Request extension of time to pay an employment record infringement

Form
If you are unable to pay an employment record infringement notice penalty amount by the due date, complete the application form to request an extension of up to 28 days to pay.
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DO NOT use this form for traffic infringements

Visit traffic infringements for queries related to traffic infringements

If you have been issued an infringement notice by an industrial inspector at the Department of Energy, Mines, Industry Regulation and Safety Private Sector Labour Relations division for a 'record-related' civil penalty, the penalty amount must be paid within 28 days after the day the notice is served.

If a person is unable to pay the penalty amount for the employment record infringement notice by the due date, they may request an extension of up to a further 28 days by completing a 'Request extension of time to pay an infringement notice' form and forwarding it to the industrial inspector who issued the notice.

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