Please complete the form below to register or update your details. Items marked with an * (asterix) are required to be completed.1. Type of Registration* Registration type * Please add me to the list Please amend my details Existing details 2. Contact DetailsTitle -- Please Select --MissMrMrsMS * Given name * * Family name * Employer Contact Phone Mobile Email Use of contact details * Do you agree to your contact details being used in any manner that WorkCover Tasmania may choose in performing its functions under the Workers Rehabilitation and Compensation Act 1988? Yes No 3. Qualifications* Have you undertaken RTWC training? Yes No If Yes, Name of Training Provider Please name the Training Provider where you obtained your qualification from. Date of Qualification Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJunJulAugSepOctNovDec Year 19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 Qualification obtained Last updated: 29 October 2019
