Professionals who provide psychosocial intervention services at CNESST's request complete this five-page report after evaluating the worker's psychosocial needs. The services address personal difficulties arising from the employment injury that hinder social or occupational rehabilitation. The report covers the reasons for referral, case history, symptoms, the worker's perception of their situation and return to work, conclusions, and any recommended intervention plan.
The service provider, identified by specialty and CNESST-authorized supplier number, completes all eleven sections and signs with their title; section 8 applies only to a neuropsychological evaluation.
Download the current version from the source each time; forms change without notice.
Rapport d'évaluation – Intervention psychosociale en réadaptation
Evaluation Report – Psychosocial Intervention in Rehabilitation
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Professionals who provide psychosocial intervention services at CNESST's request. CNESST's page says you must complete the form after evaluating the worker's psychosocial needs. The provider section records your name, specialty and CNESST-authorized supplier number, and you sign with your title in section 11.
It applies only to a neuropsychological evaluation. You describe observations of the worker's behaviour in the cognitive, motor, somatosensory, affective, personality and perceptual spheres, and report the results of the validity scales used. Other evaluations skip straight to section 9, the analysis, conclusions and recommendations.
Once a psychosocial intervention plan is under way, progress and end-of-plan reporting uses form 1845, the Rapport d'évolution ou rapport final for psychosocial intervention in rehabilitation. Both forms are sent to CNESST through the Envoi de document service or by fax.