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Permitted Worker Form Download

Under Stage Four Restrictions, in Victoria, only employees who are classed as permitted workers are allowed to leave the home for work. It is also a prerequisite for childcare.

Who is eligible for a Permitted Worker Permit?

The government has released a document which lists which businesses are permitted to be open and are approved for on-site work.

You can download the list of permitted industries here:

VIC Gov Stage 4 Industries
Download PDF • 201KB

To leave the house to go to work, you will need to declare that your business type is approved to be open for work and that you are doing a permitted onsite activity.

How to issue a permitted worker permit

Information that you'll need:

  • Your company name, ABN, company address and trading name

  • Your employee's name and date of birth

  • Regular hours and place of work of the employee

  • Whether you meet all eligibility criteria, including that the business is a permitted activity. You can check by looking at the list of the permitted industries above.

  • Whether you meet the relevant legal obligations 

  • Whether you have a COVID-19 safe plan in place

You can download the Permitted Worker Permit Form here:

Permitted Worker Scheme Template
Download DOCX • 63KB

I am available after hours to help and am offering work on a fixed fee basis. You can contact me on

Warm regards, Caroline Mense


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