There are 10 administrative forms used in the impairment assessment process.
Form AMS 1 is to be used by workers, employers or employers’ insurers – the remaining forms are to be completed only by an approved medical specialist.
These forms incorporate the legislative requirements. If you have any questions regarding the use of the forms or the impairment assessment systems, please contact WorkCover WA’s Advice and Assistance on 1300 794 744.
Requirement for worker to attend- Form AMS 2: Requirement for Worker to Attend before an Approved Medical Specialist (Word – 50kb)
This form indicates a requirement to attend an impairment assessment. There are penalties if a worker fails to attend as required.
- Form AMS 3: Requirement to Produce Relevant Documents or Information for an Impairment Assessment (Word – 50kb)
This form is used when an approved medical specialist 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 medical specialist.
- Form AMS 4: Requirement to Consent to Another Party to Produce Relevant Documents or Information for an Impairment Assessment (Word – 50kb)
This form is used by an approved medical specialist 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 AMS 4A: Requirement to Produce Information for an Impairment Assessment (Word – 50kb)
This form is used after an impairment assessment examination, when additional information is required from the worker.
- Form AMS 5: Report on Evaluation of Degree of Permanent Impairment (Word – 130kb)
The approved medical specialist is to produce a detailed Form AMS 5 and forward a copy to both the worker and employer alongside a Form AMS 6.
- Form AMS 6: Certificate of Degree of Permanent Impairment (Word – 50kb)
The approved medical specialist must forward this certificate alongside the Form AMS 5.
- Form AMS 6A: PIRs Rating (Word – 47kb)
Form AMS 5 and 6 may have the PIRs Rating Form attached when a psychological injury is being assessed.
- Form AMS 7: Report on Workers Condition Not Stabilised (Word – 50kb)
The approved medical specialist 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 (see the AMS publication resources section to view the PDF). The approved medical specialist is to forward this report to both the worker and the employer alongside Form AMS 8.
- Form AMS 8: Certificate Where Workers Condition Not Stabilised (Word – 50kb)
The approved medical specialist is to forward this certificate to both the worker and the employer alongside Form AMS 7. - Notice about special evaluations – on or after 12 October 2020 (PDF – 580kb)
