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Silica Exposure Registration Form

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Registration Form: Exposure to Silica Dust

Complete this form if you believe you may have been exposed to Silica Dust.

The information will be added to Slater and Gordon’s extensive private database. Should you wish to claim compensation in the future due to a Silica related disease this information may assist in making your claim more straight forward.

Please provide a brief description of your exposure, at work, the employer’s name and your job etc. (or if exposure not known – work history):

We may call you to clarify your information or to assist in identification of the whereabouts of your exposure to Silica Dust

Diagnosis of Respiratory Complaints