Impairment assessment forms

Form APIA 2: Permanent Impairment Assessment – Assessment Request
This form is used by worker, insurer, or self-insurer to request assessment of workers degree of permanent impairment.

Form APIA 3: Permanent Impairment Assessment – Requirement to Attend
This form indicates a requirement to attend an impairment assessment.

Form APIA 4: Permanent Impairment Assessment – Provision of Information
This form is used when an approved permanent impairment assessor requires a worker, employer or employer’s insurer to produce relevant documents and information to assist in the impairment assessment. The worker, employer or employer’s insurer must provide relevant documents or information to the approved permanent impairment assessor.

Form APIA 5: Permanent Impairment Assessment – Consent to Provision of Information
This form is used by an approved permanent impairment assessor when they require consent from the worker, employer or employer’s insurer, for another party to provide relevant documents or information required for the impairment assessment.

Form APIA 1: Permanent Impairment Assessment – Report and Certificate
This form is used by the APIA to produce a report certifying a worker’s degree of permanent impairment. The approved permanent impairment assessor is to forward this report to the worker, the employer and the employers insurer.

Form APIA 7: Permanent Impairment Assessment – Psychiatric Impairment Rating Scale Form
The approved permeant impairment assessor uses this form when the impairment assessment involves a psychiatric injury.

Form APIA 6: Permanent Impairment Assessment – Condition Not Stabilised Notice
The approved permanent impairment assessor uses this form when the worker has been assessed, but their injury has not stabilised to the extent required by the Act and the WorkCover WA Guides for the Evaluation of Permanent Impairment. The approved permanent impairment assessor is to forward this report to the worker, the employer and the employers insurer.

Form Permanent Impairment Notice
This form is used by the worker and employer to indicate whether or not the employer agrees with the assessed degree of permanent impairment.

Form Permanent Impairment – Further assessment 
This form is used by the employer to request a further assessment if the employer does not agree with the assessed degree of permanent impairment. The cost of further assessment is to be paid by the employer.