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Workers Comp Waiver Form Template for New Zealand

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Key Requirements PROMPT example:

Workers Comp Waiver Form

"I need a Workers Comp Waiver Form for my construction company in Auckland, with specific provisions for high-risk work activities and additional private insurance coverage we offer above the ACC scheme, to be implemented by March 2025."

Document background
The Workers Comp Waiver Form is a specialized document adapted for New Zealand's unique accident compensation framework. While traditional workers' compensation waivers common in other jurisdictions are not applicable due to New Zealand's universal, no-fault ACC scheme, this document serves several crucial purposes. It provides formal documentation of the employee's understanding of their rights and benefits under the ACC system, outlines any supplementary benefits offered by the employer, and establishes clear procedures for workplace injury reporting and management. The form is particularly relevant for high-risk industries or roles where clear documentation of injury management procedures is essential. It should be used during employee onboarding or when implementing new workplace safety protocols, ensuring all parties understand their rights, obligations, and available benefits within New Zealand's distinctive workplace injury compensation system.
Suggested Sections

1. Parties: Identification of the employer and employee, including full legal names, addresses, and relevant identification numbers

2. Background: Context of the employment relationship and purpose of the document

3. Definitions: Key terms used in the document, including specific workplace terminology and legal concepts

4. ACC Scheme Acknowledgment: Statement acknowledging understanding of NZ's ACC scheme and its universal coverage

5. Employee Declarations: Employee's confirmations regarding understanding of their rights and obligations under the ACC scheme

6. Employer Obligations: Outline of the employer's commitments regarding workplace safety and injury management

7. Reporting Requirements: Procedures for reporting workplace incidents and injuries

8. Execution: Signature blocks for all parties, including witness requirements

Optional Sections

1. Additional Benefits: Details of any supplementary benefits offered by the employer beyond ACC coverage

2. Return to Work Provisions: Specific procedures and commitments regarding return to work after injury, if the employer has a formal program

3. Overseas Coverage: Special provisions for employees who may work overseas temporarily

4. Third Party Claims: Provisions regarding claims involving third parties or contractors

5. Medical Examination Requirements: Any specific requirements for medical examinations or assessments, if applicable to the role

Suggested Schedules

1. Schedule 1: Employee Details: Detailed employee information including emergency contacts and relevant medical history

2. Schedule 2: Workplace Safety Procedures: Summary of relevant workplace safety procedures and protocols

3. Schedule 3: Incident Reporting Form: Standard form for reporting workplace incidents and injuries

4. Appendix A: ACC Information Sheet: Standard ACC information sheet explaining the scheme and coverage

5. Appendix B: Employee Rights Summary: Summary of employee rights under NZ employment and health and safety laws

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions


























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Relevant Industries

Construction

Manufacturing

Mining

Agriculture

Healthcare

Transportation

Retail

Hospitality

Education

Professional Services

Maritime

Forestry

Industrial Services

Entertainment

Sports and Recreation

Relevant Teams

Human Resources

Health and Safety

Legal

Operations

Risk Management

Compliance

Industrial Relations

Workplace Relations

Employee Relations

Occupational Health

Relevant Roles

Operations Manager

Health and Safety Officer

Human Resources Manager

Risk Management Specialist

Compliance Officer

Site Supervisor

Factory Worker

Construction Worker

Healthcare Worker

Mining Engineer

Forestry Worker

Machine Operator

Warehouse Manager

Field Service Technician

Production Line Worker

Agricultural Worker

Maritime Worker

Professional Athlete

Industrial Worker

Laboratory Technician

Industries





Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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