Safety, Rehabilitation and Compensation Act 1988 - section 34S - Approval of Form of Application for Initial Approval as a Rehabilitation Program Provider (Workplace Rehabilitation Provider) (30/10/2009)
Appendix 5- Comcare agreement and authorAppendix 5- Comcare agreement and authorisation
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Turn the raw legal text into a practical explanation grounded in Safety, Rehabilitation and Compensation Act 1988 - section 34S - Approval of Form of Application for Initial Approval as a Rehabilitation Program Provider (Workplace Rehabilitation Provider) (30/10/2009).
Appendix 5- Comcare agreement and authorisation
I, _________________________________________________________________
(please print full name)
holding the position of: _______________________________________________ ,
(please print title)
on behalf of the applicant: _____________________________________________
(please print name of applicant)
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certify that the information provided in this application and in support of the application is true and correct. I understand that giving false or misleading information is a serious offence under the Criminal Code
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agree to advise Comcare as soon as possible of any changes to the information provided in this application, and
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authorise relevant persons to provide to Comcare personal information in relation to this application and for the purposes of enabling Comcare to determine whether the applicant, a relevant principal or employee of the applicant is complying with the Operational standards for rehabilitation program providers (workplace rehabilitation providers) determined under section 34E of the SRC Act. In particular, I understand that this authorises Comcare to seek confirmation of the qualifications, probity and financial standing of the applicant, relevant principals and any workplace rehabilitation provider engaged or employed and the likely effectiveness, availability and cost of the rehabilitation programs which may be provided by the applicant.
If the applicant is approved as a workplace rehabilitation provider, I:
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understand that failure to comply with the Operational standards for rehabilitation program providers (workplace rehabilitation providers) determined under section 34E of the SRC Act or the Criteria for initial approval or renewal of rehabilitation program providers (workplace rehabilitation providers) determined under section 34D of the SRC Act may result in the revocation of approval under section 34Q of that Act; and
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agree to advise Comcare in writing within one month of any changes in workplace rehabilitation providers employed or engaged by the applicant to manage return to work plans under the SRC Act, including evidence of qualifications, experience/supervision arrangements and training
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agree to Comcare listing the applicant’s name, service delivery description and contact details on Comcare’s website.
Signed………………………………………(Applicant) Date………………….