident notification Reference Number that must be included on this form. This number is proof of your notification phone call as soon as was practicable.

In addition to immediate (as soon as is practicable) phone notification, this 2-page notification form must be faxed or emailed to NT WorkSafe within 48 hours after the incident occurrence.

Email: ntworksafe@nt.gov.au
Fax: 08 8999 5141.