Injury or disease details sheet
Form ID
D2049
Audience
General
This is not a claim form. It must be used as an attachment to either the D2020 Claim for Rehabilitation and Compensation or D2051 Claim for Liability and/or Reassessment of Compensation.
If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.
How can I access this form?
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Form (PDF or Word)