Regulations 1996 No.11 of 1996 Amendments of Work Health Regulations
Tabled Paper 2359
Tabled Papers for 7th Assembly 1994 - 1997; Tabled papers; ParliamentNT
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Work Health Regulations Important: Even if you do request mediation, an application to the Work Health Court must still be made within 28 days after receiving this notice. MEDIATION If you wish to have mediation complete the request below and send this form by post, or deliver it, to the Work Health Authority within 14 days of your receipt of this notice. The mediation will not be part of a court process. The mediation may involve you in a meeting with the Mediation Officer and Insurer. The mediation will be confidential. For more information regarding the mediation process please refer to the information bulletin prepared by the Work Health Authority. Do not detach Request for mediation I hereby request mediation in relation to the decision on my claim as given on this form. Name: _________________________________________ Postal Address:_________________________________ Phone No (home) : ________ Phone No (work) :________ Signed: ________________ Date:_____________ Send or deliver one complete document to the Mediation Officer,. c/- Work Health Authority, GPO Box 2010 DARWIN NT 0801 - Minerals House 66 The Esplanade DARWIN NT 0800 Keep other copy of the document for your records. 5
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