Incident notification form

Use this form to notify NT WorkSafe that serious injury, a dangerous incident or death has occurred at the workplace. These type of incidents are called notifiable incidents under the Work Health and Safety (National Uniform Legislation) Act 2011.

The notification must be made by the Person conducting a business or undertaking (PCBU) or by a person with management or control of the workplace (e.g. a manager or shift supervisor). A worker (unless authorised by the PCBU) or witness (bystander) cannot make the incident notification, but can report a safety concern.

Notification can be made use the online form below or download either a pdf or word version of the form and emailing the completed form to ntworksafe@nt.gov.au.

• Online incident notification form.