Form 11 - Direction For Access To Information And Premises

1.2 Request for access to premises:

The defendant is required to provide or allow the claimant named above, access to specified premises

within the period specified below for a purpose relevant to the claimant’s claim

1.2.1 Address of specified premises:

1.2.2 Purpose for requesting access to specified premises:

1.2.3 Specified period for access to specified premises:

From

PART 2 – Notice to Claimant

Compliance with Direction

This direction is to be served at least 28 days before the commencement of the period specified in the

direction for compliance with the direction, or by the time stated in Part 3 below.

A person who fails to comply with a direction without a reasonable excuse is guilty of an offence under

section 318 (1) of the Workplace Injury Management and Workers Compensation Act 1998.

Direct any enquiries about compliance with this direction to the party that filed this direction. If after

discussion with that party a dispute exists concerning the production of information or access to premises,

the claimant may apply to the Commission for a decision. Any application must be made in writing prior to

the compliance date.

PART 3 - Authorisation to Reduce Time for Service

(Office use only)

This direction must be served no later than _____ am/pm on ___/___ /____

Signed: _________________________________ Date: ___/___ /____

PART 4 – Approval to Issue

(Office use only)

Issued under delegation of the Registrar

Signed: _________________________________ Date: ___/___ /____

Privacy of Personal Information

The privacy of personal information is important to the Workers Compensation Commission. The

Commission collects personal information to register application forms and make decisions about disputes

or claims. The NSW workers compensation laws permit the Commission to collect this information.

The Commission may give personal information to another person or agency (e.g. a doctor, a party,

WorkCover NSW) as required or authorised by law.

Decisions by the Commission will generally be published, including on the Internet, unless there are

exceptional circumstances justifying the decision being withheld.

A person has a right to access their personal information and correct any inaccuracies.

Form 11 – July 2011

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Form 11 - Direction For Access To Information And Premises - 2011 Page 2