Please complete this form to request access to your personal and/or health information under the Privacy and Personal Information Protection Act 1998 and/or Health Records and Information Privacy Act 2002.

Your details
Proof of identity

When seeking access to your, your child’s or another person’s personal or health information, an applicant may be required to provide proof of identify in the form of a copy of any one of the following documents:

Australian driver’s licence (with current address)

Current Australian passport (with current address)

Other proof of name, signature, relationship to the person on whose behalf you are acting or current address details.

You will be advised by the person processing your application if proof of identity is required.

Information requested
Please select the relevant statement/s
I am seeking the above information for the period from
to
Access and cost

As an applicant you have a legislative right to request access to personal and/or health information concerning yourself that is held by SafeWork NSW. You are entitled to have access without excessive delay or cost.

SafeWork NSW may require you to pay a fee if the application is made under the Health Records and Information Privacy Act 2002.

You have a right to request an internal review of a decision in relation to your application for access by SafeWork NSW. A request for internal review can be emailed to privacy@safework.nsw.gov.au or sent to SafeWork NSW, Locked Bag 2906, Lisarow NSW 2252.

Declaration
I declare that the information I have provided on this form is true and correct.

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