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Small Business Rebate Form
Submission Complete - Small Business Rebate Application Thank you Your form has been submitted for processing

Next steps

You are required to complete these additional forms to finalize your request.
Your submission reference number for this form is:
Covid-19 Virus UPDATE – As of 17th March 2020, the delivery of some services from SafeWork NSW will be affected by the COVID-19 Virus and restricted office operations. There may be delays in processing your application. Please contact the Small Business Rebate team at safetyrebate@safework.nsw.gov.au if you have any questions.

What happens next? 1.Your eligibility and application will be assessed. 2.If your application is successful, your payment will be processed within 4 weeks of your application being received. We will send an email confirming your application has been successful and when you are likely to receive your payment 3.If we need more information about your application we will call or email you asking for further details before the final assessment 4.If you are not eligible for the rebate, we will email or write to you and explain why
Should you have any questions relating to your application please contact us at the Small Business Rebate website or by email to safetyrebate@safework.nsw.gov.au. Please include your reference number and name to assist us with your enquiry. Getting in contact with us Email: safetyrebate@safework.nsw.gov.au Telephone: 13 10 50 Website: The Small Business Rebate website

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Small Business Rebate Form
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Receipt

Small Business Rebate Form
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Your form has been successfully submitted. Please keep a copy of this acknowledgement for your records.
To save or print a copy of the completed form and acknowledgement go to the "File" menu and select "Save as" or "Print".

Application Information

Small Business Rebate Form
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Application Information

The small business rebate gives up to $500 back to small business owners who buy and install eligible safety equipment to address a safety problem in their workplace. It is open to sole traders or small businesses with up to 50 full time employees or equivalent. To be eligible for a rebate, small businesses must attend an eligible free SafeWork NSW workshop, webinar, program, event, or have an advisory visit from a SafeWork NSW officer. This engagement aims to help businesses identify safety issues and put effective safety solutions in place.

Who’s eligible

You must: •Be a business who has 0-50 employees (or equivalent). •Be registered in NSW and conducting a business that provides goods / services in NSW. •Attend an eligible safety event, workshop, program, have an advisory visit from SafeWork NSW staff or participate in a webinar. •Purchase and implement an eligible safety solution AFTER your interaction with SafeWork NSW. •Apply within 12 months of attending your eligible event.

What you’ll need for your application

•A paid Tax Invoice, receipt or proof of purchase for the item(s). •Your business banking details eg. business account name and number, BSB.•Your business contact details eg. address, email, contact phone number.•Details of the eligible SafeWork NSW event (date, name, location) you attended or date of the advisory visit.

How to apply

•Check you are an eligible applicant – event attendance, business size. •Check you have purchased an eligible item(s). •Check you are applying within 12 months of attending your eligible event. •Have your business details at hand, including your ABN number and Workers Compensation policy number (if applicable). •Click the “Continue” button. •Don’t forget to attach the paid Tax Invoice, receipt or proof of purchase to your application. •Read and acknowledge your declaration, including terms and conditions.

Things to keep in mind.

•Make sure the attachments (tax invoices, receipts etc) you have scanned or photographed are clear and easy to read. •If you want to PRINT a blank application form and mail it or email it to us, click here. •You cannot claim a rebate for goods/services you received BEFORE your eligible interaction. •You cannot claim a rebate for items already rebated through other SafeWork NSW rebate programs. •There are some exclusions for eligible items. Check them out here eg. second-hand items, training, personal protective equipment. •The rebate does not cover GST, insurance or freight. •Our Privacy Notice is detailed in Section 7 of our Terms & Conditions

Need Help?

Contact us: Email safetyrebate@safework.nsw.gov.au

Telephone 13 10 50

Business Details

Small Business Rebate Form
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Business Owner Name

Business Details

Business Size
Business Age * This is the number of years the business has been operating (irrespective of the length of time you have owned it)
Industry Type * Select your predominant business activity

Activity Details

Small Business Rebate Form
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Activity Details

Please provide details of your eligible safety activity eg. Advisory visit, webinar, event
of 250 characters
Safety items – date of purchase
of 250 characters

Rebate Information

Small Business Rebate Form
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Rebate Information

Would you like to receive further details?
How would you like to receive the information? * Multiple choices can be selected
How did you hear about the rebate? * Multiple choices can be selected

Payment Details

Small Business Rebate Form
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Payment Details

Please provide your business bank account details. If you do not have a business account in your business name, we must be able to identify you through your ABN or Workers Compensation Policy in the “Business Details” section of this form.

Supporting Documents

Small Business Rebate Form
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Supporting Documents

For the items you have purchased you must attach: •a Tax Invoice showing payment in full The Tax Invoice must show the ABN number of the merchant / supplier and the date of purchase.
•a receipt or proof of payment with the Tax Invoice showing payment in full

Supporting Document

Tax Invoice *
Tax Invoice *
File:
Receipt or proof of payment *
Receipt or proof of payment *
File:

Applicant Declaration

Small Business Rebate Form
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Applicant Declaration

I, , declare that:•I have authority from the business owner (if applicable) to lodge this application.•The information in this application is true and correct to the best of my knowledge.•I agree to the Terms and Conditions.
I, , declare that:•I have authority from the business owner (if applicable) to lodge this application.•The information in this application is true and correct to the best of my knowledge.•I agree to the Terms and Conditions.