Complete equipment order form

Use the Equipment Order form (EOF) to notify the Contracted Equipment Supplier or Health Funding & Analysis team of the order for equipment or related service. All fields within this form must be completed.

Requirements for completing the EOF

Section 1 - order details

  • if one item is required to be supplied and another repaired, a separate EOF should be used
  • the delivery timeline should be reasonable taking into account the equipment being ordered

Section 2 - worker details

  • ensure worker details are up to date

Section 3 - equipment supply or repair details

  • detail the product/service, accessories and customisation requirements. Include all specifications (make, model, etc)
  • each piece of equipment should be allocated a number (eg 1. shower stool 2. bath mat 3. hand rail, etc)
  • if available, include total product cost, brand and quotation/reference number
  • THP Treating Health Practitioner reports detailing the equipment can also be attached
  • if an Agent is uncertain as to the cost benefit of a hire or repair compared with purchase, the Agent can specify in the ‘comments’ section of the EOF that they would like to be contacted prior with quotes before the equipment or repair is provided
  • if the worker is required to make a contribution to the costs of the equipment, details of the contribution should be noted in the ‘comments’ section of the EOF
Email EOF to supplier
  • email the typed EOF to the selected Contracted Equipment Supplier or Health Funding & Analysis team. Save a copy on the claim file
  • WorkSafe's Contracted Equipment Supplier will:
  • respond within three hours acknowledging receipt of the EOF and advise whether they are able to fulfil the order
  • if unable to complete the order, the Agent is to email the EOF to another Contracted Equipment Supplier
  • if able to complete the order, the equipment supplier will follow up with an Equipment Services Plan (ESP Equipment Services Program) which specifies the service to be provided, delivery details and timeframes
  • a copy of the ESP must be saved on the claim file
Process payment

Process payment once the equipment has been supplied and invoice received.

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