Workers' Compensation and Injury Management Amendment Regulations (No. 2) 2014 (WA)

25 February 2014 GOVERNMENT GAZETTE, WA 505

WORKCOVER

WC301*

Workers’ Compensation and Injury Management Act 1981

Workers’ Compensation and Injury

Management Amendment Regulations

(No. 2) 2014

Made by the Governor in Executive Council.

1.             Citation

These regulations are the Workers’ Compensation and Injury

Management Amendment Regulations (No. 2) 2014.

2.             Commencement

These regulations come into operation as follows —

(a) regulations 1 and 2 — on the day on which these

regulations are published in the Gazette;

(b) the rest of the regulations — on the day after that day.

3.             Regulations amended

These regulations amend the Workers’ Compensation and Injury

Management Regulations 1982.

4.             Appendix 1 amended

Delete Appendix 1 Forms 40 and 41 and insert:

Form 40

[r. 52]

Workers’ Compensation and Injury Management Infringement

Act 1981 notice no.

INFRINGEMENT NOTICE

Alleged	Name
offender
Address
Details of	Date or
alleged	period
offence
Place
Written law
contravened
Details of
offence

506 GOVERNMENT GAZETTE, WA 25 February 2014

Date	Date of
notice
Authorised	Name
officer
Signature
Modified	$_________
penalty
Due date for	/ /20
payment of

(Within 28 days after the giving of the notice)

modified

penalty

TAKE	It is alleged that you have committed the above offence.
NOTICE
If you do not want to be prosecuted in court for the
offence, pay the modified penalty to an authorised officer* by the above due date.
If you need more time to pay the modified penalty, you should contact an authorised officer* at the address below.
Paying the modified penalty will not be regarded as an admission for the purposes of any civil or criminal court case.
If you want this matter to be dealt with by prosecution in
court, sign and date here:
__________________________________ / /20 and post this notice to an authorised officer* at the address below within 28 days after the date of this notice.
If you consider that you have good reason to have this notice withdrawn, you can write to an authorised officer* at the address below requesting that this notice be withdrawn and setting out the reasons why you consider that this notice
should be withdrawn.
How to pay	By post Tick the relevant box below and post this notice to:

Workcover WA

[Insert address]

	I want to pay the modified penalty. A cheque or money order (payable to
[insert details of authorised officer*]) for the
modified penalty is enclosed.
	I want to pay the modified penalty by credit card. Please debit my credit card
account.

Card type _____________________________

Cardholder name

_____________________________________

Card number

[ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

25 February 2014 GOVERNMENT GAZETTE, WA 507

Expiry date of card _____/_____

Amount $__________

Signature ____________________

Complete all details

Direct	[Insert details]
deposit
Electronic	[Insert details]
transfer

*The following are authorised officers for the purposes of receiving

payment of modified penalties:

Method of	Date of
service	service

Form 41

[r. 53]

Workers’ Compensation and Injury Management Withdrawal no.

Act 1981

WITHDRAWAL OF INFRINGEMENT NOTICE

Alleged	Name
offender
Address
Details of	Infringement
infringement	notice no.
notice
Date of issue
Details of	Date or period
alleged
Place
offence
Written law
contravened
Details of
offence
Signature of	Name
authorised officer
Signature
Date	Date of
withdrawal
Withdrawal	The above infringement notice issued against you for the
of	above alleged offence has been withdrawn.
infringement
If you have already paid the modified penalty for the
notice
alleged offence, you are entitled to a refund.

508 GOVERNMENT GAZETTE, WA 25 February 2014

[*Delete	* Your refund is enclosed.
whichever is not
applicable]	or

* If you have paid the modified penalty but a refund is not enclosed, you may claim your refund by signing and dating this notice and posting it to:

Workcover WA

[Insert address]

Your	Date
signature

5.             Appendix V amended

Delete Appendix V items 23 and 24 and insert:

23.	170(1)(a)	Failure to keep a current policy of
insurance under section 160(1) of
the Act ..................................................... $400.00 in

respect of each
worker to
whom the

alleged

offence relates

24.	170(1)(a)	Failing to comply with
section 160(2)(a) or (b) of the Act $400.00
25.	171(1)	Failing to transmit to WorkCover
WA statements and means for
conveying information in
machine-readable form ............................ $200.00
26.	175D(1)(a)	Obstructing or interfering with
inspector performing functions ................ $500.00
27.	175D(1)(b)	Contravening requirement made
by inspector ............................................. $500.00
28.	175D(1)(c)	Providing answer or information
to inspector that is false or
misleading in a material particular $500.00
29.	175D(1)(d)	Giving false or misleading
information in a certificate under
section 175B(1)(f) of the Act .................. $500.00
30.	175D(1)(e)	Preventing another person from
complying with a requirement
under the Act ........................................... $500.00
31.	180(5)	Failing to comply with request to
provide copy of relevant
document ................................................. $200.00

G. MOORE, Clerk of the Executive Council.

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