* Mandatory Fields	WorkHealth Enquiry Form * Title Ms Mrs Miss Mr Prof. Dr. * First name * Surname * Who are you? An employer A worker   Business name* Business name * What is your preferred method of   contact? Email Telephone   Email* Email   Contact number   include area code, eg 0399991111* Contact number   include area code, eg 0399991111 * State ACT NSW NT QLD SA VIC WA * What is your enquiry about? I would like more information about: The WorkHealth program Applying for worker health checks Applying for a workplace grant The progress of my application   How can we help? Give details (max 200 characters) Cancel   Clear Details Submit Privacy Statement Personal information collected by WorkSafe Victoria on this form is used for the purposes of disseminating and promoting information, new tools and other forms of education material about WorkHealth initiatives. The information collected may also be disclosed to our contracted service providers. To ensure you are kept up to date about new developments please contact WorkHealth at info@workhealth.vic.gov.au or 1800 136 089 with any changes to your contact details. You have a right to access personal information WorkSafe holds about you by contacting our FoI team on 03 9651 1555. You may access our privacy policy at www.worksafe.vic.gov.au.