Have your say
Proposed amendments to the NT Workers Rehabilitation
and Compensation Act
Complete and submit this form with your submission by the specified closing date as
outlined on the NT WorkSafe website.
Email submissions to email@example.com
Public or confidential
Do you wish to lodge your submission ‘IN CONFIDENCE’ YES NO
An ‘IN CONFIDENCE’ submission will be considered but not published on the NT WorkSafe website.
Submission Details – NOTE: The following information WILL be placed on the NT WorkSafe website.
This submission is written on behalf of Please select ONE of the following
Name: Individual Organisation
Individual / Organisation Details
– NOTE: The following information WILL NOT be placed on the NT WorkSafe website.
Principal contact name:
Contact phone number: Email address:
Are you making this submission as: Please select ONE of the following
Business Union Community organisation OHS Consultant
Employer organisation Insurance Company Worker Other, please specify:
Industry representative Government representative Professional
Which industry sector do you operate in: Please select ONE of the following
Agriculture, Forestry and Fishing Finance and Insurance
Mining Property and Business Services
Manufacturing Government Administration and Defence
Electricity, Gas and Water Supply Education
Construction Health and Community Services
Wholesale Trade Cultural and Recreational Services
Retail Trade Personal and Other Services
Accommodation, Cafes and Restaurants N/A
Transport and Storage Other, please specify:
NOTE: Only typed electronic submissions will be accepted. Please contact NT WorkSafe if you wish to submit hand written
submissions on 1800 019115 or via email firstname.lastname@example.org
Confidential material – Where a submission includes confidential and non-confidential material, the confidential material should
be provided under a separate cover sheet and clearly marked ‘IN CONFIDENCE’ and will not be placed on the website.
Copyright in submissions – Copyright resides with the author(s), not with NT WorkSafe.
Liability – Neither the Northern Territory Government nor NT WorkSafe takes responsibility or shall be liable for any breach of
the copyright, or libellous or defamatory comments in submissions published by NT WorkSafe.