Request WorkCover Assist

Workplace Injury Commission (WIC) Application for Conciliation Form

The request for Conciliation Form and Checklist is available for download in pdf format." It can be completed on your computer prior to printing."

Application for Conciliation form
PDF 291.55 KB
(opens in a new window)

To request WorkCover Assist to help with your dispute, just tick the box on the Request for Conciliation Form where it asks:

Do you require an assistance provider at conciliation?

  1. Tick Yes
  2. Next to WorkCover Assist tick 'Yes'

What if I have already completed and sent the form to the WIC?

Please contact WIC directly on 9940 1111 or and advise them you require assistance by WorkCover Assist.

WIC will add WorkCover Assist to the dispute.