This form is to be used to apply for a review of a decision, or for an extension of time for compliance with improvement notice(s) under the following legislation:
- Work Health and Safety Act 2020
- Work Health and Safety (General) Regulations 2022
- Work Health and Safety (Mines) Regulation 2022
- Work Health and Safety (Petroleum and Geothermal Energy Operations) Regulations 2022
in relation to matters for the performance of a function at a general workplace, mine or petroleum site.
A signed and dated copy of the form must be submitted to WorkSafe before the notice expires. You can submit the form via the following methods:
- Email review.officer@lgirs.wa.gov.au
- Post WorkSafe Commissioner, Locked Bag 100 East Perth 6892
- In person Level 1, Mason Bird Building, 303 Sevenoaks St, Cannington WA 6107.
Mine sites who are Safety Regulation System (SRS) users, a review of an improvement notice or a prohibition notice, or to apply for an extension of the due date of the improvement notice(s) must be requested using SRS.