WorkerHealth Check Employer Request Form

1. Completion of this form, will register your worksite with Incolink

 
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1. Site information
2. Please estimate the total number of workers on your worksite at your preferred month below? (tick one box)
0-2525-5050-100100-200200-300300-400400-500500+
April
May
June
July
August
September
October
November
December
3. Onsite Employer Contact Details
4. Onsite Workers Representative Contact Details
5. Please advise if you have facilities onsite, to accommodate WorkerHealth checks (i.e. induction, first aid, amenities, hut, etc... N.B. these rooms need to be private spaces for the duration of the event)

Rooms Available
Number of Rooms Available
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