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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  |  974KB

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'
WIC application for consiliation form example

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

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

WIC will add WorkCover Assist to the dispute.

Updated 12 May 2026