Referral: Work Health, Safety and Wellbeing training and consulting services Step 1 of 2 - Referrer & Patron Details 0% Referrer's DetailsTitle*Name* First Last Street Address* Street Address Address Line 2 City State Post Code Postal Address* Referrer's postal address the same as street address? Street Address Address Line 2 City State Post Code Phone*FaxEmail* Are you paying of for this service?*YesNoDetails of the Person paying for this serviceTitleName* First Last Street Address* Street Address Address Line 2 City State Post Code Postal Address* Is postal address the same as street address? Street Address Address Line 2 City State Post Code Phone*FaxEmail* Is this Patron aware of this referral?*YesNo Services RequiredPrivate Training Courses* HSR Refresher OHS Training course (Victoria) Initial 5 day Health & Safety Representatives (HSR) course (NSW WorkCover approved) 1 Day Health and Safety Representative (HSR) Refresher Training course (NSW WorkCover approved) Comcare Initial 5 Day Health & Safety Representatives (HSR) course Comcare 1 Day HSR Refresher Course Return to Work Coordinator Return to Work / Injury Management for Managers and Supervisors Manual Handling Office Ergonomics Bullying & Harassment Managing & Preventing Psychological Injuries Development a mentally healthy workplace Preventative Exercise Building Resilience WHS Incident Investigation WHS Committee Wellbeing Other Please Specify*Note: for Public training please register via this linkConsulting* WHS Gap Analysis / Audits WHS Inspection WHS Risk Assessment WHS Management System / Policy and Procedure review or development Office Ergonomic assessments Manual handling consulting WHS cultural survey Job Dictionary / Task Analysis Onsite Return to Work Onsite WHS Contractor Management WHS and Injury Management Induction Functional Capacity Evaluation (not related to a workers compensation claimant) Other Please Specify*Expected Outcomes and CommentsWhat do you expect from the above servicing?*Additional Comments? Yes (Leave blank if none)Additional Comments*Thank you for your referral. One of our staff will contact you to discuss your request details, including proposed costing. This iframe contains the logic required to handle Ajax powered Gravity Forms.