Report Occupational Illness to WorkSafe New Zealand

When a worker develops a notifiable occupational disease or illness, New Zealand law requires employers to notify WorkSafe within a specified timeframe. This WorkSafe Notifiable Illness Notification Form helps employers, health and safety officers, and medical professionals report work-related illnesses efficiently and in compliance with the Health and Safety at Work Act 2015.

Who needs this form?

This template is designed for New Zealand businesses across all sectors—construction, manufacturing, healthcare, agriculture, and professional services—that need to report:

• Occupational diseases such as work-related asthma, dermatitis, or hearing loss
• Illnesses caused by workplace exposure to hazardous substances, noise, or biological agents
• Any notifiable illness as defined by WorkSafe New Zealand regulations

Medical practices, occupational health clinics, and ACC-registered providers can also use this form to document and report diagnosed work-related conditions on behalf of their patients.

What makes this template effective?

This form captures all the essential information WorkSafe requires: employer and worker details, diagnosis and symptoms, details of workplace exposure or hazards, medical certification, and preventative measures taken. Conditional logic ensures that only relevant follow-up questions appear based on the type of illness and exposure reported.

The structured format helps you meet your legal obligations while creating a clear record for ACC claims, internal investigations, and ongoing health monitoring. Because it's built in Paperform, you can receive instant notifications, route submissions to your health and safety team, and integrate with your existing incident management systems.

Streamline compliance with Paperform + Stepper

Pair this form with Stepper to automate what happens next. When a notifiable illness is submitted, Stepper can automatically notify your health and safety officer, create a case file in your project management tool, update your incident register in Google Sheets or Airtable, and send follow-up tasks to the right people—no manual handoffs required.

If you need the worker or medical professional to sign a formal notification or consent form, Papersign lets you convert the submission into a legally binding eSignature document, creating a complete audit trail from report to response.

With Paperform's SOC 2 Type II compliance, data residency controls, and enterprise-grade security, you can trust that sensitive health and employment information is handled with care and kept within New Zealand if required.

Start managing notifiable illness reporting with confidence—meet your WorkSafe obligations, protect your people, and keep your operations compliant.