The template can be used where a claimant wishes to make an application for review of an adjudicator’s determination.
The template for an application for adjudication review by the claimant is recommended, but not mandatory.
A claimant may use their own template or one provided by an authorised nominating authority.
The Department of Energy, Mines, Industry Regulation and Safety – Building and Energy Division (Building and Energy) cannot assist with filling out the template or completing it on your behalf.
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